Suprabubic liposuction

What is suprapubic liposuction?

Suprapubic liposuction is performed or recommended when the tissue above the penis is rich in adipose tissue. There are some patients who are bothered by this aspect and want to improve the appearance of this area. I usually associate suprapubic liposuction with procedures such as penis thickening or other lipofilling in other regions, or with complete abdominal liposuction. I do not like to associate it with dorsal elongation in the same intervention due to the increased risks that I will detail in the sections below.

Ideal candidates

Suprapubic liposuction is indicated when there is a moderate or severe lipomatosis of this area and in which the procedure itself will leave a good or very good result.

The ideal candidates are patients who are in good health, without acute or chronic decompensated infections, without chronic treatments such as anticoagulants, antiplatelets, immunosuppressants, chemotherapeutics, antipsychotics, antidepressants, no signs of cellulite, lymphadenitis or folliculitis of the suprapubic area. , chronically decompensated without diabetes (diabetes, hypertension, kidney failure, liver disease, etc.).

As with any type of liposuction in another area, the very important local condition is that the skin has a very good quality so that its possibility of retraction is optimal.

Patients with loose skin, with ptosis or in moderate or severe excess are not ideal candidates, as they will also need puboplasty.

Before suprapubic liposuction

As with any other procedure, even if we are talking about a restricted area and the technique itself seems quite simple, proper training is required.

Patients know that I recommend removing the hair by epilation with a fresh blade, clipper or cream, 2 days before, both on the suprapubic area and on the upper thighs. I want the upper thighs to be epilated as well because the adhesive tapes they use to compress the suprapubic area and the absorbent compresses will reach the thigh area and when they are removed, the patient will feel considerable discomfort.
Before the suprapubic liposuction procedure, the patient must understand the implications that will be needed after this. This means wearing a special corset that will compress the suprapubic area, the dressings that need to be changed and the postoperative edema of the area that will tampon in the coming weeks.

Suprapubic liposuction requires a set of blood tests, and if it is associated with thickening of the penis or circumcision, I also recommend a brief examination of urine and urine culture.

Suprapubic liposuction

The suprapubic liposuction procedure is practically a liposuction, only being performed on this area, it has some special considerations.
As with any type of liposuction, the first stage of the procedure is the infiltration of the modified Klein solution, and access will be through 2 holes, created either in the groin folds or immediately below the antero-superior iliac spines, to be hidden by underwear. . If in the past, after the infiltration of the Klein solution, we waited for about 20 minutes, the Safe-lipo technique that I have been practicing for many years, supposes that the second stage is the separation of the fat. I separate the fat with a special cannula, of the “basket” type, which has the role of preparing the fatty tissue very efficiently and then when I move to the 3rd stage which involves the aspiration of fat, it has already been quite well emulsified and infiltrated. to be harvested easily and with low risk of indentations and contour regularities. After the fat is aspirated, I go to remodel the area, for which I use the “basket” type cannula again to make sure that the fatty tissue that will remain immediately under the skin does not show sublevels and asymmetries and when felt everything feels regular.

What I would like to mention here at this level is the plan in which liposuction should be performed. At first glance, both the doctor and especially the patient tend to believe that the fat layer is high. This can often be the case, but in fact, the layer of fat that is felt on palpation is not that big. By that I mean that here in this area under the deep layer of fat, on the sides, the spermatic fungi that are wrapped in a cord of fat cross. These structures must be protected at all costs. Even if there was a tendency to think that after an aggressive liposuction, there would still be something consistent underneath, in fact there are the spermatic funnels. Therefore, liposuction here must be performed by an experienced plastic surgeon who knows how to control the plans and can tell the difference between the deep fat layer, the superficial ones and the spermatic cord.

The fat on the suprapubic area is usually quite raw and I do not choose to use it for lipofilling procedures.

At the end I will insert on the 2 holes that I place in the supero-lateral portion of the region (under the antero-superior iliac spines) 2 drainage tubes that will intersect inside and that together with the compression that I will make with a cut sponge exactly according to the size of the patient associated with the elastic corset, they will eliminate the last remaining liquid residues, in the first 24-48 hours after the procedure.

After suprapubic liposuction

As with any type of liposuction, it is necessary to use and wear a special compression corset that has the role of reducing edema and helps to reposition and retract the skin.
I recommend that it be worn for 3 to 12 weeks, depending on the degree of retraction that the skin should or should have, to get the desired result.

A rather important feature must be mentioned in this region: the suprapubic area is the most sloping region of the trunk, so after liposuction it is absolutely normal and it is expected that the fluid that accumulates subcutaneously due to infiltration and the remaining amount after liposuction, to produce a edema, sometimes even prolonged for a period of 1-3 months. The second day after the procedure I remove the drainage tubes and the area looks completely flat, but I will leave the holes open just to make it easier for the liquid to continue to drain if necessary, even in the next few days and weeks. Although I would advise patients to massage with specific movements and try to keep the holes through which I performed the liposuction open and use that sponge and compression corset, orthopnea position (with the torso bent over the thighs like the standing position at the table, office or car) and orthostatic position (standing) will cause the edema in the suprapubic region to reappear and become scary in some cases. I explain to patients that sometimes the area can swell so much that they think it will be more swollen than it was before the procedure, but I reassure them that there is no need to worry because it will go away on its own in the next few days. weeks. I recommend all patients who have had a suprapubic liposuction procedure to have a period of at least 7-10 days in which to stay as long as possible and not to make any effort, during this time massaging through specific movements that I indicate them at the time of discharge. Because this area is generally quite small in area, I do not usually recommend body reshaping sessions by radiofrequency, vacuum, cavity or Vela-Shape, but there may be situations where the patient’s skin does not have very good elasticity and we try to We help her with these non-surgical therapies in the retraction process that will occur during the first postoperative year.

There are situations in which patients have a substantial lipomatosis, but also a moderate or severe excess of skin (due to age or weight loss processes) and thus require in addition to suprapubic liposuction and puboplasty, or pubic facelift. This procedure involves removing the remaining excess skin that will not have a good shrinkage capacity due to the loss of elastic fibers and collagen in the dermis. Excess skin that will be removed will cause a facelift of the area itself and the base of the penis, correcting the skin that overflows over the penis and produces an unsightly appearance.

Complications

Suprapubic liposuction can cause exactly the same complications as any other type of liposuction, but the most important are related to the appearance of hematomas (excess blood accumulated subcutaneously), seromas (excess accumulated lymph), infection, prolonged chronic pain, spermatic cord injuries , skin lesions and others. All these mentioned, can be controlled and avoided very easily if the procedure is performed by an experienced surgeon.

In addition to these of a general nature, it is necessary to mention the specific ones, and of these, the most important possible complication is the one related to the irregularities and the contour deformities. In order to avoid it, it is necessary for the doctor to know how to control the plans, so as to remove the fat only from the medium and deep compartment for the most part and to a small extent from the superficial compartment and also to know how to make an effective liposculpture for that any indentation or deformity of the skin does not exist.

Price for suprapubic liposuction

Suprapubic liposuction starts at a cost of 500 euros for a standard procedure, but after the consultation I will determine if the patient falls for this cost or it may be higher due to the need for puboplasty or lifting the pubis.