Avelar Abdominoplasty - Background
Prior to Dr. Avelar’s description (and the later modifications) of his procedure, patients wishing to undergo abdominal contouring generally underwent liposuction only, and those wishing to have excess abdominal skin removed generally underwent a traditional abdominoplasty (without any liposuction). This left those seeking both abdominal contouring and the removal of excess (or lax) abdominal skin without a good option. Dr. Avelar postulated, and proved, that both may be completed simultaneously with excellent cosmetic and safe outcomes.
What Does an Avelar Abdominoplasty Entail?
An Avelar abdominoplasty (“Avelar Tummy Tuck”) is a liposuction-based tummy tuck. This operation addresses excess external abdominal fat as well as excess (or lax) abdominal skin. This operation does not address diastasis recti, which is when the abdominal muscles have a widened gap between them.
The operation starts with infiltrating tumescent solution into the abdominal fat in front of the abdominal wall musculature. Tumescent fluid is a dilute, safe solution that contains normal saline, lidocaine, and epinephrine. The epinephrine causes the very small blood vessels to constrict, which results in minimal bleeding during the operation and keeps most of the lidocaine in the area undergoing liposuction (which results in less pain). The accepted maximum safe dose of lidocaine when used for tumescent anesthesia is 55mg/kg body weight in literature. The amount of lidocaine that Dr. Stephan administers is well within this safe threshold.
Liposuction is then performed after fifteen minutes have passed to allow the epinephrine and lidocaine to take effect. In general, three 4 millimeter cannula sites are used to create the entry sites for small liposuction cannulas. Dr. Stephan uses a Power Assisted Liposuction (PAL) system to quickly and safely remove the fat cells. This device uses rapid, small back-and-forth motions of the cannula to break up fat, while preserving the blood vessels that travel from the rectus abdominis muscles (the “six-pack” muscles) to the abdominal skin.
After the liposuction portion of the operation is complete, the excess (or lax) abdominal skin is assessed once again. The lower abdominal incision site is carefully reassessed for symmetry after liposuction and before the incision. The excess abdominal skin is excised and a small tunnel is made upwards in the midline. The umbilicus is moved (if necessary) and the deep and superficial layers of the external abdominal wall are sutured together with three layers of strong sutures. Normally, no sutures are placed on the outside of the skin that need to be removed later. Also, drains are normally not placed for an Avelar (liposuction-based) abdominoplasty.
The Ideal Candidate for an Avelar Abdominoplasty
The ideal candidate for an Avelar abdominoplasty is an individual with excess external abdominal fat, lax or excess abdominal skin, and minimal diastasis recti (a midline space between the six-pack muscles). Additional patient-specific qualities that may make you a better patient for an Avelar abdominoplasty versus traditional abdominoplasty or liposuction are discussed during your consultation.
Commonly Asked Questions
Why can’t diastasis recti (a gap between the sides of the abdominal muscles) be treated during the Avelar abdominoplasty?
Diastasis recti is the widening of the linea alba, a midline band of tissue between the rectus abdominis muscles (the “six-pack” muscles). An increase in intra-abdominal girth (i.e. due to pregnancy or previous obesity) may cause this band of tissue to widen between the left and right rectus abdominis muscles. This may lead to a bulge in the midline of the abdomen, which is different than a hernia.
The skin overlying the abdominal muscles is supplied by both vessels that run between the rectus abdominis and the skin, as well as other nearby “collateral” vessels. Even with use of our liposuction technique, there is still a small chance of injury to some of the blood vessels that supply the skin. When diastasis recti is corrected (by suturing the sides of the rectus abdominis muscles together to reform the midline of the “six-pack”), there is a small risk of injury to these vessels between the muscle and the skin. If one of the vessel systems is injured, the overlying skin will stay healthy. The risk of injury to either system is small; however, if both systems are injured (i.e. if midline liposuction and tightening of the rectus muscles are performed during the same operation), a portion of the overlying skin may die.
Will this help me lose weight?
Any type of cosmetic surgery is intended to enhance the individual’s aesthetic appearance. None of these operations are indicated to help you lose weight. The Avelar abdominoplasty is a great operation to contour the abdomen and remove excess skin but must not be thought of as a quick way to lose weight.
What layers of fat are removed during the abdominal liposuction?
There are two main fatty layers that are removed during liposuction of the abdomen – a layer between the skin and a thin tissue layer named Scarpa’s Fascia, and another deeper layer between Scarpa’s Fascia and a fascial layer overlying the abdominal muscles. The fat inside of your abdomen (the fat around your organs) is not, and should never be, removed for cosmetic purposes.
Will there be a scar?
Anytime that an incision is placed on the skin, a scar will form. However, great precautions are taken to minimize and hide scarring. During the operation specific suturing techniques, types of suture, and dressings are used that take tension off the incisions, and thus minimize scarring. The dressings are kept in place for a specific amount of time, particular postoperative instructions are given, and products used to further minimize scarring.
Will I have drains after the surgery?
You should not need drains with an Avelar abdominoplasty. This is different than with a traditional abdominoplasty, where drains are commonly used.
Will sutures need to be removed after surgery?
Normally, all sutures are placed under the skin, except for one around the umbilicus which dissolves on its own over the course of 1 week. Sutures usually do not need to be removed after the surgery.
How long will I be out of work?
Individuals who undergo an Avelar abdominoplasty can normally return to work in 2 weeks. This also depends on the type of work that the individual performs.
When can I shower?
Unless instructed otherwise, you may shower 2 days after surgery. This provides time for your skin to start to heal.
My abdomen feels tight after surgery. Will I hurt something if I move?
No, you should not hurt anything if you move. There will be multiple layers of sutures in different layers of tissue under your skin. These sutures are very strong. You should take periodic short walks shortly after surgery and advance your activity level as instructed during your postoperative appointments.
If I gain weight, will the fat “come back”?
The liposuction performed during this operation removes much of the external abdominal fat. However, a small amount of fat cells will remain. If you gain weight after surgery two things will happen – those remaining fat cells will swell, and the fat surrounding your abdominal organs will swell as well. The removed fat cells are gone forever; however, the remaining fat cells (inside and outside of your abdomen) will enlarge if you gain weight.
Can I become pregnant afterwards? What happens if I do?
The surgery will not affect your ability to become pregnant. If you become pregnant after having this operation, your abdominal wall and skin may later become lax. The results of your abdominoplasty will change if you become pregnant.
Is this operation performed under general anesthesia?
Yes, this operation is performed under general anesthesia. This is a safe and comfortable way to perform most surgeries.
How long does the operation take?
This varies significantly from patient to patient. However, the operation normally takes 3-4 hours to complete.
Does someone have to stay with me after surgery?
Yes. A family member/friend must stay with you for at least the first 24-48 hours after surgery.
When will my swelling go down?
You will be swollen for up to one month postoperatively and continue to experience positive changes for up to six months after surgery.