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Liposculpture tummy tuck technique, the way I do it

Find out how Dr Beldholm’s drainless abdominoplasty can help you recover faster

  • Benefits of this operation:
    3-4 hour operation
  • Overnight stay only
  • No drains required
  • Up and walking a day after procedure
  • Can shower and go home the day after the procedure
  • Using liposuction to sculpt your tummy including love handle areas and other excess
  • Can use the Hi-Def VASER sculpting technique to get you superior definition of muscles and an athletic looking tummy
  • Removing excess skin
  • Tightening the abdominal muscles
  • Planning the incision so that it is easy to hide in a bikini
  • Able to stand up straight 10 days after the operation and in most cases pain free
  • At 4-6 weeks: back to normal activities
  • A complication rate of less than 5% and most of the complications that happen are very minor and short lived

Do you want to find out how this amazing result is possible with modern tummy tucks?

In this video Dr Beldholm discusses how he performs his drainless abdominoplasty surgery. This type of surgery is a revolution in the approach to the saggy tummy post pregnancy.

Dr Beldholm has been a great advocate of this technique for a long time. He was invited to present to the cosmetex conference way back in 2013. The cosmetex conference is a premiere conference dedicated to cosmetic surgery and plastic surgery. Dr Beldholm has also written extensively on this technique and published an article in the journal of cosmetic surgery & medicine back in 2012. Over the last few years he has evolved his technique to include modern features such as VASER liposuction and Hi-Def VASER liposculpture.

Although abdominoplasty is a procedure that has been evolving over the past century, there have been significant improvements as recently as in the last five years. Consequently, today, abdominoplasty and other body contouring procedures have become amongst the most commonly requested operations in cosmetic surgery.

Dr Beldholm helps women restore and enhance their body with tummy tuck surgery:

  • Post weight loss
  • Post pregnancy
  • And in women that are overweight and have hanging skin and fat

One unique feature of this technique is that it removes a substantial amount of fat as compared to the traditional tummy tuck. This means that even if you are a bit overweight you will greatly benefit from this surgery.

Abdominoplasty has evolved substantially in the last 100 years. While starting out as a simple skin excision procedure, it has now advanced to liposuction-assisted techniques. The most recent literature demonstrates the safety of these later techniques and, in many cases, the complication rates are far below those of traditional abdominoplasty methods. In Dr Beldholm’s personal experience of performing several hundred of these tummy tucks there is significant benefits in both the results and reduced complication rates.

In particular, the seroma rates (which are a prevalent problem in abdominoplasty) have been reported to be much improved with these techniques. Dr Beldholm has not had a single seroma in the last 3 years performing this drainless abdominoplasty surgery. From 2010 to 2013 performing more than 100 tummy tucks Dr Beldholm had 1 seroma that was demonstrated on ultrasound but was not significant clinically and did not require any intervention. During these 3 years Dr Beldholm did routine ultrasounds after the operation to exclude seromas however after 2013 Dr Beldholm stopped this practice as there was next to no issue with this complication.

The liposuction based technique that Dr Beldholm has developed provides many advantages.

  • By improving the blood flow to the skin it improves scarring and healing.
  • Most of Dr. Beldholm’s patients end up with a fine line in the bikini line.
  • There is also a much improved recovery with most patients being very comfortable in the first 1-2 weeks and some patients can even return back to work at 2 weeks.
  • As extensive liposuction is done you will also have a significantly flatter and better shape of the abdomen after the operation.
  • Creating an attractive belly button.

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Is tissue glue necessary to get these superior results?

There was a lot of reports in 2013 how tissue glue improved the outcomes of tummy tucks. During 2013 to 2014 Dr Beldholm trialled out Artiss which is one of the tissue glues. He monitored the complications and results from this and found that there was no benefits to his patients. The seroma rate was already close to zero and other benefits such as wound healing and scar formation did not change. So in 2014 Dr Beldholm decided to stop using tissue glue.

The main reason most surgeons have been using the tissue glue is to avoid using drains and to minimise seroma. However Dr Beldholm has not used drains for a long time regardless of the glue and has a seroma rate of below 1%.

However there has been further research in facelifts showing that tissue glue makes a significant difference in the healing of wounds as well as bruising and swelling after operation. For this reason Dr Beldholm re-started his use of Artiss tissue glue in 2017 to try to get additional benefits in wound heeling for his patients.

