Many of you follow me because of the wide awake surgeries that I described and chronicle on this YouTube channel. I typically reserve videography for wide-awake procedures, but as you know, more than half the operations I perform are asleep. Why do I perform operations asleep? There are 3 main categories of the operations that, in my opinion, require asleep surgery. These are 1) cases that involve permanent prostheses or implants, 2) cases involving muscles such as abdominal wall tightening, and 3) most cases involving the nose (rhinoplasty) so as to protect the airway. I also prefer to perform facelifts and lower eyelid surgery asleep, but certainly make exceptions.
Abdominoplasty, which traditionally involves removal of skin, repositioning of the belly button, and tightening of the six-pack muscles, is one operation that cannot be beat for most patients seeking abdominal wall improvement. However, as minimally invasive surgical technologies become more sophisticated, and plastic surgeons become comfortable performing awake surgeries, we are slowly but surely bridging the gap. Today I present one case that comes as close to bridging the gap as I have done. In this case, I am combining mini abdominoplasty, but for the full length of the lower abdomen, with radiofrequency assisted lipolysis (RFAL, BodyTite) and power assisted liposuction. This operation is designed to address extra skin in the lower abdomen with direct excision, revision of an unsightly C-section scar that casts an unsightly shadow, with radiofrequency based skin tightening of the upper abdomen and flanks. In addition, when the patient heals, we may address the laxity of the abdominal wall with a device called EVOLVE. Evolve is a multi-modality tool that can further enhance skin tightening, reduce or remodel subcutaneous fat, and even tighten the abdominal wall muscles. This utilizes electromagnetic stimulation to make the muscles twitch, almost as though you are doing tens of thousands of crunches in the comfort of our office. This operation was performed fairly recently; two-week results are shown. Please be sure to subscribe to our YouTube channel and follow us on Instagram @zelkeninstitute.