Abdominoplastie

Chirurgie de la silhouette - Dr Patrice Hilligot Paris

L' abdominoplastie désigne la chirurgie réparatrice et esthétique de l’embellissement du ventre. Encore appelée plastie abdominale ou dermolipectomie du ventre, cette intervention remodèle l'abdomen en supprimant les surplus graisseux (liposuccion ou lipoaspiration) et excès cutanés.

abdominoplastie et liposuccion du ventre par le DR Patrice Hilligot chirurgien esthetique à Paris

Sommaire :

• Quels sont les différents types d'intervention possibles ?

• Quelles sont les différentes techniques chirurgicales possibles ?

• Quelle est la technique d'abdominoplastie la plus adaptée selon le Dr Hilligot ?

• Photos avant / après d'abdominoplastie.

What are nasolabial folds?

Four types of interventions can improve the appearance of your belly:

– liposuction or liposuction,

– abdominoplasty with classic abdominoplasty;

– the classic mini abdominoplasty;

– the mini abdominoplasty of personal technique especially indicated in a rather thin woman and carrier of a cutaneous distention with stretch marks located above the navel.

The belly or anterior abdominal wall, can be degraded in various more or less associated circumstances: pregnancy, weight loss, weight gain, violent muscular effort or previous intervention on the abdomen. The purpose of an intervention on the stomach is:

– aesthetics: restoring a flat stomach underlined by harmonious concave and convex lines that define the beauty of the stomach;

– functional: restoring the tone and solidity of the musculo-aponeurotic wall, which makes it possible to avoid numerous back and back pains and pelvic muscular problems at the origin of urinary incontinence, which is extremely frequent;

– sexual.

The objective of an intervention on the stomach is to restore the three constituent elements of its wall which are affected to varying degrees:

– the skin: which can be distended, excessive, thinned or stretched. Its treatment is based on the excision of the excess skin and its re-tensioning by means of a suture using an original technique, avoiding scar enlargement as much as possible;

– fat: often found in excess; measuring the thickness of the skin fold makes it possible to quantify it by pinching the skin between the thumb and the index finger, the underlying muscles being contracted. The reference skin fold is that of the inner side of the arm. A skin fold greater than that of the arm is a sign of excess fat. This excess is treated by liposuction, if the skin fold exceeds 2 cm in thickness. Below this level, aspiration is contraindicated because it is a source of postoperative complications, in particular “corrugated iron” which appears either immediately, or sometimes 10 or even 15 after the intervention due to weight loss or hormonal modification;

– the musculo-aponeurotic wall: it consists of the rectus abdominis muscles – or abdominal muscles -, the oblique muscles and their respective aponeuroses on the sides. Two in number, the rectus abdominis extend vertically in the central part of the belly, from the last ribs to the pubis, circumscribing the umbilicus. These two muscles are normally closely joined to each other in the midline. In case of separation of these two edges, appears what is called diastasis of the rectus abdominis muscles. Often, this diastasis is associated with an umbilical hernia which must be systematically sought. The cure of the diastasis and that of the umbilical hernia (if it exists), are an integral part of the treatment of an abdominal wall if one wants to obtain a flat and solid stomach, hence the importance of being operated on by a surgeon. generalist, able to intervene on any organs, but also specialized in cosmetic surgery of the belly.

In addition, your surgeon should be experienced because, from a relatively simple technique, these abdominoplasty procedures become extremely complex if you want to obtain a perfectly aesthetic result.

differents

What are nasolabial folds?

techniques

What are the different surgical techniques possible?

The surgical techniques vary according to the severity of the abnormalities of the constituent elements of the abdominal wall. Three procedures are traditionally used: classic abdominoplasty or abdominoplasty, mini abdominoplasty and liposuction or liposuction.

The classic abdominoplasty or abdominoplasty includes:

- excision of excess skin and fat located below the navel;

- isolation of the superficial, cutaneous, navel orifice and its transfer upwards but without disinsertion of its deep orifice in relation to the rest of the musculo-aponeurotic wall;

- the cure of diastasis and umbilical hernia, if present;

- liposuction.

Very frequently indicated, it therefore corrects the three elements of the wall:

– the rectus muscles above and below the umbilical;

– fat by liposuction (or liposuction);

– the skin and the umbilicus by excision of the cutaneous fat pad lying horizontally between the umbilicus and the pubis, associated with a transposition of the umbilicus, that is to say, a displacement of the umbilicus upwards in an ideal position.

