Body contouring surgery at Sheikh Khalifa Medical City

What the combination can include

Breast: where the breast has lost volume or descended, a mastopexy restores position, and an implant or fat transfer restores volume. Which applies is assessed on the breast itself, and is set out on the page for breast aesthetic surgery.

Abdomen: abdominoplasty removes the excess skin and repairs the diastasis. This is usually the central component.

Flanks and other areas: liposuction addresses localised fat deposits that remain after weight has stabilised.

Diastasis recti

A protruding abdomen after pregnancy is frequently muscle separation rather than fat. During pregnancy the connective tissue between the rectus abdominis muscles stretches apart, and abdominal exercise does not bring them back together. The repair uses non-absorbable internal sutures to bring the muscles back to the midline, which flattens the abdominal wall and restores tension to the core.

This is a repair of the abdominal wall. It has a functional component, and it is assessed as such.

One anaesthetic, one recovery

Combining the procedures means one anaesthetic and one recovery period rather than several. Dr Colson limits the operating time according to the patient’s general health, and the extent of the combination is decided on that basis.

Enhanced Recovery After Surgery protocols are used, including long-acting local anaesthetic and early lymphatic drainage.

Risks, expected course and what should prompt a call

Beyond the general risks, this combination carries the risks of each component. For the abdominal repair: fluid collection under the skin, areas of altered sensation on the abdominal wall, and healing difficulty at the incision, which is longer here than in an isolated procedure. Combining procedures lengthens the operating time, and operating time is itself a factor in thrombotic and anaesthetic risk.

The expected course is tightness of the abdominal wall rather than sharp pain, swelling that settles over weeks, and walking slightly bent for the first days to protect the muscle repair. Initial recovery before returning to light desk work is two to three weeks.

Contact the department without waiting for the next appointment in case of: fever, a calf that becomes painful or swollen, shortness of breath, sudden increase in swelling or pain on one side, discharge from the incision, or a wound edge that separates.

Ultrasound-assisted lipoplasty (VASER)

Ultrasound-assisted lipoplasty, marketed as VASER, uses ultrasonic energy to emulsify fat selectively before it is aspirated. The technique acts on adipose tissue while sparing blood vessels, nerves and connective tissue, which allows work closer to the skin surface than conventional aspiration.

Because the fat cells remain viable, fat harvested this way can be reinjected where a transfer is part of the plan.

Skin tightening after aspiration

Removing fat can leave the overlying skin loose. A subcutaneous skin-tightening device, which combines a plasma with radiofrequency energy, may be applied through a small cannula immediately after the aspiration. The energy acts on the connective septa within the skin and produces contraction of that tissue.

The degree of contraction depends on the quality and elasticity of the skin, and it is limited. Where the skin excess is substantial, aspiration and tightening are not sufficient and excision is the appropriate operation. Skin continues to age afterwards, and weight stability affects how the result holds.

Areas treated

Abdomen, including definition along the midline. Chest in men, including the correction of gynaecomastia. Arms, at the deltoid and triceps. Back, including the fat rolls at the level of the bra strap.

Who the procedure suits

The assessment looks for a patient near a stable weight, with a body mass index generally under 30, whose fat deposits are localised. Significant visceral fat is not accessible to liposuction, since the fat sits inside the abdominal cavity and not under the skin. Marked skin laxity points towards abdominoplasty instead.

Risks, expected course and what should prompt a call

Beyond the general risks: contour irregularity, asymmetry between the two sides, adherence of the skin where the superficial layer has been treated, prolonged swelling, areas of altered or reduced sensation, and pigmentation change at the cannula entry points. Superficial work raises the risk of irregularity and of skin injury, which is why it is reserved for suitable skin. Where a tightening device is used, thermal injury to the skin is a specific risk of that step.

The expected course is bruising, swelling and drainage from the entry points in the first days, followed by a compression garment. The contour is not settled at the end of the operation: it evolves over months as the swelling resolves.

Contact the department in case of fever, an area of skin that becomes painful, hard and red, a burn or blister at an entry point, a calf that becomes painful or swollen, or shortness of breath.

Repair of the muscle wall

The rectus abdominis muscles can separate along the midline, producing a bulge that persists in a patient who is otherwise thin. The muscles are sutured back to the midline with non-absorbable sutures, which closes the gap, restores tension to the abdominal wall and reduces the circumference of the waist as a consequence of that closure.

Skin removal and contour

Once the muscle layer is secured, the excess skin and the fat attached to it are removed. Liposuction of the flanks is frequently carried out in the same operation, so that the transition between the treated abdomen and the untreated flank is continuous rather than abrupt.

The umbilicus

The navel is not removed during a full abdominoplasty: it stays attached to the abdominal wall while the skin around it is moved, and it is brought out through a new opening. Its shape and the position of the surrounding scar determine whether the abdomen reads as operated or not.

