Abstract
Ever since I started performing abdominoplasties with a liposuction technique, it has been evident that, quite often, cutaneous excess had to be resected as an associated procedure. Thus, the roots of the origin of new concepts in abdominoplasty arose a long time ago. Nevertheless, high rates of local disorders after combined operations (seroma formation, hematoma, sloughing of the skin, panniculus necrosis), as well as systemic complications, used to occur with all plastic surgeons. I became so disappointed with all these complications that, in 1988, I made the radical decision of not performing such combined operations anymore. However, during 10 years of anatomical studies, and by analyzing peri- and postoperative complications, I concluded that most of these problems were caused by panniculus undermining when perforator vessels coming from the rectus abdominalis were sectioned, causing interruption of the arterial blood supply and venous and lymphatic stasis.
Technique
Over a long period of time, I performed anatomical dissections on cadavers with the purpose of finding an answer to the problems mentioned above. I started to perform full-thickness liposuction of the subcutaneous tissue in an elliptical area on the suprapubic region, followed by skin resection, and found that the perforator vessels were preserved. Therefore, in 1998, I was sure that such an operation could be performed safely, without any bleeding during or after surgery. Meanwhile it was clear that a new procedure could be performed to suction the accumulated fat, combined with skin resection to remove the redundant cutaneous covering after fat suction, with minimal complications. The new approach was published and presented in 1999, detailing the original anatomical studies that are the basic fundamentals of the new concepts in abdominoplasty associated with liposuction; that is, lipoabdominoplasty. My descriptions in publications and presentations at congresses, symposiums, and courses were very clear, so that other surgeons were able to learn, employ, and confirm the basic principles concerning the new concepts in abdominoplasty, and thus other plastic surgeons were convinced to perform lipoabdominoplasty.
These surgical principles are essential for the lipoabdominoplasty procedure to improve body contouring; as well, these principles are essential in several other regions, according to my original descriptions for flankplasty, torsoplasty, medial thigh lifting, and esthetic surgery of the axillary regions. The principles may even be employed to perform face lifting, ear reconstruction, reverse lower blepharoplasty, and procedures in other segments of the human body. Such a combined approach, with its suitable physiological surgical principles, is very important in plastic surgery, so that the vascular nervous pedicles, in which are contained arteries, veins, lymphatics, and nerves, are not cut. When these structures are properly preserved in lipoabdominoplasty, smooth and esthetic results are provided, with good sensibility in the remnant abdominal panniculus.
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Keywords
- New abdominoplasty
- New surgical principles
- New concepts
- Preservation of perforator vessels
- Minimal complications
Introduction
The roots of the origin of my new concepts in abdominoplasty arose a long time ago since the time that I started performing traditional abdominoplasty and later liposuction. In fact, when I learned from Prof. Pitanguy, during my period of residence, and later from Prof. Illouz, respectively, how to perform abdominoplasty and liposuction procedures, I already thought of searching for a safer approach. In my private practice, beginning in 1974, I used to have a rate of local and systemic complications after abdominoplasty similar to that mentioned by other plastic surgeons. According to Grazer and Goldwyn [47] and later Guerrerosantos et al. [48], complications after abdominoplasty were a constant problem among plastic surgeons. With the combination of traditional abdominoplasty and a liposuction technique, the complications became even more frequent, as reported by Goldwyn [46] a few years after liposuction was introduced and popularized by Illouz. No longer was I so disappointed with all the complications that used to occur with most plastic surgeons. In my judgment the troubles were related to vascular damage during surgery, and as there was no adequate solution for the problems I then made the decision of not performing such combined operations anymore [16]. Of note, Hetter et al. [49], Dellerud [43], and later Flageul et al. [45] reported that seroma formation, hematoma, sloughing of the skin, minor and major areas of panniculus necrosis of the abdominal wall, thromboembolism, and unesthetic scars around the umbilicus were some of the most frequent complications after abdominoplasty. Since the earlier period of the practice, these kinds of complications concerned me so much that I was motivated to study and research the anatomy of the abdominal panniculus, searching for a new method in order to avoid these complications. In 2006, Matarasso et al. [56] reported the findings of the American Society for Aesthetic Plastic Surgery’s 2004 Cosmetic National Data Bank: during the previous 7 years, the number of abdominoplasty operations performed had increased by 344%. This is important information; due to safety procedures, surgical results have improved, with minimal rates of complications, encouraging plastic surgeons to perform abdominoplasties.