 

Over the last 2 years Dr Beldholm has adjusted a number of steps in the operation to give you an amazing result

Using v-loc stitches to close all his wounds

This stitch is available both permanent and absorbable. It has barbs incorporated into the stitch that means that the wound is approximated in a very precise manner.

Dr Beldholm uses the the permanent stitch to plicate the muscles (bringing the rectus abdominis muscle back to its normal position).

The absorbable suture is used to close the skin and this means that you do not need to have any sutures or clips removed after your surgery.

Prevention is better than cure!

The wound complications and infections from this operation is very low with Dr Beldholm. However in an attempt to reduce this rate even further from 2014 onwards Dr Beldholm instituted antibacterial washes preoperatively and also prophylactic antibiotics. In addition to this Dr Beldholm and his highly skilled surgical nurses monitor every patient closely after the surgery and institute aggressive measures if there is any sign of redness or wound infection.

Since instituting these measures there has only been 1 significant infection and 2 minor infections (which settled within 2 days). This constitute around 1 percent wound infection rate which is significantly lower than any other reported research on this operation has demonstrated.

Hi definition Vaser abdominoplasty

This is at the cutting edge of cosmetic surgery. Dr Beldholm has been performing Hi-Def Vaser liposculpture since 2013. Dr Beldholm started to combine this with his tummy tucks in 2014 with amazing results.

Find out more about VASER Liposculpture in this blog article.

What is next for the tummy tuck

There are always improvements that can be made in any procedure. However at this stage after 10 years of refinements and adjustments and close monitoring of his patients Dr Beldholm feels that he can provide you with the absolutely state of the art tummy tuck.

Transcript of this video were Dr. Beldholm discusses his current technique in 2016 and going into 2017

Initial steps

What we’re going to go through today is, I’ll go through the steps of the operations to show you the detail that we need to do to get you the best results.

Initially I’ll have a chat with you in the anaesthetic bay. Where you can have your final questions answered. We’ll draw out all the markings and I’ll go this is what we’re doing for you, and I’ll usually draw out the side bits as well, where I am going to do the liposuction.

This patient has lost a lot of weight and has a small amount of excess skin when he sits down. He is quite fit and is in really good shape. However he wants to do underwear modelling and so has asked for a tweak. He had a mini-tummy tuck and hi definition vaser liposculpture. As he was planning to do underwear modelling it was critical that I get the scar right down below his underwear line and that the scarring was not going to be visible. At the 3 months mark after the operation he was extremely happy and gave us a 5 star review on google. Thank you!

Getting the patient on the table

Before going into the theatre my anaesthetist will have a chat with you regarding your medical history and if you have had any anaesthetist problems in the past. The team will then get you into theatre and the anaesthetist will give you a general anaesthetic.

Once we put you in the theater and you’re asleep, we put in liposuction fluid, which consists of lignocaine with adrenaline. That goes in all of your tissues and the side bits that we’re performing the liposuction on.

This photo shows Dr Beldholm holding the infusion cannulae for the liposuction fluid. He uses this cannulae to inject the tumescent liposuction fluid in the abdominal area as well as the side areas. He has just finished injecting the fluid into this patient and the tissues are full of lignocaine and adrenaline. Each of these substances have different purpose:

  1. The adrenaline constricts the blood vessels which means that when we do the liposuction there will be minimal damage to the blood vessels and also there will be minimal bleeding and bruising.
  2. Lignocaine is a local anaesthetic. The lignocaine makes a big difference to your recovery after this procedure. The lignocaine will give you good pain relief for up to 24 hours after the surgery. This means that the next morning you can usually be up out of bed, have a shower with minimal discomfort.

Liposuction of the abdomen

The next step is to do liposuction. We do aggressive liposuction to get rid of all the fat, to get you flat. Once this is done you skin will easily move down without having to do extensive dissection on the inside.

This photo shows Dr Beldholm doing the liposuction part of the operation. To get a really good result you need to be quite aggressive with removal of the fat. The more fat we remove the better the result!! Doing this under a general anaesthetic means that we can get an amazing result and remove quite a bit of fat. The modern liposuction based abdominoplasty is quite different from the more traditional or standard tummy tuck. With the standard tummy tuck there is minimal liposuction done due to the fear of interfering with the blood supply as the blood supply has been cut during the dissection. However in the liposuction based tummy tuck the blood supply is preserved and it is therefore possible to remove a lot of fat without any risk to the blood supply or skin.

