Tummy Tuck with Liposuction

HD video by the Medical Director of the Loudoun Center for Plastic Surgery, Dr Michael J Brown, MD. This plastic surgery video shows a tummy tuck operation.

Lipo and Skin Removal Surgery

This video demonstration is on liposuction with a mini tummy tuck. This particular patient has actually undergone a relatively large weight loss and would be an excellent candidate for a full tummy tuck. However, at this point in her life, she does not want to proceed with that long of a procedure, or more importantly, this long of a recovery. At this point, she's opting to have liposuction performed and then have some redundant skin excised, deferring the better operation for a later date.

At this point, I am taking fluid and putting it in prior to liposuction. What you see here is liposuction being performed. This is the canula that I would use during this procedure. The tube that you see along the bottom of the screen is actually the fat being removed. The reason why I put fluid into the tissues first is to allow easier removal of the fat and safer removal of the fat. Larger volume removal of the fat and a better pain controlled removal of the fat. That fluid is called the wedding solution. Some people will call it the tumescent fluid.

The evacuation phase is a relatively tedious procedure of passing the canula back and forth through her fatty tissue planes. My left hand is actually feeling where the canula is, so I know where it is at all times, and I actually know how deep I am in the tissues by the feel of the canula passing through the tissues.

Because of the length of this canula and my position, I'm actually doing her side right now. We call this the flank. She's having her anterior flank suctioned as part of this procedure. She will then proceed to have her left side of her belly contoured and then her right side of her belly contoured and then her right flank contoured. It's done in a very sequential fashion to maintain a consistent tissue thickness. You can see by the color of the fat that's coming out that it's not bloody. It's basically just the fat and the fluid. She's really having a lot of fat come out.

Again, she would have been a wonderful candidate for a full tummy tuck, but the patient declined this. What I'm doing with my left hand here is I'm feeling how much fat is in the tissue plane. That will allow me to determine what my end point will be. My goal is to make this tissue thickness uniform or consistent throughout the entire area. You can see as I lift it up for a video demonstration the difference between the area that I've suctioned and the area that I haven't suctioned.

I'll be able to feel these tissues and get a sense of what area still has a little bit more fat. My left hand's responsibility is to make sure that I get that tissue as uniform as possible. You can really see here how that left side has really had significant lipo evacuation compared to the right side. What I'm doing here is I'm trying to pinch the fatty tissue plane on the right side of her abdomen compared to the nice thin pinch on the left side of her abdomen.

When I'm done, those two tissue planes will be the same. At this point on the unsuctioned side, I have a hard time actually picking up the right side of her abdomen compared to the left side, which is relatively thinned out. After I've done the other side, you can see here that the tissue thickness is basically the same. I think she's a little fuller on that right side than she is on the left side, but it's not very much. You can see here that all that skin, which is so loose... I'm going to go ahead and take some of it out to make her belly look a little tighter, but she'll have no visible scar. This scar will be down well below her bathing suit line and well below her underwear line.

The pencil looking device you see is actually an electric cautery. It cauterizes the bleeding blood vessels as well as divides the fat. It has two different buttons on it, so I can either cut tissue with it or I can cauterize tissue with it. It's done through electricity and it allows me to do this operation with minimal bleeding.

What you see here is that I've basically raised this flap, and now I'm going to pull it down and cut off the part that would overhang her clothes and her pants and her bathing suits. At least when she stands up straight, she won't have a significant pudge in the lower half of her abdomen. Again, she's not going to be super tight, but every patient has a right to decide what type of a surgery that they would like to have done. In this particular situation on this particular patient, this seemed like the best option for her and this is what she wanted to go ahead and have done.

This skin will be cut, and then the electric cautery will be brought back into the area. I will cut through the fatty tissue, control the bleeding with the same instrument and then this area will be closed in many layers. After both sides have been cut off, the wound will be closed with staples for an initial assessment of how the scar will look and to make sure I'm happy with her contour. Again, this particular patient is not going to have he flattest abdomen, but this is a marked improvement.

You'll remember earlier in the video, I said that I felt she was still a little thick in one area. Even after I took out the skin and fat layer, I still felt she was a little too full and therefore, I'm improving her result by suctioning a little bit more tissue. At this point, the staples will be taken out in a sequential fashion and all the tissue planes will be reconstructed at different depths. This is a very deep suture, which will be used to bring the deeper tissues back together. These types of sutures will be placed throughout the entire wound.

Then there will be an intermediate layer. A deep dermal suture layer, which is what you're going to see here. This will help bring the wound edge in a very nice approximation, but it's also the strength layer of the closure and this is what's going to give her very nice wound healing and scar formation. She'll be left with a very thin line. After that layer is done, the entire length of the wound is closed using a suture. This extra layer or extra suture is used to really allow the skin edge to be nicely approximated. Again, under no tension so that the wound heals in a pencil thin line. What you see here is the fat that was evacuated.