Technique
Among the complications after abdominoplasty, the creation of a new umbilicus was a constant task that used to be reported by most plastic surgeons. It bothered me so much that during my first 2 years of practice, I developed a personal approach to create a new umbilical area during abdominoplasty [2–6]. The main surgical principle of my procedure is to avoid a circular scar around the umbilicus during surgery. The first reference for transposition of the umbilicus is credited to Vernon [62], who performed a circular incision around the umbilicus during surgery for abdominal panniculus, and for its reimplantation, he removed a circle of skin on the abdominal flap and sutured the wound. All procedures described afterward were similar to that, since with a vertical, horizontal, or a curved incision, the final scar around the new umbilical area is a circular one. Until my publications all authors used to make a circular incision around the umbilicus according to Vernon’s method. Instead of a circle, I proposed creating three cutaneous flaps on the umbilicus, and another three cutaneous flaps on the abdominal panniculus in order to suture alternately between them. The final scar, instead of a circular one, is an asymmetric triple Z-plasty which avoids retraction and contraction, which were frequent complications in an worldwide survey reported by Grazer and Goldwyn [47]. Therefore, in my operations the problems regarding creation of the new umbilicus were adequately solved.
Nevertheless, other complications occurring perioperatively and also after abdominoplasty were a constant challenge for several years. Regarding the origin of my new concepts, an important step occurred in August 1975 when I participated in the Sixth Congress of the International Confederation of Plastic and Reconstructive Surgery (IPRS) held in Paris. During that meeting I was invited to attend a private reception at a plastic surgeon’s office. That surgeon was Dr. Illouz. As soon as we met each other, a strong friendship developed between us. As he was an active member of the French Society of Aesthetic Plastic Surgery, he invited me to speak at the next congress, to be held in Paris in 1976. My talks were about umbilicoplasty and negroid nose procedures [3]. So, due to my original publications, I met Dr. Illouz some years before his first publication concerning the liposuction technique [50].
Later, I quite often used to hear about a French surgeon who had developed a new technique for fat removal. In 1980 Dr. Illouz came to speak about it at the Brazilian Congress of Plastic Surgery (held in Fortaleza, Ceara State), which was quite controversial since most surgeons were not convinced about the method. In the meantime, I often heard about his procedure. Early in 1982 I called him with the purpose of learning his technique. For 1 week I attended several surgeries and I saw some patients in postoperative recovery showing very good results. I was impressed and convinced about his technique. During my stay he gave me a copy of his publication printed in a public journal (tabloid) with a clear description in French of his methodology; this is still at my institute as a special souvenir (Fig. 1.1). At that time I was the President of the Brazilian Society of Plastic Surgery ( São Paulo State region), and I invited him to come to São Paulo to give a course to introduce his technique. So, in November 1982 he came to give a course, and he performed six surgical demonstrations with excellent results, which were a success; the course was a memorable event [51]. As I had already learned his technique, during the first course, I introduced to Dr. Illouz some of my patients who had undergone the procedure on the abdomen, neck, and torso. Afterward I invited him again several times to come once a year to teach his technique at other courses and also to give lectures at the Brazilian Congress of Plastic Surgery [52]. As he used to come to São Paulo quite often, and as we were so involved in introducing and teaching his technique, we decided to publish our book, in which we described the basic fundamentals and advanced technical information.
During that period of introduction, learning, practising, and teaching the liposuction technique, several questions about it came to mind:
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1.
The limit of the patient’s age for undergoing liposuction
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2.
The limit of fat tissue to be removed in each operation
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3.
Criteria of indications for overweight patients
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4.
The anatomy of the panniculus
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5.
The clinical and metabolic alterations after liposuction
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6.
Redundancy of the skin secondary to the liposuction procedure
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7.
Liposuction combined with traditional procedures
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8.
Behavior of the remaining fat tissue after surgery.
The first three questions mentioned above led to the establishment of adequate rules and criteria for plastic surgeons; these have been useful from that period to the present.
However, regarding the anatomy of the panniculus, I devoted much time to research in cadavers in order to know fat tissue, as well as its distribution in all regions of the human body (Fig. 1.2) [12]. That knowledge was a good support at that time, providing proper conditions to employ the new technique of liposuction. Even nowadays that anatomical information is still very useful when fat-suction is done.
Regarding clinical and metabolic alterations, I demonstrated, in a comparative study with patients who underwent esthetic procedures (reduction mastoplasty, abdominoplasty, rhytidoplasty), that there was no specific disturbance in patients after liposuction [7–9, 12, 14, 15]. Apart from my research, other surgeons studied the same subject and had similar results [1].
