Operation Guide: Lipo-abdominoplasty Surgery


Dr Bernard Beldholm

Many people have loose skin on their tummy after weight loss or pregnancy. Perhaps your excess skin is not obvious when you lie down, but it is while standing. Some clothing styles may draw unwanted attention to skin folds, fat bulges or separated muscles on your abdomen.Many people have loose skin on their tummy after weight loss or pregnancy. Perhaps your excess skin is not obvious when you lie down, but it is while standing. Some clothing styles may draw unwanted attention to skin folds, fat bulges or separated muscles on your abdomen.

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Preparing for your Tummy Tuck Surgery

What is a Lipo-abdominoplasty?

A Lipo-abdominoplasty removes excess skin and fat on the abdomen. The type of abdominoplasty combines liposuction with an abdominoplasty. The liposuction that Dr Beldholm prefers is VASER liposuction. However, other liposuction types are also suitable for this type of operation.

How is it different from a normal tummy tuck?

Lipo-abdominoplasty improves your abdomen in four ways. Meanwhile, a standard tummy tuck only does two things: It removes excess tummy skin and tightens ab muscles. The liposuction-assisted abdominoplasty has the added benefit of fat removal with VASER liposuction. Unlike a standard tummy tuck, drains are not needed.

4 Benefits of a Lipo-abdominoplasty

1. It flattens your tummy

Skin tightening is often necessary after pregnancy or major weight loss. If you have excess skin on your abdomen and sides, Lipo-abdominoplasty can help. Doctor Bernard trims off the loose skin.

2. It gets rid of fat bulges

When loose skin is cut, fat comes along with it. However, this procedure goes a step further with VASER liposuction. Doctor Bernard melts fat and suctions it away using specialized equipment. The result is a slimmer midsection.

3. It defines your abdomen

Even if you don’t have a lot of belly fat, VASER liposuction is still beneficial. It improves your tummy tuck results by defining and contouring your abdomen better than a standard tummy tuck can.

4. It fixes abdominal muscle separation

Torn ab muscles are common in patients who were pregnant or overweight in the past. Exercise can help diastasis recti, but surgical repair is needed in some cases. Like most abdominoplasties, the procedure repairs separated abs.

Do I really need liposuction?

Not everyone has a lot of fat to remove. However, nearly all patients can benefit from VASER liposuction during the Lipo-abdominoplasty. This is true, even if you are slim. The VASER System does much more than remove fat.

Benefits of VASER liposuction

VASER liposuction is part of all Doctor Bernard’s tummy tucks. Keep reading to discover the reasons why!

It defines your abdominal contours

If you are slim, VASER can still help further define your abdomen. Doctor Bernard defines your muscle and curves during the Lipo-abdominoplasty. He shapes your sides and highlights your existing ab muscles. The result is a more defined tummy and waist.

It eliminates fat in your midsection.

If you have fat on your tummy and sides, VASER can help. This fat removal technology melts fat until it’s soft, like butter. Once the fat is liquified, Doctor Bernard can remove it with liposuction. VASER targets fat cells closer to the skin surface than traditional liposuction. That means it removes fat more effectively.

It makes skin removal easier and safer.

This is the most important reason to have VASER liposuction, regardless of the fat removed. During the operation, the VASER probe enters your skin and creates tiny holes in your abdominal tissue. That makes it easier for your surgeon to cut off the loose skin later. Less cutting is required. Therefore, VASER may lower the risk of side effects, such as Seroma.

VASER may lead to less bruising as compared to standard liposuction

VASER melts fat into a liquid form. That makes it easy to remove with suction. With the fat melted, low suction is all that is needed to remove it. Meanwhile, traditional liposuction requires your surgeon to break apart solid fat with an aggressive back-and-forth motion manually. VASER is gentler, in comparison. There is less tissue trauma. That means you may have less bruising and discomfort in recovery.

You may be able to avoid abdominoplasty drains.

With Lipo-abdominoplasty, you can enjoy a more comfortable recovery. You don’t have to worry about cleaning drains, measuring fluid output, or having your surgeon remove the drains after surgery.

Drains are small plastic tubes that pass through your skin. They help remove fluid buildup at the wound site. In a standard tummy tuck, the patient may have to wear drains for up to two weeks.

What happens during the operation?

Let’s talk about each step of the Lipo-abdominoplasty operation:

  • Pre-surgical appointment
  • Sterilization
  • Anaesthesia
  • Local anaesthesia
  • VASER fat melting
  • Fat removal
  • Tissue dissection
  • Epigastric tunnel
  • Abdominal muscle repair
  • Skin tightening
  • Belly button shaping
  • Closing the incision
  • Wound dressing
  • Compression garments

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How to perform Doctor Bernard’s Lipo-abdominoplasty

Step 1: Pre-surgical appointment

During your pre-op appointment, Doctor Bernard draws on your skin with a special maker. This helps him plan the incisions.

Skin markings are important for a great result. The goal is to ensure you have an even result on both sides once your loose tummy skin is tightened.