The benefit of removing a lot of fat is two fold:

  1. Remove the fat gives you a great shape and gets you slimmer.
  2. By emptying the fat and doing what is called hydrodissection we can move the skin down without having to cut the tissues all the way up to the ribs.

This photo shows the fat after removal. Each bag is 2.5 liters in size and in this patient we have removed nearly 6 liters of fat.

This photos shows our Hi-Definition patient getting his abs sculpted. We have done his mini-abdominoplasty and now we are really getting that 6- pack for him. The approach to the Hi-Def Vaser abdominoplasty is different from the liposuction based abdominoplasty. In this patient we are also going to sculpt his chest area.

Getting started with the incision for the tummy tuck

After the liposuction, we re-prep and get you re-sterilized, because sometimes the liposuction can adjust the drapes, so you can get some contamination from there. Once we have re-prepped you and re-sterilized you, we make the incision. The way I do the cut is to bevel the cut. This allows you to get a little bit of the epithelium, deep epithelium, underneath where you’re suturing. This allows a much better final scar then you would otherwise get.

The key thing is, when we make the incision, we don’t go all the way down to your tummy wall. What we do is we go down to the Scarpa’s fascia, which is in the middle of your layers. We follow the Scarpa’s fascia up to about the belly button area. Then we don’t go any further. What we do then, is to do a little tunnel in the middle. Then we go deep into the abdominal wall so we can see the muscles, we can see the separation, and we do a little tunnel all the way up to the sternum.

Bringing the rectus abdominis back to its normal position

Once we’ve done that, I’ll assess how much tightening we need to do of the muscles. We put a permanent stitch all the way down from here, down to the bottom if we need to bring the muscles together. Once we’ve done that, we usually do what’s called plication stitches. We put stitches from the top to the bottom where we’re pulling that skin down. This is because you tend to get a bit of looseness up top in the epigastrium if you don’t do a lot of pulling in that area. That’s one of the problems with the tummy tuck from the bottom, that it’s hard to get tightness up top. These sutures will help that issue.

This photo shows Dr Beldholm using a permanent V-Loc suture to bring the rectus abdominis muscle together. The photo also shows the tunnel that we have created to allow us to bring the muscles together all the way up to the rib area. All the yellow colored tissue is fat that is left after the liposuction is done.

Getting rid of loose, hanging skin

Once we get all the way down to the bottom, we obviously get to the bottom, we cut the skin to that end point, then I’ll go and mark out how much skin we’re going to cut on the two side bits. Once we get the markings done, we do another beveled cut from the middle to the side to get rid of that loose tissue. Again, the bevel cut allows that extra epithelium to be there to give you that extra bit of strength in the wound to minimize the scar and get as much of a hairline scar as you can possibly get.

Once you’ve done that, you do the deep stitches. Depending on how much loose skin and how deep the tissues are and how heavy set you are, I use either permanent stitches on the deep end or absorbable. If you’re very, very slim lady and you only have basically little bit of skin to excise, I don’t use the permanent stitches, because you can feel the lumps from them, but if you have a little bit more padding, we use the permanent stitches deep, because you’re not going to feel those and they will give you that additional support of the scar.

This photo shows Dr Beldholm marking out the skin to be removed. It is really important when removing the skin to make sure that both sides are even and that we don’t take too little or too much. Just right!

Closing the incision for a nice flat result

Once we’ve done all those deep stitches, we do another two layers of absorbable stitches, and then we do the v-lock on the top of the wound. V-lock is a little barbed suture that gives you a really good apposition on the skin. That will allow me to give you the best possible result. The scar is basically in the bikini line, flatten your tummy, tighten everything up, and because we’re doing the liposuction and limiting the dissection, you’re going to get a really good recovery.

This photo shows the finalised closure of the abdomen. We always bend the patient around 10 degrees to get a nice tight result. The skin tends to loosen over 6 -12 months so it is important to make it slightly tight so that once the skin loosens you still have a great result.

Conclusion from Dr Beldholm

As a cosmetic surgeon it has been amazing to be part of the great advancements that has happened in this field. When I started doing these surgeries more than 10 years ago I was doing the tradition tummy tuck. However at that stage I was very disappointed with the results that I could provide the patients and also the high complications rates, long stays in hospital and pain and discomfort nearly made me stop doing theses operations. I was searching for a better way. I came across the high lateral tension abdominoplasty and the initial liposuction techniques as described by Avelar.

