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Body contouring — liposuction and abdominoplasty

Liposuction is for localised fat in elastic skin, not for weight loss, and its safety depends on the volume aspirated and the lidocaine dose; abdominoplasty removes skin and fat and repairs the abdominal muscles, and its common complication is seroma.

לקריאה בעברית

Why it matters in the exam

Wetting solutions: dry, wet, "superwet" (about 1 to 1 ratio between infiltrate and aspirate) and tumescent (2 to 3 to 1); the lidocaine dose in tumescent solution is safe up to about 35 mg per kg, and the peak blood level occurs 12 to 14 hours after injection — after the patient is already at home. Large-volume liposuction (over 5 litres) requires hospital monitoring. Methods: standard suction, power-assisted (PAL), ultrasound-assisted (UAL — good for fibrous areas such as the back and male chest, with a risk of thermal burn and seroma) and laser-assisted (LAL). The common complication: contour irregularity; rare serious complications: fat embolism, venous thrombosis and pulmonary embolism, lidocaine toxicity and abdominal perforation.

Abdominal wall blood supply by Huger: zone 1 — central abdomen, from the deep epigastric arcade; zone 2 — lower abdomen, from external iliac branches; zone 3 — the flanks, from the intercostal, subcostal and lumbar arteries. After abdominoplasty the remaining skin is fed mainly from zone 3, so aggressive flank liposuction combined with wide undermining endangers the flap. The umbilicus is fed by the subdermal plexus, the round ligament, the median umbilical ligament and deep perforators in its stalk. In lipoabdominoplasty (Saldanha) the perforators are preserved and undermining is limited to a central tunnel, so liposuction can be combined safely. Risk factors: smoking (stop at least 4 weeks), diabetes (wound complications), high BMI; thrombosis prevention by Caprini. After bariatric surgery: wait for weight stability of 3 to 6 months, and check protein, iron, B12 and vitamins; operations: belt lipectomy, thigh lift and brachioplasty — in which the medial antebrachial cutaneous nerve can be injured.

Key points

• Liposuction — localised fat, elastic skin.
• Lidocaine up to about 35 mg per kg; peak after 12 to 14 hours.
• Huger: after abdominoplasty — zone 3.
• Abdominoplasty — seroma common; smoking and diabetes.
• After bariatric surgery — weight stability and nutrition.

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Sources

• American Society of Plastic Surgeons practice advisory on liposuction, 2004 (reaffirmed) — Wetting solutions, lidocaine limits and large-volume liposuction
• Huger, vascular zones of the abdominal wall, 1979 — Zones I to III
• Plastic Surgery (Neligan), 5th edition (2023) — Abdominoplasty; Body contouring after massive weight loss

Sources are given for further reading; the text is written afresh and not copied from them.

Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.