To solve the problem concerning redundancy of the skin after the liposuction procedure, it became mandatory to remove such skin in order to achieve a good balance of the regions with harmony in body contouring. In fact, the traditional abdominoplasty described by Callia [42] and popularized by Pitanguy [57] used to be the fundamental procedure for combination with the liposuction technique developed by Illouz [50, 51]. However, when such a combined procedure was performed on the abdomen, several kinds of local complications were seen quite often: seroma formation, hematoma, cutaneous sloughing, and skin and panniculus necrosis. As well, systemic complications and even, unfortunately, deaths, were reported worldwide. Although that combined procedure was performed by most plastic surgeons, I was deeply concerned about the procedure, as described in my publications [10, 11].
The behavior of the remaining fat tissue after liposuction, the selection of patients, and the indications for liposuction are meticulously emphasized in my publication [17]. It is described that the fibrotic and thick tissue developed secondarily to fat-suction is very difficult to dissect and to undermine, and even makes it difficult to move the panniculus for resection [10]. It is mentioned that in cases of a secondary liposuction on the abdominal wall, the procedure must be done carefully, since the cannula may accidentally perforate the muscular structures, causing severe damage to the internal organs.
Besides these situations, several other problems used to occur during and after liposuction procedures. Bleeding during operation was a frequent problem, requiring transfusion of donated or autologous blood [61]. Nowadays, most of these problems have been adequately solved. But during that time it was my obsessive pursuit to learn widely and very broadly about these problems. Nevertheless, performing liposuction on the abdominal wall used to be even more complex than previously, since physical abnormalities as well as expectations of the results were a constant challenge.
Undoubtedly a very high incidence of local complications used to occur after liposuction in conjunction with conventional procedures with most surgeons, as reported by Goldwyn [46], Hetter et al. [49], and Dellerud [43]. These problems intrigued me so much that I became discouraged from performing combined approaches due to the psychological repercussions for the patients [15], [58]. So, in 1988 (only 6 years into my practice in the use of the fat-suction technique), even after the publication of our book [13], I decided not to perform such associated procedures anymore [16]. During a period of 10 years, from 1988 to1998, I used to perform only conventional abdominoplasty in patients without localized adiposities, or isolated fat-suction in young patients to remove only localized adiposities without skin resection. Although I no longer performed the combined procedure, I followed my research in my previous study of the anatomy and behavior of the remaining fat tissue [12, 14, 15, 17]. As well as studying these complications, I was looking for a new approach to solve both deformities – flaccidity with the excess skin associated with treatment of localized adiposities on the abdominal wall.
During a long period of anatomical studies and analyzing the complications of conventional abdominoplasty, I concluded that most of the problems were caused by venous and lymphatic stasis, due to the cutting of the perforator vessels (Fig. 1.2). However, after the liposuction procedure the perforator vessels coming from the rectus abdominalis to the remaining panniculus were preserved, as demonstrated in some slides that Prof. Callia gave me. He had performed conventional abdominoplasty in a group of female patients 6 months after liposuction because of their complaints about the redundant skin. I analyzed his slides in comparison with mine, taken from my previous anatomical research in cadavers, and came to the conclusion that it would be possible to perform panniculus resection combined with liposuction, as long as the perforator vessels coming from the rectus abdominalis would be preserved. That is the basis of my new concepts, which I pursued in order to perform abdominoplasty safely.
Due to my conclusion, I was motivated to perform, on cadavers, full-thickness suction of the subcutaneous tissue in an elliptical area on the suprapubic region and on the medial thigh. Afterwards skin resection was done and I identified structures similar to those I had found on cadavers after liposuction procedures in my previous anatomical research, which was a fundamental support of information [12, 17]. Later, liposuction was done below the fascia superficialis that is underneath the areolar layer of the panniculus which is moved from one border to another to facilitate the suture of the surgical wound. At that moment I was sure that such an operation could be performed safely without any bleeding during or after surgery.
My first patients were operated in early 1998, 10 years after my radical decision of not performing combined procedures of liposuction with skin resection. My first operation was done in a female patient presenting unesthetic and deep surgical scars in the suprapubic region. The second patient was another female, with dark, thick skin with localized adiposity on the medial thigh region. First, I demarcated the excess skin that should be removed and also the area to perform fat-suction. The operations were successfully done through a liposuction procedure on a full thickness area of the skin which was removed afterward without bleeding. Following the operation liposuction was done underneath the remaining panniculus without undermining, and the wound was sutured.
It was clear to me that a new procedure could be performed, with minimal complications, in order to suction the accumulated fat, combined with skin resection of the redundant cutaneous covering after the fat-suction. In my original publications [18–21], this method was employed for treatment of the abdominal wall, medial thigh lifting, flanks, and axilla, as well as in a closed vascular system, since no vessels are damaged.