Your favourite swimwear and underwear styles are considered as Doctor Bernard plans your tummy tuck incision. When the scar heals, it is hidden so no one can see it.

Step 2: Sterilization

Before your operation begins, everything must be sterilized. A nurse applies Betadine prep to clean your skin before surgery. On the operating table, sterile drapes are placed above and below you to prevent contamination.

Step 3: Anaesthesia

To ensure total comfort during your operation, general anaesthesia is used. Anaesthesia is a cocktail of sedatives that make you feel sleepy. A nurse places a mask over your mouth to provide oxygen while you are asleep. A tube is inserted to help you breathe during the operation. This is known as intubation. Once you are fully sedated, the operation can begin.

Step 4: Lipo-abdominoplasty using VASER liposuction

Vaser liposuction is initially used to remove fat from the abdomen and sides. VASER liposuction targets fat close to your skin surface. In Doctor Bernard’s medical opinion, this allows for better fat removal the ordinary liposuction.

There are three steps to performing VASER liposuction.

Local anaesthetic

First, a wetting solution is applied. Doctor Bernard mixes lignocaine (lidocaine) with adrenaline. The liquid is infused into areas that you wish to reduce fat. The cannula is passed into your skin through tiny incisions. The pump disperses the fluid. The fluid must be applied evenly. This ensures a smooth, even liposuction result.

Fat melting

Next, he melts the fat with VASER technology. The VASER probe is passed through your skin. It vibrates at a high frequency to liquify the fat. This makes it easier to remove the fat. Liquid fat is easily removed with suction. It is much easier to remove than solid fat.

Sculpt Tummy Tuck Fat Melting

The VASER probe gets hot. Small ports are placed at the insertion points to protect your skin from heat damage. Doctor Bernard places the ports on areas of your abdomen where he will later remove excess skin. That way, there won’t be any scarring in the rare event of heat damage from the VASER probe.

Fat removal

Now that your fat is melted, Doctor Bernard focuses on defining your abdomen. He uses machine-assisted suction (also known as liposuction) to suck away the fat.

Sculpt Tummy Tuck Fat removal

Step 5: Tissue dissection

Once the fat is removed, it’s time to remove loose skin. Doctor Bernard makes a horizontal cut on your lower abdomen to accomplish this. Your abdominal tissue is lifted to reveal a white membrane known as the scarpa’s fascia. The VASER liposuction he did earlier makes it easy to locate the fascia.

Sculpt Tummy Tuck Tissue dissection

At this stage, Doctor Bernard lifts your skin up. He can see where the VASER probe has created lots of small tunnels in your tissue. Thanks to these small holes, he doesn’t have to do as much disection to separate your loose skin from the underlying tissue.

Step 6: Create the epigastric tunnel

If you have torn ab muscles due to past weight gain or pregnancy, Doctor Bernard can fix it with a Lipo-abdominoplasty.

Instead of dissecting the tissue all the way up to the ribs as is done in the standard abdominoplasty, Doctor Bernard dissects up to your belly button. Then, he creates a tunnel the rest of the way up to your ribs. This is known as the epigastric tunnel.

The tunnel allows him to see your rectus abdominal muscles. Ab muscles often become separated due to past weight gain or pregnancy. Now that Doctor Bernard can see the muscles, he can fix them.

Step 7: Abdominal muscle repair

Next, Doctor Bernard repairs your ab muscle separation. He carefully stitches the muscles together. This makes your ab muscles tighter. It reduces the gap or bulge you might have experienced due to past weight gain or pregnancy.

Step 8: Skin tightening and mons lift

Doctor Bernard turns his attention to removing and tightening your loose abdominal skin. He carefully measures how much skin to remove. He places the operating table on a slight tilt (approximately 15 degrees) to do this. To close the incision, he pulls your upper tummy skin down toward the lower tummy skin so they meet at the incision line. The excess skin is marked and cut off.

Sculpt Tummy Tuck Skin tightening and mons lift

There are special tools to measure and mark excess skin. However, Doctor Bernard finds more success with an old-school method. He attaches an allis forceps (surgical clamp) to your lower tummy skin. Next, he pulls your upper tummy skin down so it meets the lower tummy skin. He can feel the allis forceps beneath the upper tummy skin. This shows him how much loose skin to trim off.

Doctor Bernard draws markings on your skin. Any excess skin that hangs past the incision line is removed. Finally, your loose skin is gone!

Step 9: Belly button repositioning

Since your skin is pulled down tight, your belly button may need to be moved. Otherwise, it may sit too low on your abdomen. That would not be a good result. Moving it puts the belly button in a natural position.

Sculpt Tummy Tuck Belly button repositioning

Cutting the belly button (umbilicus)

Doctor Bernard cuts around your belly button to free it. Your belly button is not cut off. It is simply freed from the upper layer of skin. Your umbilical stalk remains intact.

Attaching a plastic piece to the belly button

He attaches a small piece of plastic to your navel with a 2/0 silk stitch. This is temporary. The plastic bit allows him to feel where your navel is located underneath the skin when he moves it later.

