Classic Abdominoplasty Research Articles

Abdominoplasty in a patient after bariatric surgery – case study

Introduction: Up to 96% of patients after bariatric surgery struggle with excess skin, which negatively affects their daily functioning due to frequent skin infections, difficulties with sexual activity and physical exercise, as well as discomfort, especially in social situations. Abdominoplasty is a surgical procedure that allows post-bariatric patients to resolve these problems. At the same time, like any surgical intervention, the incidence of complications is relatively low. These potential complications after surgery include mainly superficial wound dehiscence or other minor complications. Purpose of the work: This study aims to detail the stages of abdominoplasty performed on a post-bariatric surgery patient and to demonstrate the outcomes achieved. Materials and methods: In this study, the individual case study method was used. The subject of the study was a 36-year-old woman after bariatric surgery who, having lost more than fifty kilograms and already having a normal BMI= 23.88 kg/m², applied for an abdominoplasty procedure. For practical reasons, despite indications for a circular abdominoplasty, the patient underwent a classic abdominoplasty complemented by liposuction. Results: During the abdominoplasty procedure, liposuction of the lateral fat tissue was performed, along with the removal of a skin-fat fold weighing over 1 kilogram, reinforcement of the abdominal muscles, and repositioning of the navel. The patient left the clinic without any drainage in place. After 8 days, the sutures placed during the operation were removed and after 4 weeks, the effects of the surgery were also verified by photo documentation. The abdominoplasty performed in the post-bariatric patient allowed for the successful removal of the excess skin after a considerable amount of weight loss. The procedure required meticulous planning and adaptation of surgical methods and techniques to the patient's living situation.

Physical properties of Scarpa's fascia.

Preservation of Scarpa's fascia has improved clinical outcomes in abdominoplasty procedures and in other body contour surgeries. However, the physical properties of Scarpa's fascia have not yet been described, and grafts are still underexplored. Fresh surgical specimens from five female patients subjected to classical abdominoplasty were dissected and analyzed. A grid was drawn on the fascia surface, dividing it into equal upper and lower halves; four Scarpa's fascia samples (30 × 10 mm) were collected from each half, 40 mm apart. The thickness was measured with a caliper. A strain/stress universal testing machine was used for mechanical tests. Twenty-five samples were obtained (nine from the upper half, 16 from the lower). The average thickness was 0.56 ± 0.11 mm. The average values for stretch, stress, strain, and Young's Modulus were, respectively, 1.436, 4.198 MPa, 43.6%, and 23.14 MPa. The upper half showed significantly greater thickness and strain values (p = 0.020 and p = 0.048; Student's t-test). The physical and biomechanical properties of Scarpa's fascia can make it a donor area for fascial grafts as an alternative to fascia lata, as it is always available and has minimal donor-site morbidity. Further studies are needed to validate this statement. It seems advantageous to use the lower half of the abdomen instead of the upper part as a donor site.

The advantages of complex anterior abdominal wall plastics with Scarpa’s fascia preservation in patients with class I–II obesity

Recently, the frequency of treatment of patients with various deformities of the anterior abdominal wall has increased dramatically. Abdominoplasty is a large-scale surgical intervention that entails a number of complications, such as impaired lymphatic drainage, chronic seroma, the formation of “dog ears”, displacement of the navel from the central line. A technology of Scarpa’s fascia preservation (SFP) has been developed to prevent these complications. The aim of this work is to study the effectiveness of treating patients with correction of the tissues of the anterior abdominal wall using SFP technology in comparison with standard abdominoplasty.Material and мethods. The study involved 30 males and females aged 35 to 60 years with class I-II obesity who underwent complex plastic surgery of the anterior abdominal wall. Patients were divided into 2 groups of 15 people: in the 1st group, classical abdominoplasty was performed, in the 2nd, complex plastic surgery of the anterior abdominal wall using SFP technology. Observation of the patients took place in the early and late postoperative periods.Results. Group 2 patients lacked both early postsurgical and chronic seromas, did not develop so-called “dog ears”, which indicates the most favorable course of the postoperative rehabilitation period and the achievement of the best aesthetic results. Also, when using the SFP technology, there were no longterm inflammatory processes, the amount of postoperative exudative fluid in the drains decreased, the pain syndrome was significantly lower, and earlier restoration of the sensitivity of the anterior abdominal wall was noted in comparison with patients who underwent classical abdominoplasty. Complex plastic surgery of the anterior abdominal wall using SFP technology makes it possible to reduce the intensity of pain on the first day by 1.75 times (to 4 ± 1 points, p ≤ 0.05), to speed up the removal of drains (reduce the duration of exudation) by 3 times (to 16 ± 1 h, p ≤ 0.05). According to the BODY-Q scale, in the main group, satisfaction with the aesthetic result was 2 times higher than in the comparison group.Conclusions. Complex anterior abdominal wall plastics with Scarpa’s fascia preservation has a number of significant advantages over classical abdominoplasty.