Therefore, the final conclusions of my new approach were to treat not only the abdominal wall, since the whole body may present localized adiposities and redundant skin as well. Due to my anatomical investigations, several segments of the human body were adequately repaired with minimal complications using the same surgical principles, which are to preserve the perforator vessels to work as multiple pedicles for the abdominal wall, medial thigh, flanks, and torso, as well as in the axillary regions. I have also employed similar surgical principles to perform face lifting, ear reconstruction, and reverse lower blepharoplasty, and to treat other segments of the human body. Also I perform rhytidoplasty with reduced cutaneous undermining by tunnelization preserving the perforator vessels to assure adequate blood supply. My technique for ear reconstruction involves the same surgical principles as those described for abdominoplasty. The reconstructed auricles present a vascular and nervous pedicle through which an adequate blood supply and adequate sensibility are provided. My reverse lower blepharoplasty approach is performed using the same surgical principles, since no liposuction procedure is done, nor is there cutaneous or muscle undermining.
Apart from my publications in 1999, I presented the new concepts at a congresses in Brazil [22] and abroad ([23]). In early 2000 Prof. Callia’s unit invited me to demonstrate the new concepts in abdominoplasty at a course at the Municipal Hospital in São Paulo City. Apart from my classes, I also performed a surgical demonstration [24]. In 2000 I was invited to speak about my abdominoplasty procedure at several meetings in Brazil [25–27] and abroad. It is referred to by Matarasso [55] as new concepts in abdominoplasty. Also I presented again at other international congresses [28–30]. In October 2000, I organized The Second Course of Abdominoplasty at the Heart Hospital (Hospital do Coração) in São Paulo when several of the plastic surgeons who had attended the First Course presented their experience in the use of the new technique [31]. Among these plastic surgeons, Erfon introduced the plication of the aponeurosis below the umbilicus to reduce the extent of the final scar of the abdominoplasty [44]. Also, Leao presented, during the Second Course, plication of the superior segment of the abdomen creating a tunnel from the umbilicus to the xiphoid process, preserving the perforator vessels on each side [53]. Following my presentations, I spoke again at the 37th Brazilian Congress of Plastic Surgery [32]. At the Brazilian Congress, Leão presented his procedure for plication of the superior abdominal wall without panniculus undermining [54]. In 2001 I was invited to participate in many congresses abroad-- in Spain [33, 34], at the Balkan Congress in Belgrade [35], at the American Congress in New York [36], and again at the International Society of Aesthetic and Plastic Surgery (ISAPS) Course in Rio de Janeiro [37]. Also, early in 2002, details of my findings were published in the American Aesthetic Journal [38], presented at the ISAPS Congress in Turkey [39], and again presented at the American Congress in Boston [41].
My descriptions in publications and my presentations at congresses, symposiums, and courses were very clear, convincing other plastic surgeons to perform abdominoplasty combined with liposuction, so that in December 2001 there were other reports [59]. My first publication and presentations were in 1999; therefore, the long period of 2 years was enough for other surgeons to learn, to employ, and to confirm the basic principles of my new concepts in abdominoplasty.
Discussion
Abdominoplasty is an important procedure to improve the harmony of the body contour. The treatment must be done through a technique that achieves esthetic, reconstructive, and functional results. For this reason patient selection, correct indications, and the choice of a suitable surgical technique are essential steps before surgery. Therefore, before any esthetic procedure is performed on the abdomen, the patients must be well evaluated in order to analyze all abnormalities according to the scientific knowledge and sense of beauty of the surgeon.
For various reasons, all layers covering the abdominal wall--skin, subcutaneous tissues, aponeurosis, and muscles--may be damaged, resulting in deformities that require surgical repair. Such deformities may be caused by repeated pregnancies, cutaneous flaccidity, striae, retracted scars secondary to previous operations, severe local trauma, hernia, diastasis of the rectus abdominalis, localized adiposities, and weight loss, among others. It is well known that several kinds of complications may occur after abdominoplasty, as well as after combined procedures with liposuction. All complications were quite common before the liposuction era introduced by Illouz [50, 51]. However, in the combined surgeries the rate of complications increased very much, which prompted me to search for an adequate solution. During a few years of practising the associated procedure, I made the radical decision of not performing the procedure anymore until I developed a new approach avoiding such complications. I was greatly concerned about all the problems occurring after surgeries, encouraging me to study and research the anatomy of the panniculus and the behavior of the remaining fat tissue following my previous studies on cadavers [12, 14, 15, 17].