Moving the belly button

Doctor Bernard moves your belly button upward, to the new position. The goal is to move your belly button so it looks natural. Your navel is placed similar to where it was before you had surgery.

Create a new hole for the belly button

Doctor Bernard creates a new hole for your belly button. Doctor Bernard cuts a small oval, about 1.5 cm.

Moving the umbilical stalk

Your umbilical stalk is pulled through the hole. The plastic bit is removed. Now your belly button is in place.

Closing the belly button

He stitches your belly button in place using 2-0 PDS sutures.

He makes sure your new belly button looks good

Closing the belly button correctly is key to a great tummy tuck result. His goal is to create an oval belly button that has a small hood. This looks very natural.

Your belly button is an important structure. It makes all the difference cosmetically. It takes time to design your belly button. Doctor Bernard spends a significant amount of time shaping your belly button. He has perfected his techniques over the last 14 years.

Every belly button is unique. He shapes it to suit your body. Doctor Bernard has several techniques for different kinds of bodies. Usually, he makes a small triangular cut above the navel. This creates an oval belly button, not a circle. That flap of skin is inset into the belly button so the scar is hidden.

A belly button that is too round does not look natural.

Doctor Bernard has another trick to make your belly button look good. He removes a small cylinder of fat below your new belly button. That allows your belly button to dip inward naturally. The navel looks very natural this way.

Step 10: Closing the layers

With the excess skin gone, it’s time to close the incision. Doctor Bernard neatly stitches the incision closed in layers. This ensures a tight seal that holds up well over time.

It starts in the deepest layer of your abdomen.

Sculpt Tummy Tuck Closing the layers

Once that layer is done, Doctor Bernard uses V-Loc sutures (or Stratafix) to close the layers above. V-Loc is a type of absorbable suture. It lasts about three to six months before your body breaks it down. For the first few months of recovery, your skin really needs that extra support for proper healing.

Remember the scarpa’s fascia from earlier? This strong, tough membrane is ideal for stitches. It can withstand a lot of tension. Docor Bernard sews it together with plication sutures. He prefers to use a barbed suture, V-Loc 180. He also uses tissue glue.

Keeping the layers closed tightly with glue and stitches lowers the risk of seroma after a tummy tuck. With your abdominal cavity closed tightly, there is no room for fluid to buildup.

A Lipo-abdominoplasty does more than tighten abdominal skin. When the incision is closed, it helps to lift a saggy mons area, too. The mons pubis is a common trouble spot that is located above the pubic bone. It tends to get saggy due to age, a past pregnancy, or a history of obesity. The procedure makes your mons look more taut and youthful.

With the incision closed, you now have a flat, tight tummy and mons.

Step 11: Drains are not necessary

Standard tummy tucks require a patient to wear drains for up to two weeks. A Lipo-abdominoplasty does not use drains.

Step 12: Wound dressings with the PICO System

It’s important to keep the wound clean. Wound dressings protect your incision from contamination. Some surgeons use sterile bandages. Bandages stop germs from getting in and causing infection. They also provide a soft, cushioned layer to prevent abrasion from clothes as the wound heals.

However, Doctor Bernard finds that using PICO wound dressings are superior to ordinary bandages.

The PICO System is an advanced wound dressing. It does not just protect the wound from germs and irritation. It is battery-operated and creates gentle negative pressure on the wound as it heals. According to the manufacturer, it may also promote blood circulation to speed healing.

PICO’s advanced inner layer is made of super absorbent material with AIRLOCKTM technology. This helps to ward off bacteria and keep the wound dry. It is said to keep up to 99.9% of bacteria from reaching the wound.

The PICO negative pressure dressing is more complex than a basic bandage. It takes skill to apply correctly. It can be a little finicky to get it just right.

Doctor Bernard does not leave it to the nurses to apply the PICO bandage. Instead, he does it himself. It takes some time to get it right, but he feels the results are well worth it. After your surgery, you’ll wear the soft, comfortable PICO bandage for seven days.

Step 13: Compression garments

The final step of surgery is placing a compression garment on your tummy. Compression garments apply constant, gentle pressure to your skin in the first few weeks of recovery.

Wearing a garment helps keep the abdominal layers closed. It prevents gaps from forming between the tissue that was separated during your surgery. Reducing space between the layers helps to minimise swelling. It also lowers the risk of seroma, or fluid buildup, after surgery.

Doctor Bernard includes a soft, high-quality tummy tuck compression garment for free as part of your Lipo-abdominoplasty. It is placed on your skin while you are asleep on the operating table. After surgery, you’ll wake up in the recovery room wearing the garment.

Your Lipo-abdominoplasty is now complete.

Bernard Beldholm Logo


30 Belmore Rd
Lorn NSW 2320


This website contains adult content. You must be 18 years or over to read. All surgery carries risks. You should seek a second opinion before proceeding. Results vary from patient to patient. See our disclaimer.
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