Once I started performing my tummy tucks using these revolutionary techniques I was amazed. Instead of dealing with wound breakdowns and unhappy patients I was now dealing with patients that could go home with just an overnight stay and not requiring any drains. I hardly ever had any wound breakdowns and my seroma rate was close to zero. As a surgeon I have never seen such a big difference between 2 techniques. Usually as a surgeon when you change the way that you do things it makes a small difference but this change was like night and day!
If you are considering having a tummy tuck, make sure that the surgeon that you select is using this technique. If he is not go elsewhere because you will not get the best result possible.

Case studies

PATIENT 3102

The liposuction based tummy tuck is very versatile. The technique works both in very large patients that have a lot of fat to removed but it also works very well in patients that have lost a lot of weight or have had weight loss surgery. The technique is all about hydrodissection. This means that you are putting liposuction fluid in the tissues and creating tunnels to be able to move the skin lower and get a tight result. The removal of the fat is an additional bonus of this technique.

This patient had gastric bypass and lost 34 kg of weight. She had very little fat left after the weight loss.the main issue was the loose skin. By doing the liposuction based tummy tuck for her she was able to get rid of her excess skin and get a flat tummy. This technique allowed her to be back home the next day and back to normal in 6 weeks. The irritation and rashes that she was experiencing before the surgery all gone.*

PATIENT 3100

The technique works especially well in post pregnancy women that has separation of the muscles as well as some excess fat. As part of the technique we create a tunnel in the middle up the the ribs which allows us to bring the muscle together all the way from the mons pubis up to the rib area making sure that you get a flat results.

This patient had 3 children and she hated several things about her tummy:

  • Overhanging skin over the C-Section scar
  • Bulging tummy making her feel like she was still pregnant
  • Unable to wear nice fitting clothes as the tummy made her self-conscious
  • Umbilical hernia

This is a patient that is ideally suited to come to a specialist general surgeon that has extensive training in cosmetic surgery such as Dr Beldholm. Plastic surgeons do not normally get trained in dealing umbilical hernias or other hernias. Being able to repair this as part of your overall result is essential.

This patient only had 600ml of fat removed so the liposuction was mainly used as a tool to do hydrodissection.*

PATIENT 3082

The advice to many overweight patients in the past has been to lose weight and than come back and have their tummy tuck. This is the standard advice that surgeons performing the standard tummy tucks will provide. Things have changed rapidly since the invention of the liposuction based tummy tuck.

Even though I agree that losing weight is ideal and if you can lose weight than you will have a much better result. However I have many patients that struggle to lose weight and also the rashes and discomfort when the exercise. Doing a liposuction based tummy tuck for them makes a massive difference.

This lady had overhanging skin since she had children. She had lost 20kg after giving birth but was unable to lose any more. She also found that she had rashes and discomfort when trying to exercise.

I did a liposuction based tummy tuck for her. We removed nearly 3kg of fat with the liposuction and another 2 kg of skin and fat removing the excess lower abdominal skin.

She was very happy!*

PATIENT 3077

This lady had 2 children. She had extensive stretch marks and hanging skin. I removed 1.5 kg of fat with the liposuction and another 2 kg of skin and fat when removing lower abdominal excess.*

Time for a consult?

You can also give us a call at (02) 4934 5700.

References:

Juarez M. Avelar, Abdominoplasty Combined with Lipoplasty Without Panniculus Undermining: Abdominolipoplasty—a Safe Technique, Clinics in Plastic Surgery Volume 33, Issue 1, January 2006, Pages 79–90 Lipoplasty.

Parvizi D; Friedl H; Schintler MV; Rappl T; Laback C; Wiedner M; Vasiljeva A; Kamolz LP; Spendel S. Use of 2-octyl cyanoacrylate together with a self-adhering mesh (DermabondTM PrineoTM) for skin closure following abdominoplasty: an open, prospective, controlled, randomized, clinical study. Aesthetic Plastic Surgery. 37(3):529-37, 2013 Jun.

 

*Disclaimers

General disclaimer (including google ad disclaimer)

There is no guarantee of specific results and the results can vary from patient to patient. The photos shown have not been altered, other than removing identifiable marks such as tattoos and birthmarks at the request of the patient. If any such alteration has been done then it has been done equally on both before and after photos and there is a notation under the photo stating what alteration has been done.

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AHPRA (Australian Health Practitioner Regulation Agency) disclaimer, required by Australian Law

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.