I devoted much time to research on anatomy dissection to study the subcutaneous compartment, which was not well known previously, since few surgical procedures needed knowledge about it. As the cannulas used to perform liposuction work specifically on the level between the skin and muscles underneath, I became motivated to study and research this segment of the human body. The anatomy of the panniculus is formed by the areolar layer and lamellar layer divided by the fascia superficialis (Fig. 1.2). After my anatomical studies of the abdominal panniculus, it seemed suitable to mention that the fascia superficialis is a symbol of the new concepts in lipoabdominoplasty, since it covers whole regions of the body and is particularly important in the abdominal wall. The perforator vessels come from the muscles passing through the lamellar layer until they reach the fascia superficialis, where a strong arch of channels of communicating vessels is created. From that arch small vessels cross the areolar layer perpendicularly until they reach the subdermal level. Therefore, preservation of the perforator vessels is the main surgical principle, as this preservation provides adequate blood supply to the areolar layer and to the fat tissue remaining after liposuction.
According to the American Society for Aesthetic Plastic Surgery’s 2004 Cosmetic Surgery National Data Bank, the number of abdominoplasties increased by 344 % between 1997 and 2004. This increase is a result of the combination of abdominoplasty with the liposuction technique, which is a safe procedure with a minimal rate of complications after operation. Therefore, the minor complications occurring during and after such combined abdominoplasties have stimulated patients and plastic surgeons to perform the combined procedures.
Other authors have also searched for suitable procedures for abdominoplasty, as mentioned by Shestak, with his marriage of liposuction combined with abdominoplasty [60].
The surgical principles of lipoabdominoplasty are also employed to perform medial thigh lipoplasty, face-lifting procedures (rhytidoplasties), ear reconstruction, reverse lower blepharoplasty, torso and flank lipoplasty, and gluteus lipoplasty (Fig. 1.3).
My ideas in searching for new concepts in abdominoplasty did not come immediately. In fact, I was wondering and thinking about the problems for some time, and more than that, I was looking for a safe procedure. My previous publications in a wide field concerning abdominoplasty before the liposuction era, as well as my publications on the use of combined procedures, are permanent witnesses to my scientific activities.
I am deeply thankful to Prof. Pitanguy for giving me a good level of specialization, to Prof. Illouz for the opportunity to learn his technique, and to Prof. Callia for his useful support during the period of researching a new approach for abdominoplasty. They gave me great sensibility and the scientific spirit for searching for a new way in plastic surgery. It was a privilege to give Prof. Illouz some commemorative plaques in recognition of and gratitude for his outstanding scientific contribution to plastic surgery (Figs. 1.4 and 1.5).
Conclusions
The first operation for esthetic treatment to reinstate the abdominal wall is credited to Kelly (1899). During all of the period since then, much attention has been focused on finding a procedure through which good results could be achieved. However, the very high incidence of complications in abdominoplasty was a problem to be solved, since the perforator vessels were cut in order to achieve wide undermining.
When the liposuction technique was developed and popularized worldwide by Illouz ([50, 51], 1992), I found a new way to improve my surgical results, performing this technique in association with traditional abdominoplasty [10, 11, 40]. Several complications after abdominoplasty were reported by all plastic surgeons; however, with the use of the liposuction procedure combined with conventional techniques, the rate of these complications became even higher and the complications more complex. I was concerned about these problems, since seroma formation, hematoma, skin sloughing, cutaneous infection, and panniculus necrosis, as well as systemic complications, were a constant challenge.
After reports in my publications [18, 19, 24–32], abdominoplasty showed significant technical improvements, because it became possible to perform it in combination with a liposuction technique, in which preservation of the perforator vessels is the main surgical principle of the lipoabdominoplasty. In fact, during this operation, the perforator vessels are not cut, providing blood supply to the remaining abdominal panniculus, working as multiple pedicles. This is a major surgical contribution, with a minor rate of complications, because the operation can be carried out without panniculus undermining and resection.
These surgical principles are essential for the lipoabdominoplasty procedure to improve body contouring; as well, the principles are employed in several other regions, according to my original descriptions for flankplasty, torsoplasty, medial thigh lifting, and esthetic surgery of the axillary regions [18–21].
Similar surgical principles may also be employed to perform face lifting, ear reconstruction, reverse lower blepharoplasty, and plastic surgery procedures in other segments of the human body. Such a combined approach, with its suitable physiological surgical principles, in which the vascular nervous pedicles are not cut, is very important in plastic surgery, as these structures contain arteries, veins, lymphatics, and nerves. . As long as these structures are properly preserved, they provide smooth and esthetic results with good sensibility for the remnant abdominal panniculus.