Analysis of options for reducing the duration of simultaneous operations in plastic surgery

The main problem of simultaneous operations is their duration, which, as a rule, is more than 4 hours, which exceeds the allowable time and often causes complications in the postoperative period. Aim of the study was to evaluate the effectiveness of simultaneous operations performed by two surgical teams simultaneously. Material and methods. The object of the study was 24 patients aged 25 to 55 years, who simultaneously underwent classical abdominoplasty with navel transposition and anchor breast lift on implants by one and two surgical teams. The evaluation and comparison of the duration of surgical interventions according to the data of anesthesia charts have been carried out. Further, the assessment of the condition of patients before surgery and for 1 day in the postoperative period was carried out using the questionnaire for assessing the quality of recovery after anesthesia (QOR-40, quality of recovery 40-item questionnaire).Results and discussion. Performing abdominoplasty simultaneously with the correction of the shape and volume of the mammary glands by two surgical teams simultaneously reduces the duration of the intervention by 27 % on average, and therefore the quality of recovery of patients in the postoperative period is signifcantly higher. Prolonged exposure to general anesthesia and other potentially dangerous intraoperative conditions (for example, blood loss, hypotension, hypothermia, infections) interfere with the maintenance of physiological homeostasis by the body. And, therefore, reducing the time of surgery is important to reduce the frequency of complications. In order to minimize the operation time in combined cases of abdominoplasty and breast plastic surgery, it is logical to involve two operating teams at the same time, which reduces the total operating time to 3 hours. Conclusions. Today one of the main methods of solving problems associated with the duration of complex simultaneous operations is the simultaneous coordinated work of two surgical teams to minimize the duration of intervention and reduce postoperative complications.

Reliable diagnosis of implant rotation in high-resolution ultrasound depending on the implant manufacturer

Rotation of an anatomical breast implant may require revisional surgery. High-resolution ultrasound can help determine the exact implant alignment. However, the directional markings of anatomical implants are implemented very inconsistently by manufacturers. Therefore, a definite diagnosis is often not possible without precise knowledge of the expected imaging. The aim of this work is a differentiation of the imaging of common implant brands in high-resolution ultrasound. Methods To simulate an authentic imaging, anatomical implants were viewed through abdominal skin thinned to 1.5-2 cm, which was obtained during a classic abdominoplasty. Implants from the companies Allergan, Eurosilicone, Mentor, Motiva, Nagor, Polytech and Sebbin were compared. The marking positions and dimensions were documented by ultrasound. Results Based on placement and shape, a clear allocation between alignment and manufacturer is basically possible among the implants used. The base plate and caudal markers could be clearly visualised for all brands. In Polytech implants, however, the visible structural change is limited to a very small central area. The visualisation of directional marks, base plate and implant shell also allow conclusions to be drawn about the manufacturer. In high-resolution ultrasound, a fast and reliable diagnosis of implant alignment is possible for all implants examined. Also it was possible to make a clear allocation between implant and manufacturer in this context. Flip over of the implant can also be reliably depicted. The cataloguing of the markings summarised here can be used to determine the exact alignment of the implant and thus provide diagnostic certainty, especially if the brand is unknown.

Classic versus High Lateral Tension Abdominoplasty in Post-bariatric Patients

Abstract Background: Obesity is a chronic condition with a high prevalence and multifaceted etiologies; it is accompanied by an increased risk of morbidity and mortality. Bariatric surgeries (weight loss surgeries) include a variety of procedures performed on people who have obesity. Skin redundancy is a common post-bariatric complication. Abdominoplasty or "tummy tuck" is a cosmetic surgery procedure used to make the abdomen thinner and more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. This type of surgery is usually sought by patients with loose or sagging tissues after pregnancy or major weight loss. This study is a comparison between Classic and High lateral tension abdominoplasty techniques in treatment of abdominal skin redundancy in post bariatric patients. In our research, we compared between two techniques of abdominoplasty in treatment of post bariatric abdominal skin redundancy, the classic technique and High Lateral Tension technique, the comparison was in patient satisfaction and in post operative complications The study showed that patient satisfaction was higher in classic technique than the High lateral tension technique due to smaller and less apparent scar, while post operative complications were almost the same in both techniques According to our study, we advise plastic surgeons to perform classic abdominoplasty technique in treatment of post bariatric abdominal skin redundancy.

