Karen M. Horton, MD answers:
Abdominoplasty has the goals of removing excess skin and fat from the lower abdomen, tightening the abdominal wall contour, and bringing the rectus abdominis muscles back together in the midline.
On the other hand, liposuction simply removes excess fat in areas where it is deposted in excess. Sometimes, these two procedures are combined for the most aesthetic result. However, this must be done in the safest way possible, without creating additional risks.
I usually perform the abdominoplasty portion first. This removes most of the lower abdominal and pubic area fat by direct excision, and liposuction is not needed for these regions. I then evaluate whether there is any additional fat remaining that may be appropriate for liposuction - for instance in the flank and/or upper abdominal regions.
Of course, other areas of the body such as hips, inner or outer thighs are often addressed at the same time as an abdominoplasty, as complimentary procedures.
Next, if considering liposuction to enhance the abdominoplasty procedure, I will infiltrate the tumescent solution into the remaining abdominal regions.
Tumescent solution functions to temporarily constrict the blood vessels in the area and decreases the risk for bleeding and bruising with suctioning of fat. If any of the abdominal skin appears to have a compromised circulation, then I will stop here and not perform liposuction, to avoid the risk of wound healing problems.
However, if the abdominal skin appears to be healthy and pink, without any circulatory compromise, I may also perform a careful and limited amount of liposuction, usually to the flanks and possibly upper abdomen and/or pubic area at that time.
In Plastic Surgery, healing is based on having a good circulation to the tissues. It is always wise to do the safest procedure and avoid complications, rather than power ahead and risk "doing too much" at one time! Safety first!
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.