References
Andrews JM (1984) Fisiopatologia na lipoaspiração (Physiopathology in liposuction). Simp Bras do Contorno Corporal. Soc Bras Cir Plas – Reg São Paulo, São Paulo
Avelar JM (1976) Umbilicoplastia – uma técnica sem cicatriz externa (Umbilicoplasty – a technique without external scar). 13° Congr Bras Cir Plast, 1° Congr Bras Cir Estética 13th Braz. Congr. of Plastic Surgery and First Braz. Congr. of Aesthetic Surgery, Porto Alegre, pp 81–82
Avelar JM (1976) Umbilicoplasty. A technique without external scar. Cahiers de chirurgie Esthétique. Journees internationals de Chirurgie Esthetique. Vendredi 21 mai, pp 5–25
Avelar JM (1978) Abdominoplasty – systematization of a technique without external umbilical scar. Aesthetic Plast Surg 2:141–151
Avelar JM (1979) Cicatriz umbilical – da sua importância e da técnica de confecção nas abdominoplastias (Umbilical scar – its importance and technique for creating during abdominoplasty). Rev Bras Cir 1(2):41–52
Avelar JM (1983) Abdominoplasty: technical refinements and analysis of 130 cases in 8 years’ follow-up. Aesthetic Plast Surg 7:205–212
Avelar JM (1983) Análise metabólica comparativa entre cirurgia estética e lipoaspiração (metabolic comparative analysis between aesthetic surgery and liposuction). XX Congr Bras. Cir. Plas. Nov, Brasília
Avelar JM (1984) Fisiopatologia na lipoaspiração (Physiopathology in liposuction) Simp Bras do Contorno Corporal. Soc Bras Cir Plas – Reg São Paulo, São Paulo
Avelar JM (1984) Estudo comparativo das alterações metabólicas na lipoaspiração e cirurgia convencional (comparative study of metabolic changes in conventional surgery and liposuction) Simp Bras do Contorno Corporal. Soc Bras Cir Plas – Reg São Paulo, São Paulo
Avelar JM (1985) Fat-suction versus abdominoplasty. Aesthetic Plast Surg 9:265–276
Avelar JM (1985) Combined liposuction with traditional surgery in abdomen lipodystrophy. XXIV Instructional course of Aesth Plast Surg of ISAPS, Madrid
Avelar JM (1986) Anatomia cirúrgica e distribuição do tecido celular no organismo humano (surgical anatomy and distribution of the cellular tissue on human organism). In: Avelar JM, Illouz IG (eds) Lipoaspiração (liposuction). Editora Hipócrates, São Paulo, pp 45–57
Avelar JM, Illouz YG (1986) Lipoaspiração (liposuction). In: Avelar JM, Illouz YG (eds) Lipoaspiração; Editora Hipócrates, São Paulo
Avelar JM (1986) Perfil psicológico do paciente – introdução ao estudo (psychological profile of the patient – introducing to the subject). In: Avelar JM, Illouz IG (eds) Lipoaspiração (liposuction). Editora Hipócrates, São Paulo, pp 8–12
Avelar JM (1986) Fisiopatologia e Estudo Metabólico da Lipoaspiração (physiopathology and metabolic study of the liposuction). In: Avelar JM, Illouz IG (eds) Lipoaspiração (liposuction). Editora Hipócrates, São Paulo, pp 42–44
Avelar JM (1988) Abdominoplastia – reflexões e perspectivas biopsicológicas (abdominoplasty – reflections and bio-psychological perspectives). Rev Soc Bras Cir Plast 3(2):152–154
Avelar JM (1989) Regional distribution and behavior of the subcutaneous tissue concerning selection and indication for liposuction. Aesthetic Plast Surg 13:155–165
Avelar JM (1999) Uma nova técnica de abdominoplastia – sistema vascular fechado de retalho subdérmico dobrado sobre si mesmo combinado com lipoaspiração (a new technique for abdominoplasty – closed vascular system of subdermal flap folded over itself combined to liposuction). Rev Bras Cir 88/89(1/6):3–20
Avelar JM (1999) Cirurgia Plástica de Face Interna de Coxas/aesthetic plastic in the inner side of the thigh – new concepts and technique without cutaneous or subcutaneous undermining. Rev Bras Cir 88/89(1/6):57–67
Avelar JM (1999) Flancoplastia e Torsoplastia - Nova Abordagem Cirúrgica/flankplasty and torsoplasty – a new surgical approach. Rev Bras Cir 88/89(1/6):21–35
Avelar JM (1999) Cirurgia Plástica e Estética de Axilas/aesthetic plastic surgery of the axilla – a new technique to the treatment of excess skin, hyperhidrosis, cutaneous flaccidity, hyperhidrosis and bromidrosis. Rev Bras Cir 88/89(1/6):41–54