“Abdominoplasty with “En block” removal of the skin island: a safe and fast approach”

The aim of abdominoplasty is to restore a normal abdominal contour, with minimal signs of the surgery. The purpose of this study was to determine the feasibility, safety, and advantages of en block removal of a skin island before upper abdominal dissection during abdominoplasty. Five hundred-forty female patients who underwent abdominoplasties between January 2004 and December 2018 were retrospectively analyzed. In these cases, the planned skin resection was initially made en block, as done with an elliptic skin excision. In this way, symmetric skin removal is achieved. After the removal of this skin, epigastric skin undermining was easily achieved. The mean age of the patients was 41.4 y, and the mean body mass of index was 27.3 kg/m2. The mean operative time for abdominoplasty only was 98 min. Eight patients had minor skin problems, 22 patients needed aspiration for seroma formation, and 7 patients needed scar revision surgery. There was only one hematoma postoperatively. The final position of the scar from the upper vulvar commissure was 8.9 cm. The results obtained were comparable to those of classical abdominoplasty, suggesting that en block removal of the skin before upper flap dissection is a safe maneuver. En block removal of skin island at the start of the surgery has the added advantage of a reduced operative time and acceptable aesthetic outcome, without an increase in complication rates. In cases of planned abdominoplasties, we suggest that removal of the abdominal skin at the beginning of the operation is a safe and feasible procedure. Abbreviation: PDS: polydioxanone

Laser Doppler flowmetry in the determination and evaluation of blood flow characteristics during the correction of cosmetic defects of abdominal wall

The aim — to determine the possibility of using Laser Doppler flowmetry (LDF) for the study of blood flow in the vessels of the anterior abdominal wall in order to improve the results and develop new methods of treatment of patients with cosmetic defects of the anterior abdominal wall in patients with obesity I — II stage.Materials and methods. The study of blood flow on the anterior abdominal wall using LDF scan was performed in 132 patients, predominantly females 116 (87.9 %). The average age of patients was 43.4 ± 10.3 years. All patients had obesity of grade I or II. The average body mass index was 32.8 ± 2.7 kg/m2. The patients were divided into two groups: the main group — 64 (48.5 %) patients who underwent abdominoplasty in combination with other simultaneous operations and liposuction (lipoabdominoplasty), and the control group — 68 (51.5 %) patients who underwent abdominoplasty in combination with other simultaneous operations without liposuction. The mean duration of the operation in the main group was 255.3 ± 23.5 min., in the control group — 210.2 ± 21.2 min. Patients were examined in the preoperative period according to the standards of the Ministry of Health of Ukraine. LDF was performed before and during surgery and within 10 days of the postoperative period to determine the microcirculation indices (MI) of the anterior abdominal wall.Results and discussion. The study of MI in the control and main groups prior to the treatment, no statistically significant difference was found between the groups (p = 0.83). Immediately after the operation, the relationship between low‑frequency rhythms, which characterize the active mechanism of microcirculation, and high‑frequency and heart rhythms is disrupted. Normally, the amplitude of vasomotions is 20 — 25 % of the level of the LDF signal, immediately after the operation it decreases to 46 — 55 % at an oscillatiofrequency of 6 — 8 per minute. The average period of recovery of MI to the initial level is 8 days, the maximum is 11 days (for a smoker with type 2 diabetes). A decrease in the level of microcirculation within 1 — 2 days after surgery was 5.2 % bigger in the liposuction group than in the control group. There was no statistically significant difference between the groups in the dynamics of changes in MI during the study period (p = 0.767).Conclusions. The study showed that during lipoabdominoplasty there is no critical reduction in the microcirculation in the flaps compared to the classical abdominoplasty. «Ischemic crisis» in the flaps after lipoabdominoplasty is present during the first 2 days of the postoperative period. In the future, the progressive recovery of microcirculation in the flaps is noted. The safety of simultaneous abdominoplasty with liposuction has been proven. The advantage of lipoabdominoplasty is better mobilization of flaps which reduces the necessary dissection of the flap, preserves the musculo‑dermal perforants, helps to obtain better body contours and reduce the risk of repeated corrections in the postoperative period.