The different operating times are as follows:

1) The incision has the following characteristics:

– Supra pubic, just above the pubis;

– concave upwards and not horizontal as practiced by many surgeons;

– very low, avoiding crossing the inguinal regions;

– as short as possible;

– carrying the maximum of dermis on the upper and lower edges according to an original technique, thus preparing a type of suture with an original and personalized technique called abutment flap or Adhesion Flap which will avoid secondary scar enlargement as much as possible.

What are nasolabial folds?

adaptee

Les différents temps opératoires sont les suivants :

❶  L’incision présente les caractéristiques suivantes : 

• sus pubienne, juste au-dessus du pubis ; 

• concave vers le haut et non pas horizontale comme le pratiquent beaucoup de chirurgiens ; 

• très basse, en évitant de traverser les régions inguinales ; 

• la plus courte possible ; 

• emportant le maximum de derme sur les berges supérieures et inférieures selon une technique originale, préparant ainsi un type de suture de technique originale et personnalisée appelé lambeau d’accolement ou Adhesion Flap qui évitera au maximum l’élargissement cicatriciel secondaire.  

shema plastie abdominale classique abdominoplastie et liposuccion du ventre par le DR Patrice Hilligot chirurgien esthetique à Paris

2) The pre-aponeurotic dissection under the umbilical

This dissection is in fact a detachment which is carried out from the pubis to the umbilicus, in contact with the muscle, except around the pubis where a certain thickness of fat must be left attached to the deep muscles. Haemostasis with an electric scalpel is meticulous, coagulating each perforating vessel and especially all the whitish tissue "dendrites" which stretch regularly, inside the fat, especially on the sides and near the ribs.

3) Isolation of the umbilicus.

The periumbilical incision follows a rounded line, in fact adapted to each shape of umbilical and rather intra-umbilical, a few mm inside the circumference of the conduit. This is a particularly important stage of the operation if one wishes to obtain a beautiful umbilicus.

4) Supra-umbilical pre-aponeurotic dissection.

This dissection is carried out upwards, above the umbilicus, most often up to the xiphoid appendage and is little extended laterally, as little as possible.

5) Dissection and cure of any associated umbilical hernia The hernia is dissected, its contents reintegrated into the abdominal cavity and the deep umbilical orifice is securely closed to prevent any recurrence.

6) The cure of diastasis above and below the umbilical.

The suture is performed in 2 planes: stitches in X with non-absorbable thread n°0 (Mersuture*) doubled by an overlock with slow resorption thread n°1 (Vicryl*) which covers the first plane of suture and isolates it from superficial cutaneous fatty tissues. The needles are of round section in order to avoid any tearing of the muscular aponeurosis, which is often fragile.

7) Exeresis of the fatty skin pad below the umbilical.

Carried out according to a layout adapted to each case, this excision is associated with a deep and careful degreasing of the slices of section.

8) Verification of hemostasis

Haemostasis or coagulation of the vessels with an electric scalpel is meticulous after rinsing with lukewarm betadine serum.

9) Drainage

Carried out by two suction drains, one above and the other below the umbilical exiting through the pubic region.

10) Externalization of the umbilicus

After its isolation, the umbilicus is located under the skin. It is exteriorized in a good position at a very precise and variable level according to each case. The umbilicus is then sutured thinly to the surrounding abdominal wall.

11) Skin closure

suture abdominoplastie et liposuccion du ventre par le DR Patrice Hilligot chirurgien esthetique à Paris

It is very specific, consisting of an abutment flap or Adhesion Flap in 3 planes:

-deep dermal, with semi-slow resorption thread 2/0;

- more superficial dermal, with a 3/0 semi-slow resorption thread;

- epidermal, by fine staples. The two lateral extremities are treated preventively in order to avoid any excess residual fatty skin called “ears”.

12) Terminal liposuction

This liposuction regularly concerns the flanks and the lumbar regions (love handles and hips). Performed through a tiny lateral incision on each side, it frequently takes away 1 to 1.5 liters of fat.

13) Band-Aid

A kind of net called Contensor is glued, directly to the skin, from one lumbar region to the other. The umbilicus is covered with a fatty compress (Tulle Gras*). The aspirated lumbar regions are very strongly compressed by elastic sticky bands.