M. A. Shiffman, S. Mirrafati (Eds.) Aesthetic Surgery of the Abdominal Wall

M. A. Shiffman, S. Mirrafati (Eds.) Aesthetic Surgery of the Abdominal Wall

Melvin A. Shiffman · Sid Mirrafati (Eds.)

Aesthetic Surgery

of the Abdominal Wall

With 212 Figures in 398 Parts and 36 Tables

Melvin A. Shiffman, MD, JD Sid Mirrafati, MD

Mira Aesthetic Medical Center 1101 Bryan Avenue, Suite G Tustin, CA 92780, USA

ISBN 3-540-21157-8 Springer-Verlag Berlin Heidelberg New York

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Introduction

We have come a long way since the days when abdominal wall contouring was per- formed by simple dermolipectomies, with no attention to diastasis correction and muscular reinforcement, and little regard for the final aesthetic result. Nowadays, an abdominoplasty may be indicated for even the most demanding of patients. Details such as placement of the incision and umbilicoplasty are meticulously planned so as to conceal undesirable scars. Since the advent of suction-assisted lipectomy, in asso- ciation with a classical operation or as an isolated procedure, the plastic surgeon has become capable of remodeling the entire trunk, assuring removal of considerable amounts of adipose tissue. Drs. Shiffman and Mirrafati have brought all of these aspects together, in this most timely book, Aesthetic Surgery of the Abdominal Wall.

Here the reader will find an all-encompassing textbook, written in collaboration with outstanding colleagues, all of whom have contributed to this field of plastic sur- gery that has been of particular interest to me. I am sure that, for both the younger and the more experienced surgeon, this book will become a reference text, covering all aspects of plastic abdominal surgery.

Ivo Pitanguy, MD

Preface

This book on aesthetic surgery of the abdominal wall is an attempt to bring together the existing knowledge on body contouring of the abdomen. The major emphasis is on abdominoplasty and liposuction of the abdomen with the various combinations and techniques. Of course, not all the variety of procedures can be covered, but the information made available will be valuable to the novice and the experienced ab- dominal wall surgeon alike.

Personal techniques are described and information is given on the avoidance and treatment of complications. This is especially valuable in our present litigious society where awareness of the standards of care and informed consent are so essential. The chapter on medical legal aspects shows what can go wrong and discusses why the problems occurred and methods for avoiding these situations. The chapter on guide- lines for the prevention of thromboembolism gives insights into how to prevent this problem, especially in the moderate risk patient, the type that is so common in cos- metic surgery. There is nothing more essential than the safety of the patient in a field where surgery is elective and for beautifying rather than the correction of a disease, defect, or disorder.

The hope is that surgeons can learn the proper techniques for performing aesthet- ic surgery on the abdominal wall with the greatest safety by understanding the tech- niques and pitfalls of the procedures and their complications.

Melvin A. Shiffman, MD, JD Sid Mirrafati, MD

Contents

Introduction

Ivo Pitanguy . . . V Preface

Melvin A. Shiffman, Sid Mirrafati . . . VII List of Contributors . . . XI

1 Anatomy of the Abdominal Wall

Orhan E. Arslan . . . . 1 2 Anesthesia for Liposuction and Abdominoplasty

Gary Dean Bennett . . . . 29 3 Tumescent Anesthesia for Abdominal Liposuction

Timothy D. Parish . . . . 55 4 Abdominoplasty History and Techniques

Sid Mirrafati . . . . 62 5 Patient Consultation and Instructions for Abdominoplasty

Melvin A. Shiffman . . . . 67 6 Abdominolipoplasty: Classification and Patient Selection

Steven G. Wallach, Alan Matarasso . . . . 70 7 Mini-abdominoplasty

Bruce A. Mast . . . . 87 8 Full Abdominoplasty

R. Jobe Fix, John M. Anastasatos . . . . 94 9 Personal Approach to Aesthetic Abdominal Deformities

Ivo Pitanguy, Henrique N. Radwanski . . . 102 10 Abdominoplasty Techniques: A Personal Approach

Oscar Ramirez, Keith M. Robertson, Anjum Khan . . . 115 11 Horseshoe Abdominoplasty

Richard Moufarr`ege . . . 121 12 Umbilical Approach in Aesthetic Abdominal Surgery

Jacques Faivre, Jean-Marie Faivre, Chiraz Moheli . . . 130 13 Abdominoplasty With Only Cutaneous Resection

and Without Deep Detachment

Jacques Faivre, Jean-Marie Faivre, Chiraz Moheli . . . 134 14 Endoscopic Intracorporeal Abdominoplasty

Mark L. Zukowski . . . 138

15 Umbilical Reconstruction in Abdominoplasty

Melvin A. Shiffman . . . 146 16 Prevention and Management of Abdominoplasty Complications

Melvin A. Shiffman . . . 150 17 Avoiding Abdominal Wall Necrosis in Abdominoplasty

Melvin A. Shiffman . . . 155 18 History of Liposuction

Melvin A. Shiffman . . . 160 19 Patient Consultation and Instructions for Liposuction

