Abdominal Contour Surgery Research Articles

D6. Accidental Drain Dislodgement Is Associated With Post-operative Complications after Abdominal Contouring Surgery

D6. Accidental Drain Dislodgement Is Associated With Post-operative Complications after Abdominal Contouring Surgery

Standards and Trends in Lipoabdominoplasty.

Background:Lipoabdominoplasty has evolved over the last 6 decades through contributions from numerous luminaries in plastic and reconstructive surgery.Methods:The authors review historical perspective and provide a contemporary examination of trends in lipoabdominoplasty.Results:In 1967, Pitanguy popularized abdominoplasty (without liposuction) as a technique for augmenting ventral hernias repairs and subsequently for aesthetic improvement of the abdomen. After the introduction of suction assisted lipectomy by Illouz in 1983, abdominoplasty became a central tool in a diverse armamentarium of anterior and lateral abdominal wall contouring procedures. Liposuction was initially utilized with mini-abdominoplasty in order to improve contour. Subsequently, Matarasso advanced the safe combination of liposuction with full abdominoplasty. Additionally, he systematized the variety of cutaneous undermining, excision, and liposuction procedures utilized in abdominal contouring as indicated by the degree of skin laxity and musculofascial diastasis. Lockwood advocated high lateral tension closure of the superficial fascial system of the abdomen to improve the contour of the hips and flanks. Saldanha advanced selective undermining and anterior abdominal wall perforator preservation to minimize wound healing and seroma complications associated with lipoabdominoplasty procedures.Conclusion:In abdominal contour surgery, surgeons can rely on classic techniques and algorithms that have withstood the test of time while modifying their approaches with advances backed by compelling and rigorously obtained evidence.

Risk Factors for Undergoing Elective Abdominal Contouring Surgery Shortly After Hospitalization

BackgroundHaving posthospital syndrome (PHS) at the time of an elective surgery increases the risk of postoperative adverse outcomes. The purpose of this article was to identify incidence and risk factors for having PHS at the time of abdominal contouring surgeries. MethodsInsurance claims from the Truven MarketScan Databases were used to identify patients who underwent outpatient abdominoplasty, liposuction, or panniculectomy between April 2010 and August 2015. Patients were presumed to have PHS if they were hospitalized within 90 d before surgery. Incidence rates of having PHS were calculated for patient groups defined by demographic data and comorbidities. Statistical inference based on adjusted odds ratios was used to evaluate the association of potential risk factors with PHS. A nonparametric regression method was used to demonstrate nonlinear effects of patient covariates on the risk of PHS. ResultsThis study included 18,947 patients who underwent abdominal contouring; 77% were female, and the mean age was 48.7 y (SD = 14.7). Six percent (n = 1045) of patients had PHS at the time of surgery. A significantly stronger association with PHS (P < 0.001) was observed in patients with deep venous thrombosis (adjusted odds ratio = 3.56), Elixhauser score > 8 (3.28), and smokers (2.16). Age was found to have a piecewise linear effect on PHS, with odds increasing by 2.1% per year over the age of 45 y. ConclusionsOlder patients have an increased risk of undergoing abdominal contouring surgery in a deconditioned state. Screening at-risk populations for PHS would help identify patients who need rehabilitation before operative intervention.

Effect of Posthospital Syndrome on Health Care Utilization After Abdominal Contouring Surgery.

Posthospital syndrome (PHS) is a transient condition after acute hospitalizations when patients are physiologically deconditioned. The objective of this study was to determine if having PHS at the time of abdominal contouring surgery increased the incidence of postoperative adverse medical events. We conducted a retrospective cohort study of patients enrolled in the MarketScan Databases who underwent outpatient functional or cosmetic abdominal contouring surgery (ie, abdominoplasty, liposuction, or panniculectomy) from April 2010 to August 2015. Patients were separated into 2 groups based upon PHS exposure, defined by hospitalization within 90 days before surgery. Differential health care utilization within 30 days after surgery was compared between cohorts. Among the 18,947 patients included in the final cohort, 1045 patients (6%) had PHS at the time of abdominal contouring surgery. Patients with PHS experienced more emergency department visits (0.16 vs 0.08 visits; adjusted odds ratio, 1.60; P < 0.001) and more episodes of hospitalization (0.11 vs 0.04 episodes; adjusted odds ratio, 1.70; P < 0.001) within 30 days postoperatively. The mean unadjusted health care utilization after abdominal contouring surgery for patients with PHS was US $7888 (SD, 17,659) versus US $2943 (SD, 9096) in patients without PHS. After controlling for confounders, such as comorbidity burden, PHS was associated with US $3944 greater cost than patients without PHS (P < 0.001). Among patients undergoing outpatient abdominal contouring surgery, having PHS increased the incidence of adverse medical events requiring medical attention in the 30-day postoperative period. These findings support the inclusion of PHS in preoperative evaluation and preparation for patients seeking abdominal contouring surgery.

