Background: The use of liposuction combined with abdominoplasty has been controversial. The combination of techniques has been associated with an increased rate of venous thromboembolism and wound-healing complications. Through improvements in venous thromboembolism prophylaxis, refinements in liposuction techniques, and an understanding of anatomy, this cumulative risk has decreased, although the negative stigmata persist. This study describes the evolution of abdominal body contouring through a critical review of a single surgeon's 20-year experience with abdominoplasty. This clinical outcome analysis will highlight the significant contributions that have led to the improvement in the safety and efficacy of this technique. Methods: A retrospective review of patients undergoing abdominoplasty procedures was performed. Patient demographics and procedural information, including postoperative course and complications, were recorded. Preoperative and postoperative photographs were scored by blinded evaluators for aesthetic result and scar quality. Results:: Two hundred fifty patients undergoing abdominoplasty from 1987 to 2007 were included in the study. The use of a "superwet" liposuction technique in combination with abdominoplasty significantly decreased intraoperative blood loss (p < 0.04) and length of hospital stay (p < 0.05). Liposuction volume and region had no significant effect on abdominoplasty outcome, although refinements in operative technique, including abdominal and flank ultrasound-assisted liposuction, high superior tension, and limited abdominal undermining, did improve the postoperative aesthetic score. Venous thromboembolic events significantly decreased with aggressive venous thromboembolism prophylaxis (p < 0.001). Conclusions: The technical evolution of a single surgeon's 20-year experience demonstrates that liposuction can be safely and effectively combined with abdominoplasty. Preoperative trunk analysis, intraoperative surgical refinements including superwet technique and ultrasound-assisted liposuction, and perioperative venous thromboembolism prophylaxis significantly improve the outcome of abdominoplasty.
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