Full or mini abdominoplasty

A full abdominoplasty addresses the abdomen above and below the navel, and is the operation used after pregnancy or major weight loss. A mini abdominoplasty addresses only the area below the navel, and applies where the skin excess is limited to that area and there is no separation of the upper abdominal muscles. The examination determines which applies.

The incision

The incision is placed low on the pubis and extends between the two hips. Its length is proportional to the amount of skin removed. It is a long scar, it is placed so that it sits below the line of underwear, and it remains visible.

Risks, expected course and what should prompt a call

Beyond the general risks: collection of fluid under the flap, which is the most frequent specific complication of this operation and may require drainage; healing difficulty at the incision, particularly at its centre; necrosis of the edge of the flap, whose risk is markedly raised by smoking; areas of reduced or absent sensation on the lower abdomen, which may persist; asymmetry of the navel; and a scar that widens or thickens. Venous thromboembolism deserves particular attention here, because the muscle repair raises intra-abdominal pressure.

The expected course is a sensation of tightness rather than sharp pain, walking slightly bent for the first days, drains in place at the start, and a compression garment. A future pregnancy will stretch the repair again, which is why the operation is generally deferred until the patient does not plan a further pregnancy.

Contact the department in case of fever, a calf that becomes painful or swollen, shortness of breath, an area of the flap that turns dark or cold, discharge from the incision, or a sudden increase in swelling.

The technique

Piezoelectric ultrasonic instruments are used to work on the bone. A controlled incomplete fracture, of the type described as a greenstick fracture, is created in the eleventh and twelfth ribs. The bone is thereby made pliable without being divided, and is then repositioned closer to the spine.

The ribs are not removed. They remain in place, in continuity, and continue to perform their protective role.

The corset

A custom corset is worn for six to eight weeks after the operation. It holds the ribs in their new position while the bone consolidates, and it is the determining element of the result. The position obtained is not maintained without it.

What the procedure does not do

It does not remove fat and does not act on the skin. It does not correct a separation of the abdominal muscles. It does not reduce weight. Where the objective involves skin or fat as well, the corresponding operation is a separate one, and rib remodeling is sometimes carried out in the same session as an abdominoplasty or a liposuction.

Risks, expected course and what should prompt a call

Beyond the general risks, this operation is carried out close to the pleura, and the risks specific to it follow from that: injury to the pleura and pneumothorax, injury to an intercostal nerve with pain or altered sensation along the path of the nerve, pain that persists beyond the usual healing period, incomplete or asymmetric consolidation of the bone, displacement of the position obtained, and the possibility of a further operation.

The expected course includes limitation of deep breathing and of trunk movement during consolidation, and the continuous wearing of the corset. Return to desk work is around one week, and to light physical activity around four weeks.

Contact the department without delay in case of shortness of breath, chest pain on breathing, fever, or pain that increases instead of decreasing.

Lower body: belt lipectomy

A standard abdominoplasty is frequently insufficient after a large weight loss, because the excess skin continues around the flanks and the back. The belt lipectomy, also called a 360 body lift, removes a circumferential strip of skin and fat around the whole midsection. It repairs the abdominal wall, lifts the buttocks and produces a limited lift of the outer thighs.

Arms: brachioplasty

Excess skin on the upper arm is removed between the axilla and the elbow. The incision is placed on the inner or the posterior aspect of the arm. The scar is long and it is a direct consequence of the amount of skin removed.

Thighs: medial thighplasty

Excess skin on the inner thigh causes friction between the two sides, which can make walking painful and provoke maceration. The excess skin and the fat attached to it are removed from the upper inner thigh. The indication here is frequently functional.

Timing and staging

Weight must be stable for at least six months. Operating during ongoing weight loss exposes the patient to a recurrence of the skin excess. Nutritional status is assessed beforehand, since deficiencies are common after bariatric surgery and they affect healing.

These operations are long and extensive. Dr Colson frequently stages them, for example the belt lipectomy first and the arms and thighs three to six months later, which limits the operating time of each session.

Risks, expected course and what should prompt a call

Beyond the general risks, this surgery carries a higher rate of local complications than the same operations in a patient who has not lost a large amount of weight: collection of fluid, which is frequent after a circumferential excision; separation of the wound edges, particularly where the tension is greatest and at the junction points of the incisions; healing difficulty related to nutritional deficiency; and scars that widen. The extent of the excision and the length of the operation raise the thrombotic risk, and the risk of hypothermia and of blood loss during the operation.

The expected course involves drains, a compression garment, restricted movement in the first weeks, and scars that continue to change in appearance over twelve to eighteen months. The scars are long and they are visible.

Contact the department in case of fever, a wound edge that separates, discharge from an incision, a calf that becomes painful or swollen, or shortness of breath.