Abstract: Hip Asymmetry: Implications in Abdominal Contour Surgery

INTRODUCTION: Asymmetry is a known phenomenon in the human body and has been analyzed in multiple areas including the face, breasts, and trunk.1–3 Nonetheless, asymmetry of the hips and its implication in body contouring procedures has not yet been reported. Hip asymmetry is common in the general population4 and may account for uneven abdominoplasty scar and the apparent discrepancies in volume following liposuction of the hips and flanks. The ASIS or iliac crests are often used as landmarks for incision and umbilicus placement. It is crucial to analyze the area preoperatively for proper operative planning and discuss the presence of asymmetry with patients. The goal of this study was to determine the presence of hip asymmetry in healthy females presenting for abdominal contour surgery. METHODS: Analysis of preoperative standardized photographs of 100 healthy female patients presenting for abdominoplasty was performed by three independent plastic surgeons. They were asked to evaluate for hip asymmetry, and when present, determined which side was higher. Adobe Photoshop CS2 was also used to objectively measure hip asymmetry. Patient demographics were collected. Patients were females with no known history of hip abnormalities. Age range 17–64 (average 43.6). BMI 16–47 (average 23.6). RESULTS: At least 2 plastic surgeons found asymmetries in 90% of patients. The surgeons noted discrepancies in hip height in 93%, 82% and 63% of patients, averaging 79%. The objective data showed that 93% of patients have hip asymmetry, and the left hip was higher in the majority of patients, 58%. CONCLUSION: The results showed that the majority of patients who present for abdominal contour surgery have asymmetric hips. Patients are usually unaware of the unevenness of their own hips, however, they often notice postoperative discrepancies in scar height after abdominoplasty or volume differences after liposuction. Hip asymmetry has become apparent to the senior author, and as a result he utilizes photographic grids as a tool to help identify asymmetries during the preoperative consultation. In the operating room, a crisscross suture technique is used to determine ideal scar placement.5 Evaluation of preoperative asymmetries is a critical part of the consultation and should be adopted by plastic surgeons performing abdominal contour surgeries. Detailed hip analysis aids in the management of patient expectations, helps with umbilicus/scar placement and mitigates medical-legal issues. Reference Citations: 1. Rohrich RJ, Hartley W, Brown S. Incidence of breast and chest wall asymmetry in breast augmentation: a retrospective analysis of 100 patients. Plast Reconstr Surg. 2003 Apr 1;111(4):1513–9; 2. Aston SJ, Smith DM. Taking it on the chin: recognizing and accounting for lower face asymmetry in chin augmentation and genioplasty. Plast Reconstr Surg. 2015 Jun;135(6):1591–5. 3. Rohrich RJ, Sorokin ES, Brown SA, Gibby DL. Is the umbilicus truly midline? Clinical and medicolegal implications. Plast Reconstr Surg. 2003 Jul;112(1):259–63; discussion 264–5. 4. Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Knutson GA1. Chiropr Osteopat. 2005 Jul 20;13:11. 5. Matarasso A. Traditional abdominoplasty. Clin Plast Surg. 2010 Jul;37(3):415–37.

Abstract: Secondary Full Abdominoplasty Following Prior Umbilical Stalk Detachment

