Model Photo Pioneered by Brazilian surgeon Juarez M. Avelar in the 1990's, this procedure basically combines liposuction with excision of excess skin and fat. The difference between this method and the traditional abdominoplasty is the avoidance of separation of the flap of skin and fat from the underlying fascia. This allows the nerves, vessels, and lymphatics to remain intact within Scarpa's fascia. This minimizes loss of sensation, fluid collections, and low blood flow to the tissue. The dreaded complication of tummy tuck is necrosis or death of a portion of the skin of the abdominal wall, typically at the lower midline. This is the reason many surgeons will not offer this procedure to active smokers. Experience with the Avelar method has shown necrosis to be quite rare, even in smokers. This is attributed to the preservation of the blood supply to the tissue.The addition of liposuction in the Avelar method eliminates the excess fat from the abdominal flap which in turn releases the excess skin so that it can be pulled down and removed. The resulting scar is similar to traditional abdominoplasty. The belly button is moved if necessary. The result is a thinner abdomen with improved contour and tighter skin. Large aprons of fat (pannus) can be removed with this method as can stretch marks. If there is excessive laxity of the abdominal musculature leading to bulging of the abdomen, a muscular plication can be performed similar to the traditional method.The Avelar Abdominoplasty can be performed in the office setting with conscious sedation combined with tumescent anesthesia. This decreases the risks of anesthesia and brings the cost of the procedure down allowing more people to have access to a tummy tuck.R. Shane Palmer, M.D., medical director of Commonwealth Surgery Specialist, PC and Vein and Laser of Virginia, now offers this procedure in his offices. Dr. Palmer is a board certified surgeon with offices in Fredericksburg, Stafford, and Woodbridge Virginia. Dr. Palmer is one of the first in the Rappahannock River area to offer the Avelar Abdominoplasty. His offices can be reached at 1-866-963-7372.