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 This is an umbrella term which encompasses several aesthetic procedures to reshape the abdomen, breasts and other parts of the body. Significant advances have been made in recent years with respect to each. More importantly, these refinements are critical in achieving a truly successful outcome.
A procedure developed in France in 1977 and introduced in the United States in 1982, liposuction can remove localized collections of fatty tissue in most areas of the body. The popularity of liposuction is due to the efficacy of the technique in the hands of a qualified surgeon.
 The tumescent, or superwet, technique remains the standard approach to this procedure though other variations of conventional liposuction exist. Small incisions in hidden or concealed locations are utilized during the course of this procedure. It is incumbent upon the surgeon to respect the patient's concerns with respect to the placement of these incisions and the use of undergarments and swimwear are helpful for this purpose. Herein, a fluid solution is administered which reduces blood loss, provides anesthesia during and after surgery, helps to reduce the amount of bruising after surgery and ultimately facilitates fat removal. Among the key elements of a successful outcome is the approach of a targeted area via two routes, often referred to as cross-tunneling or cross-suctioning. This not only enables the area to be thoroughly treated but also allows for a smooth, uniform result.
Following surgery, a compression garment is most often utilized to promote skin shrinkage and minimize swelling. In addition, this office utilizes a silicone-backed foam padding which has been shown to be quite effective in minimizing bruising and accelerating recovery.
 Abdominoplasty is a surgical procedure that helps to flatten and shape the abdomen and waist by bringing the abdominal muscles to a midline, more anatomically sound, strong position and by removing excess skin and fat. Sometimes after pregnancy or significant weight loss, abdominal muscles assume a more separated, weaker position and the overlying skin becomes lax or redundant. Abdominoplasty can be helpful in this regard.
This operation may be performed on an outpatient basis or during a brief hospital stay. The procedure entails a low abdominal incision that spans the hips. Because sagging skin will be pulled down over the abdomen before it is removed, it may be necessary to release the navel from its surrounding skin and bring it out through a new skin opening. In some instances, when skin laxity and muscle weakness are limited to the area below the navel, a modified or mini-abdominoplasty may be indicated. This procedure usually requires a shorter incision and no incision around the navel.
Regardless of the specific procedure utilized, it is not adequate to merely address the abdominal wall musculature and skin laxity. There are several considerations which distinguish a superior result from a mediocre result. These considerations essentially represent attention to detail and consist of:
- Location of the incision
The incision should be positioned so that the resultant line of closure is concealed beneath all garments inclusive of swimwear and lingerie
- Design of the incision
The incision should be designed so that the resultant line of closure has a pleasing, aesthetic flow, most often curvilinear, with symmetry from side to side
- The use of quilting sutures
One of the most frequent untoward sequelae of this procedure is fluid accumulation in the potential space created between the layer of skin and underlying musculature. Quilting sutures, described by a South American plastic surgeon, are dissolvable sutures which essentially obliterate this potential space and are quite effective in preventing this accumulation.
- Quality and uniformity of the resultant line of closure
The resultant line of closure should be finely linear and without irregularity
- Attention to the aesthetics of the umbilicus
The final appearance of the umbilicus should not be flat nor amorphous but rather taught with a hood above and a relative hollow below.
Upon completion of the procedure, a silicone-backed foam padding is utilized to minimize both swelling and bruising. This is used in conjunction with an elastic compression garment. The well known abdominal binder is inadequate if not problematic as it tends to shift and fold upon itself acting like a tourniquet.
 After substantial weight loss, weight gain or simply from the effects of aging, skin on the upper arms can become inelastic, loose and flabby. Arm lifts, also known as brachioplasty, remove that excess skin and fat. Patients who have significant amounts of fat may want to consider combining the procedure with liposuction.
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