INTRODUCTION: There are many techniques utilized in abdominoplasty surgery.1,2 For patients presenting with primarily infraumbilical laxity in addition to a small amount of laxity above the umbilicus, an umbilical “floating” maneuver can be used as a modification of a mini abdominoplasty.3 Patients with prior umbilical stalk detachment, secondary to modified mini-abdominoplasty or prior umbilical hernia repair, occasionally desire full abdominoplasty. In these patients, a circumferential incision around the umbilicus leaves a blood supply based entirely upon scar tissue, prompting concern about the viability of the umbilicus. Minimal literature exists to help guide clinical decision-making for these patients.4 METHODS: Queries were sent to Louisiana Society of Plastic Surgery members as well the Plastic Surgery Education Network (PSEN) online forum. Case information was gathered via email and telephone correspondence. Metrics obtained included patient age, time between umbilical stalk detachment and secondary full abdominoplasty, post-operative complications, and if rectus plication was performed at time of secondary surgery. RESULTS: Ten physicians reported 16 substantive cases, including twelve following mini-abdominoplasty and four after umbilical hernia repair. All patients healed without evidence of umbilical necrosis. Average patient age at time of secondary surgery was 37.5 years. Average duration between procedures was 3.8 years. 69% of patients had the umbilicus delayed prior to secondary procedure, with average delay time being 16 days. Rectus fascia was plicated at time of secondary surgery in 69% of patients. CONCLUSION: This is the largest series of patients undergoing full abdominoplasty after prior umbilical stalk detachment. It is also the first time the PSEN online forum has been used to collect research data, highlighting its potential as a valuable research tool. The data set thus allows for consideration of various solutions when this clinical scenario is encountered. Reference Citations: 1.Matarasso A, Matarasso DM, Matarasso EJ. Abdominoplasty: classic principles and technique. Clinics in plastic surgery. 2014;41(4):655–672. 2.Sozer SO, Agullo FJ, Santillan AA, Wolf C. Decision making in abdominoplasty. Aesthetic plastic surgery. 2007;31(2):117–127. 3.Colwell AS, Kpodzo D, Gallico III GG. Low scar abdominoplasty with inferior positioning of the umbilicus. Annals of plastic surgery. 2010;64(5):639–644. 4.Matarasso A, Schneider LF, Barr J. The Incidence and Management of Secondary Abdominoplasty and Secondary Abdominal Contour Surgery. Plastic and reconstructive surgery. 2014;133(1):40–50.

The Incidence and Management of Secondary Abdominoplasty and Secondary Abdominal Contour Surgery

Limited data exist in the literature regarding the general incidence of secondary abdominal contour procedures and secondary abdominoplasty (excluding revisions) or specific recommendations for surgical management of these patients. The authors performed a retrospective chart review of 562 patients who underwent abdominal contouring procedures (liposuction and/or modified or full abdominoplasty) performed by a single surgeon (A.M.) from January of 2004 until October of 2012. Nonsurgical primary cases, secondary surgery that was revisional in nature, and massive weight loss patients were excluded. Seventy-three patients (13.0 percent) underwent secondary abdominal contouring procedures. Forty-six of 73 patients had charts available to be examined in greater detail. Thirty-four of these patients underwent secondary liposuction, whereas 12 of these patients had secondary full abdominoplasty procedures. Secondary operations occurred an average of 4.98 years after the primary procedure (range, 6 months to 15 years). Patients underwent secondary liposuction (n = 34) on average 3.16 years after their initial procedure, significantly sooner than patients who underwent secondary abdominoplasty (n = 12) 8.35 years after their initial procedure (p = 0.002). Patients with a body mass index less than 25 kg/m2 (n = 26) had both secondary liposuction (n = 16) and secondary abdominoplasty (n = 10), whereas all patients who had a body mass index of 25 kg/m2 or greater (n = 20) underwent only secondary liposuction. True secondary abdominal contouring procedures represented 13.0 percent of all abdominal contouring procedures. The most common indication for a secondary procedure was an umbilical-site closure scar. Specific recommendations for surgical management of five common scenarios for secondary abdominal procedures are discussed.

Demographic Factors, Outcomes, and Complications in Abdominal Contouring Surgery After Massive Weight Loss in a Developing Country

Few reports about body contouring surgery after massive weight loss (MWL) have been produced in the developing countries. As Mexico is considered a developing country, we performed a retrospective analysis of medical records of patients who underwent this type of surgery to evaluate their demographic characteristics as well as their outcomes and complications. Results from 684 patients with MWL, 69 (10%) had abdominoplasty; the type of abdominoplasty influenced the operative time, bleeding, and complications (P < 0.05); the body mass index influenced the weight of resected tissue (P < 0.000) and hospital stay (P < 0.020), but did not affect the type of abdominoplasty performed, surgical time, complications, reoperation, or transfusion rates. In contrast with the developed countries, in these procedures, operating time was higher and the patients had more surgical bleeding with higher rates of transfusion and a longer hospital stay, but with the same clinical results and percentage of complications.

