A Better Way to Correct Lax Muscles After Cutting Flab

Doctor suggests tummy tucks with better contouring, blood supply of skin flap and nerve sensibility.

Noted as one of the top 10 fattest nations in the world, the UAE is breeding a generation of overweight, under-exercised people. The country’s waistline continues to expand — 2012 figures from the Health Authority – Abu Dhabi show that 36 per cent of the local population is classed as obese with the expatriate community not far behind at 20 per cent.

However, solutions are being set in place to promote healthy diets and reduce levels of obesity worldwide. At a recent United Nations nutrition conference, more than 170 governments pledged to invest more in nutrition programmes.

But what happens once people shed the weight? Excess skin and poor muscle laxity leave many fighting yet another battle after slimming down, with many resorting to surgery, most commonly, classical abdominoplasty (CABP).

Classical Abdominoplasty (CABP)

Also referred to as the “tummy tuck,” this procedure corrects the muscle and tissue laxity produced by pregnancy or large weight loss.

How it works:

• Skin is cut at the lower abdominal crease.
• The entire abdominal skin with fat is lifted off the muscles till the rib cage.
• The muscles are then tightened, and the flap of skin is pulled down.
• Excess skin is removed, and the rest is re-attached to the lower skin edge.
• Drains are left to remove fluid from beneath this vast canopy.

Though widely used, CABP is plagued by complication rates. Figures show that post-surgery complications have been reported in as high as 15 to 25 per cent of cases.

Lipoabdominoplasty (LABP) – The Alternative

Now, some UAE experts are advising patients to opt for the safer alternative, lipoabdominoplasty (LABP).

How it works:

• Liposuction is carried out first.
• The skin cut is given only after the lipo. Since adrenaline and local anesthetic have been used for the lipo, when skin is cut there is hardly any bleeding.
• The skin is lifted off only till the navel. Beyond that level, only a pocket is elevated in the midline to access and tighten the muscles.
• The skin is then pulled down progressively, dividing connections only if absolutely necessary.
• The removal of fat allows the skin to slide down while still keeping its attachments for blood supply.

Dr Rangaswamy’s Approach

As a surgeon independently practising LABP since 1995, Dr Mohan Rangaswamy has seen complication rates brought down to five per cent.

Though strong directives from classical abdominoplasty experts previously claimed that liposuction done simultaneously increased patient risk, Dr Rangaswamy argues that LABP is not “classical abdominoplasty plus liposuction,” but an entirely different procedure.

“In the LABP, the technique of abdominoplasty itself has been changed considerably with the result that the combination is not only safe but actually safer than the classical technique.”

Global Development of LABP

Dr Rangaswamy says he developed the procedure in Oman out of necessity due to a high number of obese patients seeking tummy tucks. He later became aware of similar work in Kuwait and France. Important contributions also came from:

• Dr Jean Fracois Pascal (France)
• Dr Saldanha (Brazil)
• Dr Lari (Kuwait)

Now an accepted technique, important studies from Brazil and France attest to the safety and efficacy of LABP.

“Anything new takes some convincing and in general newer procedures invented elsewhere are adopted by the USA rather late,” he says, adding that courses on LABP were held in the US only in the past 6 to 8 years.

Benefits of LABP

According to Dr Rangaswamy, LABP offers:

• Better contouring
• Better blood supply of the skin flap
• Better nerve sensibility
• Fewer complications
• In many cases, no need to use drains (unlike CABP)

Recovery and Cost

Recovery time:

• LABP patients (without drains) can recover within a week.
• CABP recovery can take several weeks due to swelling, numbness, and hardness of remaining fat. Complications can prolong recovery further.

Costs:

• LABP costs between Dh35,000 and Dh55,000 depending on the work needed.
• Being a “2-in-1” procedure, LABP is more economical than doing CABP first and liposuction later.

Ideal Candidates

Dr Rangaswamy notes that the ideal candidate is:

• Overweight or obese in the abdominal area, but not internally obese.
• In good health.
• For women, those who have completed their child-bearing phase.

Final Note on Lifestyle

Dr Rangaswamy stresses that the availability of surgeries like LABP does not mean people should abandon an active lifestyle.

“This is not to say that exercise and dieting are not needed; on the contrary, everyone should aim for a healthy lifestyle and healthy body weight.”