Upper Abdominal Liposuction

Liposuction of upper abdominal fat is more challenging than that of lower abdominal fat because the upper abdomen is so fibrous. Compared with the easy skin retraction and smooth results routinely achieved for the lower abdomen, liposuction of the upper abdomen is more difficult, and the results may not be as smooth.

Excessive fibrousness often limits the thoroughness and smoothness that can be achieved by liposuction. With traditional liposuction using larger cannulas and only two or three incisions in the lower abdomen, upper abdominal liposuction was often incomplete.

Both weight loss and liposuction of the epigastric fat may produce rugosity or transverse pleats of the upper abdominal skin. This uneven appearance results from the following factors:

1. The removal of fat that once distended the overlying epigastric skin, along with incomplete dermal elastic contraction, results in fine wrinkles or dimpling.
2. The relative fibrousness of the upper abdominal fat is a result of a dense network of fibers and collagenous sheets that tether the skin to the deep muscle fascia. After weight loss or liposuction, these fibrous tethers remain. When the patient is standing upright, gravity stretches the upper abdominal tissue while the fibrous tethers pull the skin in the opposite direction and produce pleats. When the patient is supine, however, and the effects of gravity are mitigated, these folds or plications usually disappear.
3. Liposuction in the fibrous upper abdomen may predispose to uneven results. The visible effects of uneven liposuction will become more prominent with subsequent weight gain, with focal areas of excess residual fat becoming more noticeable than adjacent areas.

In most patients of average weight, only three to five 1.5-mm adits or microincisions are needed in the upper abdomen to fenestrate the fibrous subcutaneous fat with tunnels created by 16-gauge and 14-gauge microcannulas. Subsequently, most of the upper abdominal liposuction can be accomplished with 14-gauge and 12-gauge microcannulas from very few 2-mm adits.

Another explanation exists for the smoother results of liposuction of the lower abdomen compared with the upper abdomen. As a result of Scarpa’s fascia, direct fibrous connections may not exist between skin and muscle fasciae in the lower abdomen. Thus Scarpa’s fascia may cushion or mitigate the tethering effects of fibrous tissue attachments to the dermis.