Complications of Abdominal Contouring Surgery in Obese Patients

Medical records of 122 patients who underwent an abdominoplasty or panniculectomy from 2003 to 2008 were reviewed to determine current rates of wound complications associated with these procedures in the presence of obesity. An additional aim was to determine current rates of complications as compared with those found 10 years ago at our institution to determine if the finding of obesity alone continues to adversely affect wound outcomes. Sixty-three of 122 patients (51.6%) experienced 1 or more wound-related complications. Major complications occurred in 13 patients (10.7%). A striking finding was that the lowest major complication rate 4.5%, was found in patients with extreme obesity (BMI >40). Comparisons between the 1999 and current studies found that the difference in major complications in those classified as obese, with 2 (9%) in the current study and 8 (40%) in the 1999 study, was significant (P = 0.039). Our findings suggest that high rates of major complications found in those with obesity in the 1999 study are not found today. Extreme obesity is not an absolute contraindication to operation and may be performed safely.

Procedural Risk for Venous Thromboembolism in Abdominal Contouring Surgery: A Systematic Review of the Literature

To ensure that patients receive appropriate thromboembolic prophylaxis, other specialties have begun using risk stratification models. Because these models do not include plastic surgery patients, research must be directed toward exploring the risk associated with these operations. A systematic review of the literature was performed to address these issues. A thorough search for all articles discussing abdominal contouring surgery was conducted. Data were collected from this institution through a retrospective chart review and included in the analysis. Procedures were divided into four groups, dependent on what was reported, as follows: abdominoplasty alone, abdominoplasty with an intraabdominal procedure, abdominoplasty with another plastic surgical procedure, and circumferential abdominoplasty. Frequencies of venous thromboembolism were recorded. Chi-square analysis was performed to examine for statistical differences. One hundred fourteen articles were reviewed; 30 articles were included in the analysis. Circumferential abdominoplasty was associated with the highest venous thromboembolism rate (3.40 percent). This was statistically higher than the thromboembolic rate of abdominoplasty (0.35 percent) (p < 0.0001) and abdominoplasty with concomitant plastic surgery (0.79 percent) (p < 0.0001). Abdominoplasty combined with an intraabdominal procedure was associated with the second highest rate of thromboembolism (2.17 percent). This rate was higher than abdominoplasty alone (p < 0.001) and abdominoplasty with concomitant plastic surgery (p = 0.02). Circumferential abdominoplasty and abdominoplasty performed in combination with an intraabdominal procedure were demonstrated to have significantly increased risk for venous thromboembolism. Patients undergoing these procedures should be risk stratified and have perioperative prophylaxis managed accordingly. It is suggested that both of these operations be placed into a higher exposing risk category within the modified Davison-Caprini risk assessment model.

Abdominoplasty and Abdominal Contour Surgery: A National Plastic Surgery Survey

Manhattan Eye & Ear Hospital, New York, N.Y. Correspondence to Dr. Swift, Manhattan Eye & Ear Hospital, 110 East 87th Street, New York, N.Y. 10128, [email protected]

Abdominal Contour Surgery for the Massive Weight Loss Patient: The Fleur-De-Lis Approach

Abdominal Contour Surgery for the Massive Weight Loss Patient: The Fleur-De-Lis Approach

Abdominoplasty Complications: A Comprehensive Approach for the Treatment of Chronic Seroma with Pseudobursa

Abdominoplasty is an extensive surgical operation, often followed by a significant number of local and general complications. Some studies indicate that the risk of severe complications, including mortality, ranges from 1 in 617 to 1 in 2,320 cases. Seroma is one of the serious consequences that follows each type of abdominal contour surgery, from suction-assisted lipoplasty to standard and limited abdominoplasty. A case of a 46-year-old women who underwent standard abdominoplasty and liposuction during the same procedure is presented. In the follow-up examination, a chronic seroma with pseudobursa was observed. The pseudobursa was evacuated multiple times under ultrasound control. During one evacuation, 2,010 ml of seroma was evacuated. Because of the prolonged Seroma formation, the pseudobursa grew, creating a tumor-like effect in the front abdominal wall. In a second operation (miniabdominoplasty), the pseudobursa was completely excised, and the material was sent for analysis. Progressive tension sutures were placed in additional lines to decrease the dead space, and to decrease movement between the abdominal flap and the musculoaponeurotic layer, as suggested by Saltz and Matarasso. Suction drainage with a compressive girdle was maintained for 2 weeks after the second operation. The follow-up assessment, performed 3 months after the second operation, showed no infection, skin necrosis, hernia formation, or new chronic seroma with pseudobursa.

