The abdomen is the area of the body treated most often by liposuction. It is a high-priority area for both men and women. In terms of surgical anatomy, cosmetic results, patient comfort during and after liposuction, and potential complications, the abdomen is also one of the most challenging of all the areas treated by tumescent liposuction.
The clinical anatomic definition of abdomen is the body’s lower cavity, from the diaphragm downward, which contains the stomach, bowels, and other organs of nutrition; sometimes this includes the pelvic cavity. Abdomen may also refer to the belly’s outer surface.
Anatomic Considerations
Several ways to categorize abdominal fat are relevant to liposuction. For example, the surface anatomy of the abdominal wall can be subdivided into the following areas:
- Upper abdomen, or epigastric area
- Lower abdomen
- Periumbilical area
- Midabdomen, or waist area
The last area includes the periumbilical area and the area lateral to the umbilicus that overlaps the area between the upper and lower abdomen.
The gross anatomy of subcutaneous abdominal fat can be subdivided into volumes of adipose tissue, such as fascia of Camper (Camper’s fascia), sub-Scarpa’s fat, and periumbilical fat. Abdominal fat is either subcutaneous (located deep to skin and superficial to abdominal wall musculature) or visceral (located on the intestines and the omentum).
In very lean individuals the subcutaneous fascia is essentially a layered sheet of fibrous tissue containing minimal amounts of fat. With increasing adiposity, yellow fat begins to appear and accumulate within the lamellar connective tissue sheets of the fascia.
In some persons, visceral or omental fat may be relatively more voluminous than the subcutaneous fat. The proportion of visceral fat relative to subcutaneous fat tends to increase with age. This is an important distinction when evaluating a patient for possible abdominal liposuction. Even with substantial fat liposuctioned from an older woman’s abdomen, she may be dissatisfied with the results if she has a protuberant lower abdomen due to muscle laxity and visceral fat.
On the other hand, a “beer-bellied” male may have much more subcutaneous fat than suspected after an initial cursory examination. A taut abdomen, apparently of omental fat, may reveal significant subcutaneous lower abdominal fat when the patient is examined in a supine position with the back and hips slightly flexed.
The rectus abdominis muscles underlie the midabdominal fat. The anterior portion of the external oblique muscles underlies the lateral abdomen.