Detailed Explanation of Abdominal Fat Removal Procedure: A Surgical Weight Loss Plan from Anesthesia to Suturing

Skin and Fat Removal Surgery:

When excessive fat accumulates in areas such as the abdomen, buttocks, inner and outer thighs, and inner upper arms, causing localized skin and fat laxity, skin and fat removal surgery or a combination of liposuction and skin and fat removal can be considered for weight loss treatment. By removing the loose skin and fat, or simultaneously tightening deep fascia tissue, the excessive bulging in the affected area can be corrected, and the inconvenience caused by obesity in daily life and work can be alleviated.

Anesthesia: The anesthesia method is selected based on the patient's age, physical condition, and any comorbidities related to obesity. Epidural anesthesia and endotracheal anesthesia are commonly used. Local anesthesia may also be used for very small surgeries.

Surgical Method:
1. Incision Design: An ideal incision should be able to fully remove excess skin and fat tissue, resulting in better cosmetic improvement, minimal trauma, and a concealed incision. The low-lying "W"-shaped incision basically meets the above requirements. This surgery can remove a large amount of skin and fat tissue below the navel. The incision is within the area of ​​a brief, and through folded sutures of the rectus abdominis sheaths and external oblique muscle tendons on both sides, it can significantly improve the shape of the waist and is currently the most commonly used method.

2. Surgical Procedure: Incise the skin and subcutaneous tissue along the incision marks to the deep fascia, taking care to avoid damaging the large blood vessels in the groin. Use an electrocautery knife to perform extensive subcutaneous dissection along the superficial layer of the deep fascia to the navel. Using the umbilical ligament as a pedicle, make a circular incision around the navel in the skin and subcutaneous tissue, leaving the navel on the abdominal wall. Continue to dissect the skin flap upwards to the costal margin. Dissect both sides to the anterior axillary line.

If there is rectus abdominis diastasis or weak muscle strength, the anterior rectus abdominis sheath should be reinforced with a figure-eight suture to bring the rectus abdominis muscles together. If there is still laxity in the abdominal wall longitudinally or transversely, the external oblique muscle tendon should be sutured longitudinally or transversely in a mattress suture, which can significantly improve the laxity of the abdominal wall. Some scholars also lift the peritoneum of the external oblique muscles on both sides and reinforce the sutures below the umbilicus.

Adjust the operating table so that the trunk and lower limbs are flexed at 150 degrees. Pull the skin flap downwards, incise along the midline to the appropriate position, and fix and suture it to the lower end. Pull the abdominal wall skin flaps on both sides outwards and downwards to determine and remove the amount of skin and fat. During removal, be careful to retain an appropriate amount of subcutaneous fat to prevent necrosis of the skin edges.

Make a longitudinal incision of 1-1.5 cm at the umbilicus location to expose the umbilicus. Thin the subcutaneous fat around the incision, and suture the fascia, subcutaneous tissue, and skin separately.

If the subcutaneous fat of the abdominal wall is thick, liposuction can be combined for abdominoplasty. Use a suction cannula with a diameter of approximately 3.0 mm to aspirate the fat from the abdominal skin flap through the umbilical incision.

Suturing the low incision in three layers: deep fascia, subcutaneous fat, and skin. Insert negative pressure suction cannulas from both ends of the incision. Place a thick gauze bandage on the abdomen. Secure with external tape and an elastic waistband.