Abdominoplasty and Abdominal Contour Surgery: A National Plastic Surgery Survey

According to the American Society for Aesthetic Plastic Surgery's 2004 Cosmetic Surgery National Data Bank, during the last 7 years, the number of abdominoplasty procedures performed has increased 344 percent. A national report on abdominoplasty has not been since 1977. Grazer and Goldwyn's study reflects the preliposuction era of abdominal contouring surgery. The purpose of this study was to assess current trends in abdominal contouring techniques and associated procedures and the incidence of their complications. The study was designed as a descriptive correlation survey evaluating the frequency of various abdominal contour techniques and complications among 3300 randomly chosen members of the American Society of Plastic Surgeons. There were 497 respondents, for a response rate of 15 percent. A total of 20,029 procedures were reported in the survey; 35 percent (n = 7010) were liposuction of the abdomen, 10 percent (n = 2003) were limited abdominoplasties, and 55 percent (n = 11,016) were full abdominoplasties. Survey data covered the plastic surgeon's demographics, techniques, and incidence of complications during a 12-month period. The authors report the largest series of local and systemic complication rates and compare them with those of previously published abdominoplasty surveys. With respect to full abdominoplasty, lower complication rates for deep vein thrombosis (0.04 percent) and pulmonary embolus (0.02 percent) were seen. No deaths were reported. There was no correlation between a surgeon's years in practice and complication rates, in concordance with the earlier study by Grazer and Goldwyn. Despite more extensive abdominal contouring techniques and the addition of liposuction to abdominal contouring, the local and systemic complication rates coincided with previous complication rates, as outlined in other studies.

Abdominal contour surgery for the massive weight loss patient: the fleur-de-lis approach

Massive weight loss patients often have significant upper midline abdominal fullness that contributes to the overall abdominal girth. This region frequently is not adequately treated with conventional abdominoplasty techniques. The author used a fleur-de-lis pattern when performing a full abdominoplasty or circumferential abdominoplasty. The technical refinements of this procedure for massive weight-loss patients are presented, as well as considerations of the technique's safety. A full abdominoplasty pattern was marked, and the inferior incision was lowered along the midline to adjust for mons pubis ptosis as necessary. The vertical component of the abdominoplasty was marked as an inverted "V" or triangle to decrease the abdominal girth, and the cephalic portion was "rounded off" to create an inverted "U." It was important to lower the final incision of the superior margin of the original abdominal pannus resection approximately 2 to 3 cm to allow for minimal tension at the lower abdominal midline closure. The back and flanks were marked for those patients undergoing a circumferential procedure using a gull-wing type incision, joining it with the anterior abdominal marks. The mid-axillary line was marked bilaterally. Vertical reference lines were also drawn along the back to aid in aligning the upper and lower back incisions. The back was treated first for those patients undergoing a circumferential procedure, and then the patient was repositioned supine for treatment of the abdomen and flanks. Ten patients whose average weight loss was 137 pounds after gastric bypass surgery underwent abdominal contour surgery incorporating a fleur-de-lis pattern. Two men and 8 women with ages ranging from 17 to 53 years (average, 39 years) were treated. Seven underwent a circumferential procedure whereas 3 underwent an isolated abdominoplasty. The follow-up period ranged from 1 month to 26 months, with an average follow-up of 9.5 months. Five patients had a hernia repair performed in conjunction with the abdominal contour surgery. There was no flap loss or wound dehiscence at the inverted "T" closure for any patient. Use of a fleur-de-lis pattern in abdominal body contouring is a safe and effective technique for properly selected massive weight-loss patients. It is particularly appropriate for those patients with significant upper midline abdominal fullness.

Secondary Abdominal Contour Surgery: A Review of Early and Late Reoperative Surgery