Comparative Study between Outcomes of Abdominoplasty with or without Use of Diuretics in Postoperative Treatment

Background: Seroma formation is a common complication after abdominoplasty and is associated with delayed wound healing, infection, skin flap necrosis, patient discomfort and repeated visits to the outpatient clinic to deal with seroma and its sequelae. Closing the dead space after abdominoplasty seems to be key in reducing seroma and its complications. Objective: The aim of this study was to compare outcome amount of serous fluid in the drain and incidence of seroma post abdominoplasty with and without use of spironolactone in medical treatment in postoperative period. Patients and Methods: This study was conducted on 40 patients who underwent classical abdominoplasty without use of mesh, all laboratory and radiological investigations were done. Patients were divided into two groups group A involved 20 patients who didn't take spironolactone and group B included 20 patients that had taken spironolactone for 15 days postoperative. Results: In group A, there were 3 males and 17 females and mean age was 34 ± 8.6 years. Group B consisted of 5males and 15 females, their mean age was 40 ± 10.8. BMI was 13 patients >25 in group A and in group B was 6 cases >25. There is small paraumbilical hernia in 4 patients in group A and in 3 patients in group B. Group B who took spironolactone showed significant improvement in outcome including volume of fluid in the drain, time of removal of drain and no occurrence of flap edema. Conclusion: There was statistically significant decrease in the incidence of seroma formation after abdominoplasty with the use of spironolactone postoperative.

Lymphostasis and Hemostasis in Body-Contouring Surgery Using a Polysaccharide Based Hemostat (4DryField PH).

Background:Following liposuction, abdominoplasty is the most frequent body-contouring intervention in the world. The transection of small blood vessels in large areas and subsequent bleeding is a viable risk during this procedure. The resulting microvascular bleedings should be stopped thoroughly to reduce the probability of related complications. In this prospective, monocentric, randomized study, the efficacy of the polysaccharide-based hemostat 4DryField PH (4DF) (PlanTec Medical, Lueneburg, Germany) is examined in classic abdominoplasty and lower body lift after Lockwood.Methods:For this prospective, monocentric, randomized study, 40 patients underwent surgery for both interventions. Twenty patients received an abdominoplasty, and 20 patients underwent a body lift. In each group, 10 patients have been treated with 4DF, whereas 10 have been served as the untreated control group.Results:4DF had neither a beneficial nor a negative effect on necessity of drainages, drainage volume and duration, length of hospital stay or frequency of postoperative seromas, wound healing disturbances, and infections, independent of surgical intervention. Patients in the 4DF group, however, had more individual risk factors, and required extended surgical interventions that might mask primary outcome results.Conclusions:This is the first prospective, monocentric, randomized study on 4DF in body-contouring surgery. The use of 4DF did not lead to a better postoperative outcome regarding hemostasis and lymphostasis. Potential benefits need further evaluation in high-volume studies.

Outcome of Body-Contouring Procedures After Massive Weight Loss

With the increased popularity of bariatric surgery, the demand for body-contouring procedures is growing. Associated with these procedures are a number of complications due to different risk factors and patients' characteristics. The aim of this study was to assess the outcome of body-contouring procedures and correlate it to possible risk factors. The study included a collective of 112 patients who underwent 157 body-contouring procedures. Patients' characteristics, risk factors, and complications have been recorded. Three groups were formed based on the type of surgical procedure to perform correlations of BMI, weight of resected tissue, and length of hospital stay using Spearman's rank test. Correlations between patients' risk factors and complication occurrence were analyzed with Fisher's exact test. The most common procedure patients underwent was the classic abdominoplasty (n = 53). A significant correlation was found between preoperative BMI and weight of resected tissue in abdominoplasties (rho = 0.69), Fleur-de-Lis abdominoplasties (rho = 0.64), and body lifts (rho = 0.60). There was a significant correlation between weight of resected tissue and length of hospital stay (rho = 0.53) and preoperative BMI and length of hospital stay (rho = 0.4) as well. There was no significant correlation between patients' comorbidities or smoking status and the postoperative complication rate. The mean weight of resected tissue was higher in patients with than without complications requiring surgical revision. The relevance of risk factors commonly believed to have an influence on postoperative complications should be revised. The weight of resected tissue has an influence on complication.