Avelar JM (1999) Novos conceitos para abdominoplastia (new concepts for abdominoplasty). Paper presented at the 36th congress of the Brazilian society of plastic surgery, Rio de Janeiro, November
Avelar JM (1999) Abdominoplastia: nuevos conceptos para una nueva técnica (Abdominoplasty: new concepts for a new technique). XXVI Annual international symposium of aesthetic plastic surgery, Chairman: Prof. Jose Guerrerosantos, Puerto Vallarta, pp 10–13
Avelar JM (2000) I Curso de abdominoplastia (first course of abdominoplasty). Chairman: Prof. William EP Callia. Invited Professor: Dr. Juarez M. Avelar. Municipal Hospital, São Paulo, March
Avelar JM (2000) Abdominoplastia sem descolamento (abdominoplasty without undermining). XX Jorn. Paulista Cir Plast, São Paulo
Avelar JM (2000) Abdominoplasty: a new technique without undermining and fat layer removal (Abdominoplastia: uma nova técnica sem descolamento e remoção da camada de gordura). Arq Catarinense de Med 29:147–149
Avelar JM (2000) Abdominoplastia com preservação do sistema vascular profundo. Comunicação Pessoal. Abdominoplasty with preservation of the deep vascular system. Personal communication. Reunião Mensal da Sociedade Brasileira de Cirurgia Plástica do Rio Grande do Sul – Porto Alegre – maio. Monthly meeting of the Brazilian Society of Plastic Surgery of Rio Grande do Sul, Porto Alegre, May
Avelar JM (2000) A new technique for abdominoplasty subdermal flap folded over itself. The XV ISAPS congress, Tokyo, April
Avelar JM (2000) Aesthetic plastic surgery of the axilla. The XV congress of the International Society of Aesthetic Plastic Surgery (ISAPS), Tokyo, April
Avelar JM (2000) Abdominoplasty: a new technique without panniculus undermining and without panniculus resection. 57th instructional course of ISAPS, Chairman: Lloyd Carlsen, in Montreal, Canada
Avelar JM (2000) 2nd Curso de abdominoplastia (2nd course of abdominoplasty). Chairman: Prof. Juarez M. Avelar. Hospital do Coração (Heart Hospital), São Paulo, October
Avelar JM (2000): Abdominoplasty without panniculus undermining and resection. Presented at the 37th Brazilian Congress of Plastic Surgery, Porto Alegre (Rio Grande do Sul), November
Avelar JM (2001) Abdominoplasty without lipectomy. International Society of Aesthetic Plastic Surgery Education Foundation (ISAPS) – Spain, March.
Avelar JM (2001) Abdominoplasty without lipectomy. Mini course of ISAPS with aesthetic plastic surgery congress, Valladolid
Avelar JM (2001) Abdominoplasty without panniculus undermining or resection. Second Balkan Congress for Plastic, Reconstructive and Aesthetic Surgery and ISAPS mini-Course, Yugoslavia, May
Avelar JM (2001) The new abdominoplasty and derived technique. International course – American Society for Aesthetic Plastic Surgery annual meeting. The aesthetic meeting. New York
Avelar JM (2001e) Abdominoplasty without panniculus undermining and resection – analysis about 97 cases after 3 years. ISAPS Course at Jornada Carioca, Rio de Janeiro, August
Avelar JM (2002) Abdominoplasty without panniculus undermining and resection: analysis and 3-year follow-up of 97 consecutive cases. Aesthetic Surg J 22:16–25
Avelar JM (2002) Abdominoplasty. Congress of International Society of Aesthetic Plastic Surgery (ISAPS), Istambul
Avelar JM (2002) Full abdominoplasty without panniculus undermining and resection. In: Avelar JM (ed) Abdominoplasty without panniculus undermining and resection. Editora Hipocrates, São Paulo, pp 201–215
Avelar JM (2004) New concepts on abdominoplasty. American Society for Aesthetic Plastic Surgery annual meeting. The Aesthetic Meeting, Boston
Callia WEP (1965) Contribuição ao estudo de correção cirúrgica do abdomen pêndulo e globus (contribution to the study of surgical correction of the pendulum abdomen and globus). original art. Doctoral Thesis Fac Med USP, São Paulo
Dellerud E (1990) Abdominoplasty combined with suction lipoplasty a study of complication, revisions, and risk factors in 487 cases. Ann Plast Surg 25(5):333–338