A retrospective chart review of 400 abdominal contour operations produced a series of 24 patients who underwent both their primary and then their secondary abdominal contour surgeries with the senior author (Matarasso). The majority of patients were classified and treated according to the abdominoplasty classification system previously described; however, a subgroup could not be categorized according to this system. In this study, the authors identified the secondary abdominal contour surgical experience of one surgeon. A comparison was made between two groups of patients treated for both primary and secondary operations: group I, considered early, less than 18 months after the previous operation; and group II, considered late, 18 or more months after the previous operation. There was a significant difference between groups I and II (chi2 = 4.12, p = 0.05); most patients had their surgical procedures before 18 months. For patients who underwent either a miniabdominoplasty or a full primary abdominoplasty, there was a statistically significant difference between the number of patients treated in group I and the number in group II (Fisher's exact test, D = 0, p = 0.05). Next, the nature of the secondary procedure was determined to be either a revisional procedure or a completely new reoperative procedure. The majority of patients underwent revision or "touch-ups," accomplished with either liposuction alone or in combination with scar revision. There was no significant difference between types of primary and secondary procedures performed in group I or group II. Secondary abdominal contour surgery accounted for 6 percent (24 of 400) of all abdominal contour procedures performed by one surgeon. Complete secondary surgery, performing an additional open procedure, occurred in 21 percent of cases (five of 24). Revision surgery (scar revision or removal of dog-ears) was performed in 29 percent of all cases (seven of 24). There was a 4 percent (one of 24) complication rate requiring operative intervention. This rate is consistent with that reported in the literature for primary abdominal contour surgery. With the overall acceptance of aesthetic surgery increasing, the number of patients undergoing abdominoplasty increasing, an aging population, and the safety of secondary abdominal contour surgery suggested from this review, it is likely that plastic surgeons will see more patients requesting secondary abdominal contour surgery in the future.

Abdominal contour surgery: Treating all aesthetic units, including the mons pubis

Background: Many patients who seek [ldquo ]abdominal[rdquo ] contour surgery also desire improvement of areas of the torso adjacent to the abdomen, such as the flanks and back rolls. Objective: We propose a classification of the abdomen into distinct aesthetic units and report on a series of cases in which this classification was used, with special emphasis on one such unit, the mons pubis. Methods: A series of 400 consecutive patients were evaluated according the proposed designation of aesthetic units. Lipoplasty was performed as described in previous studies. A subset of 6 patients who specifically desired improvement of the mons pubis were treated by lipoplasty and/or horizontal or vertical wedge incision. Results: Most patients who received treatment according to aesthetic unit were satisfied with their outcomes. Two of the patients who sought improvement of the mons pubis specifically requested additional procedures. Conclusions: An approach to abdominal contour surgery that includes consideration of all related aesthetic units can achieve more proportional, harmonious results and increase patient satisfaction.

When does your liposuction patient require an abdominoplasty?

Abdominal surgery has evolved from one operation applied to all patients requesting contouring, to a group of procedures based on individual variations in anatomy. Currently, the authors favor four (Types I-IV) different procedures. Liposuction alone (Type I) is performed in the majority of patients. In the remainder (procedures Type II-IV) liposuction combined with modifications of open, traditional abdominoplasty are utilized. These additional methods are appropriate in patients that necessitate rectus muscle reinforcement or skin reduction procedures in order to adequately contour the abdomen. This report describes the indications for abdominal contour surgery, beyond just liposuction. A consecutive series of over 300 abdominal contour patients were reviewed and analyzed, with recommendations based on individual variations in their soft tissue anatomy. We demonstrate that the majority of patients benefit from a "closed" procedure (liposuction or ultrasonic assisted liposuction) but that patients with muscle flaccidity or laxity in their skin may require an open procedure. Abdominal contour surgery should be considered a group of operations (abdominolipoplasty system of classification and treatment) based on individual varieties in anatomy.

Classification and patient selection in abdominoplasty

Abdominal contour surgery is currently characterized by a group of procedures, corresponding to variations in individual anatomy. Patient selection is based on an assessment of the soft-tissue layers according to the abdominolipoplasty system of classification and treatment, correlated with the patient's goals. Using these methods, a choice of alternatives that include: liposuction, limited abdominoplasties, and full abdominoplasty (with or without suction-assisted lipectomy) (types I–IV); or for certain individuals, minimal-access variations in abdominoplasty [extended liposuction (type 1a), open mini-abdominoplasty (type 2a), and endoscopic or muscle access abdominoplasty (type 3a)] are applicable to a spectrum of disorders. In this article, we discuss this concept of staging patients and how it is used to determine treatment alternatives, as well as specific technical considerations necessary to achieving an optimal outcome.

Liposculpture and lipectomy superficial to Scarpa's fascia

The standard treatment of patients with type II abdominal contour deformities has been liposuction and miniabdominoplasty. This can leave a flattening or even a depression in the hypogastrium at the junction of the mons and superior flap. We present a technique of liposculpture and lipectomy superficial to Scarpa's fascia that prevents this deformity and may decrease the incidence of seromas following abdominal contour surgery.