The art of a good aesthetic surgeon is in choosing the right indication. He needs many years of experience to do this. It is possible to achieve good results without making large incisions with the new method of tumescence liposuction, particularly with collections of fat in the abdomen/hip area. If, however, there is a lot of surplus skin and the patient has lost more than 30 kg in weight, or pregnancies have severely stretched the upper abdomen and periumbilical region, abdominoplasty is indicated. If it is necessary to tighten only the lower abdomen, it may be possible to avoid moving the navel. However, it is usually necessary to make an incision around the navel and reimplant this in the correct position.
In the video, the basic abdominoplasty technique is described clearly, concisely, and simply so that every experienced surgeon will be able to perform this procedure. As with all tightening operations on the body, the procedure consists of an operation on the thick cutaneous/fatty flap along the abdominal fascia. It is essential that the surgeon makes precise markings on the torso while the patient is standing and carefully plans the surgery prior to the operation. The level of the incision must be defined precisely so that it will always be possible to avoid a vertical incision. The more surplus skin there is, the more caudally the incision may be placed. During abdominoplasty it must also be taken into account that the mons pubis is usually included in the tightening.
Dissection is carried out along the abdominal fascia as far as the costal arch. The entire cutaneous/fatty flap is then pulled downward and resected in stages, with the upper body slightly flexed, so that later neither too little skin (bulging) nor too much skin (risk of necrosis) is resected.
A preoperative autologous blood donation is advisable for very obese patients. Ultrasound investigation for umbilical and abdominal wall hernias is also recommended. Intraoperative and postoperative thrombosis and infection prophylaxis is given for 10 days after the operation. The 4.0 Monocryl sutures must not be tight. A silicone plaster is applied after 4 weeks for 2 months. Care of the scar is essential. This is the mark of a good abdominoplasty. Similarly, the reconstruction of the navel must appear natural and there should be no "dog ears" at the sides in the caudal area of the incision.
The procedure is performed under general anesthesia during an inpatient stay. A special girdle should be worn for 4 weeks after the operation.
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