Erfon JA (2000) Ressecção da fascia abdominal inferior para plicatura infra umbilical em lipoabdominoplastia sem descolamento do panículo. 2° Curso de Abdominoplastia, Hospital do Coração – São Paulo – SP (resection of the lower abdominal fascia to improve plication of infraumbilical aponeurosis during lipoabdominoplasty without panniculus undermining) – 2nd course of abdominoplasty at the Heart Hospital, São Paulo
Flageul G, Elbaz JS, Karcenty B (1999) Complications of plastic surgery of the abdomen. Ann Chir Plast Esthet 44(4):497–505
Goldwyn RM (1986) Abdominoplasty as a combined procedure: added benefit or double trouble? Plast Reconstr Surg 78:383
Grazer FM, Goldwyn RM (1977) Abdominoplasty assessed by survey with emphasis on complications. Plast Recontr Surg 59(4):513–517
Guerrerosantos J, Spaillat L, Morales F, Dickeheet S (1980) Some problems and solutions in abdominoplasty. Aesthetic Plast Surg 4:227
Hetter TR et al (1989) Abdominoplasty combined with other major surgical procedures: safe or sorry? Plast Reconstr Surg 83:997–1004
Illouz YG (1980) Une nouvelle technique pour les lipodystrophies localisées. Rev Cir Esth Franc 6(9):Ap
Illouz YG (1982) Liposuction technique. First instructional course with surgical demonstrations at São Paulo Hospital, Prof. Andrews’ Service. Organized by Brazilian Society of Plastic Surgery – Regional São Paulo, Endorsed by Brazilian Society of Plastic Surgery (BSPS), October
Illouz YG (1984) Refinements in Liposuction to improve body contour. Theory and Practical Course with surgical demonstrations at “Nove de Julho” Hospital. Organized by Brazilian Society of Plastic Surgery (BSPS) with collaboration of Regional São Paulo, May
Leão CF (2000) Plicatura da parede músculo-aponeurótica por um tunel no abdômen superior na linha média em lipoabdominoplastia sem descolamento. 2° Curso de abdominoplastia, no Hospital do Coração, outubro – São Paulo (Plication of the musculoaponeurotic wall through a tunnel on the superior abdominal on the midline during lipoabdominoplasty without panniculus undermining). 2nd course of abdominoplasty at Heart Hospital (Hospital do Coração), São Paulo, October
Leão CF (2000b) Plicatura da parede músculo-aponeurótica por um tunel criado abaixo do panículo abdominal na linha média em lipoabdominoplastia sem descolamento. 37° Congresso Brasileiro de Cirurgia Plástica, novembro – Porto Alegre. (Reinforcement of the musculoaponeurotic wall through a tunnel created below the abdominal panniculus during lipoabdominoplasty). 37th Brazilian Congress of Plastic Surgery, Porto Alegre, November
Matarasso A (2000) Liposuction as an adjunct to full abdominoplasty revisted. Plast Reconstr Surg 106:1197–1206
Matarasso A, Swift RW, Rankin M (2006) Abdominoplasty and abdominal contour surgery: a national plastic surgery survey. Plast Reconstr Surg 117:1797–1808
Pitanguy I (1967) Abdominal lipectomy: an approach to it through an analysis of 300 consecutive cases. Plast Reconstr Surg 40(4):384–391
Pitanguy I (1986) Perspectivas filosóficas e psicossociais do contorno corporal. (philosophical and psychosocial perspectives of the body contour). In: Avelar JM, Illouz YG (eds) Lipoaspiração (liposuction). Editora Hipócrates, São Paulo, pp 3–7
Saldanha OR (2001) Lipoabdominoplasty without undermining. Aesthetic Surg J 21:518–526
Shestak KC (1999) Marriage of abdominal and liposuction expands abdominoplasty concept. Plast Reconstr Surg 3(103):l027
Uebel CO (1986) Autotransfusão e hemodiluição aplicada à lipoaspiração. (auto transfusion and hemodiluision employing in liposuction). In: Avelar JM, Illouz YG (eds) Lipoaspiração (liposuction). Editora Hipócrates, São Paulo, pp 123–126
Vernon S (1957) Umbilical trasplantation upward and abdominal contouring in lipectomy. Am J Surg 94:490–492
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Avelar, J.M. (2016). New Concepts in Abdominoplasty: Origin and Evolution. In: Avelar, J. (eds) New Concepts on Abdominoplasty and Further Applications. Springer, Cham. https://doi.org/10.1007/978-3-319-27851-3_1
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