Sid Mirrafati . . . 162 20 Vibrotumescent Liposuction of the Abdominal Wall

Sid Mirrafati . . . 177 21 Syringe Liposculpture of the Abdomen

Luiz S. Toledo . . . 182 22 Megaliposculpture and Therapeutic Megaliposculpture

Pierre F. Fournier . . . 186 23 Liposuction of the Abdominal Wall Followed by Abdominoplasty

Giorgio Fischer . . . 195 24 Extensive Abdominoplasty and Large Volume Liposuction

Lazaro Cardenas Camarena . . . 201 25 Prevention and Treatment of Liposuction Complications

Melvin A. Shiffman . . . 215 26 Guidelines for the Prevention of Thromboembolism

Melvin A. Shiffman . . . 221 27 Medical Legal Aspects of Aesthetic Surgery of the Abdominal Wall

Melvin A. Shiffman . . . 223 Subject Index . . . 233

X Contents

List of Contributors

John Anastasatos, MD (e-mail: jobe.fix@ccc.uab.edu)

Division of Plastic and Reconstructive Surgery, 1813 6th Avenue South (524MEB), Birmingham, AL 35294-3295, USA

Orhan E. Arslan, PhD (e-mail: arslano2003@yahoo.com)

Department of Cell Biology and Anatomy, The Chicago Medical School, Rosalind Franklin University of Medicine and Science

3333 Greenbay Road, North Chicago, IL 60064, USA Gary D. Bennett, MD (e-mail: dasseen@cox.net) 7 Pelican Hill Circle, Newport Coast, CA 92657, USA

Lazaro Cardenas Camarena, MD (e-mail: plassurg@mail.udg.mx)

Plastic Surgery Unit, Av. Chapalita 1300 Col. Chapalita, Guadalajara, Jallisco 4500, Mexico

Jacques Faivre, MD (e-mail: drjacquesfaivre@noos.fr)

Chirurgie Plastique et Esthetique, 23, rue Vital, 75116 Paris, France Jean-Marie Faivre, MD (e-mail: drjacquesfaivre@noos.fr)

Chirurgie Plastique et Esthetique, 23, rue Vital, 75116 Paris, France Giorgio Fischer, MD (e-mail: giorgiofischer@flashnet.it)

Via della Camilluccia, 643-00135 Rome, Italy R. Jobe Fix, MD (e-mail: jobe.fix@ccc.uab.edu)

Division of Plastic and Reconstructive Surgery, 1813 6th Avenue South (524MEB), Birmingham, AL 35294-3295, USA

Pierre Fournier, MD (e-mail: pierre.fournier27@wanadoo.fr) 55, Boulevard De Strasbourg 75010, Paris, France

Anjum Khan, BA (e-mail: khan_anjum@yahoo.com) St. George’s University, Grenada, West Indies

Bruce A. Mast, MD (e-mail: bmast@accentphysicianspecialists.com) 4340 Newberry Rd., Gainsville, FL 32607, USA

Alan Matarasso, MD (e-mail: matarasso@aol.com) Albert Einstein College of Medicine, New York, NY, USA Sid Mirrafati, MD (e-mail: drmirrafati@youngerlook.com)

Mira Aesthetic Medical Center, 1101 Bryan Avenue, Suite G, Tustin, CA 92780, USA Chiraz Moheli, MD (e-mail: drjacquesfaivre@noos.fr)

Chirurgie Plastique et Esthetique, 23, rue Vital, 75116 Paris, France Richard Moufarr`ege, MD (e-mail: plasticsurg_moufar@hotmail.com) 1111, rue St-Urbain, Suite 106, Montreal (Quebec), H2Z 1Y6, Canada Timothy D. Parish, MD

Varicosis & Laser Center of Alabama, 3055 Lorna Road, Suite 210, Hoover, AL 35216,

USA

Ivo Pitanguy, MD (e-mail: Pitanguy@visualnet.com.br) Rua Dona Mariana, 65, 2280-020 Rio de Janeiro, Brazil Henrique N. Radwanski, MD

Pontifical Catholic University, Rio de Janeiro (PUC-Rio) and Carlos Chagas Institute of Postgraduate Medical Studies, Rio de Janeiro, Brazil

Oscar Ramirez, MD (e-mail: oscar@ramirezmd.com) 2219 York Road, Suite 100, Timonium, MD 21093, USA

Keith M. Robertson, MD (e-mail: plasticsurgery@hotmail.com)

Esthetique Internationale and Suburban Hospital, Chevy Chase, MD 20814, USA Melvin A. Shiffman, MD, JD (e-mail: shiffmanmdjd@comcast.net)

1101 Bryan Ave., Suite G, Tustin, CA 92780, USA Luiz S. Toledo, MD (e-mail: lstoledo@netpoint.com.br) Av. Brig. Luiz Antonio 4225, 01401-002 San Pablo, Brazil Steven G. Wallach, MD (e-mail: Sgwallach@aol.com) 1049th Avenue, Suite 2D, New York, NY 10028, USA Mark L. Zukowski, MD (e-mail: anewyou@elnet.com) 3612 Lake Avenue, Wilmette, IL 60091, USA

XII List of Contributors