Traditional abdominoplasty versus dual-plane abdominoplasty in abdominal contouring

Objectives The study aims to evaluate the effect of Scarpa's fascia preservation on the results and complications of abdominoplasty through a prospective randomized comparative study between the dual-plane and traditional abdominoplasty. Patients and methods The current study included 40 cases with redundant and/or bulged abdomen seeking abdominoplasty. Their ages ranged between 25 and 50 years, and BMI ranged from 25 to 35. BMI above 35, previous abdominal surgery, any associated hernias, postbariatric surgery, smokers, and comorbid diseases such as diabetes, chronic obstructive airway disease, and autoimmune, liver, and renal diseases were excluded. Results With Scarpa's fascia preservation, the mean total drain output in the dual plane (175.5±35.9 ml) was much lesser than the classic abdominoplasty (479.5±177.27 ml); moreover, drains were removed earlier with Scarpa's fascia preservation (2.9±0.31 days) in comparison with classical abdominoplasty (5.5±1.92 days). All patients passed without seroma formation in Scarpa's fascia preservation in group B; however, full-thickness infraumbilical necrosis in zone I occurred in a single case (5%) and hypertrophic scar in two (10%) cases. In classic abdominoplasty (group A), seroma was detected in a single case (5%), umbilical stenosis in a single case (5%), a single case (5%) presented with full-thickness infraumbilical necrosis in zone I, and a single case (5%) developed hypertrophic scar. Conclusion Preservation of Scarpa's fascia during dual-plane abdominoplasty reduces patient recovery in the form of reducing total drain output, time for drain removal, and hospital stays in comparison with traditional abdominoplasty. Its disadvantages include longer operative time and incompatibility when mesh reinforcement of the abdominal wall is needed.

Complications of lipoabdominoplasty without Scarpa fascia preservation versus classic abdominoplasty: a prospective blind study

Complications of lipoabdominoplasty without Scarpa fascia preservation versus classic abdominoplasty: a prospective blind study

Revision Abdominoplasty with Truncal Liposculpting: A 10-Year Experience.

Abdominoplasty is one of the most popular body-contouring procedures. Despite its popularity, classic abdominoplasty is still associated with a significant rate of complaints from patients such as: fullness of flanks and epigastric areas, lack of a posterior lumbar curve, hanging skin over the incision line, and visible scars over the flanks and beyond underwear or swimming suit coverage. This study reviews the authors' experience in redo abdominoplasty when the patient is not or partially satisfied with the primary procedure. A total of 115 female and 32 male patients underwent revision abdominoplasty with truncal liposculpting between 2007 and 2016. The age distribution of patients ranged from 33 to 73years, with a mean of 43.1years. All the patients included in the study had undergone classic abdominoplasty in a different institution. Overall satisfaction with the body appearance after the combined procedure was rated on a scale of 1-5, where 1 is 'poor,' 2 is 'fair,' 3 is 'good,' 4 is 'very good,' and 5 is 'excellent.' The evaluation was made 12months after the composite body-contouring procedure. Four hundred to 1500ml of fat were obtained with liposuction (mean 840ml). The amount of clean, adipose tissue transplanted to the buttocks varied from 95 to 425 (mean 286ml) and to the lower limbs from 75 to 270ml (mean 195ml). The stromal-enriched lipograft technique was used in all the cases to enrich the fat transplantation. There was no hematoma, infection or deep vein thrombosis. Seventy-five percent reported that their appearance after composite body contouring was 'very good' to 'excellent' (30% 'excellent' and 45% 'very good') and 20% responded that their appearance was 'good.' Only 5% of patients thought their appearance was less than good ('fair'). The average follow-up time for this group of patients has been 6.3years (range 1-10years). Truncal liposculpting with modified abdominoplasty accomplishes very good aesthetic results in a single surgical procedure with a low rate of complications and high patient satisfaction in cases of revision abdominoplasties. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Outcome after preservation of Scarpa’s fascia in abdominoplasty

Background Postoperative seroma formation remains the most frequent complication following abdominoplasty. The exact pathogenesis of postabdominoplasty seroma remains unclear. Both the process of flap elevation and redundant skin resection disrupt lymphatic drainage in the immediate postoperative period. Preservation of the Scarpa’s fascia in abdominoplasty leads to preservation of deep lymphatic vessels. Patients and methods Thirty-eight patients underwent abdominoplasty (18 of them with Scarpa’s fascia preservation) in the General Surgery Department of Menoufia University Hospital in the period between April 2015 and May 2017. Comparison was done between classic technique and Scarpa’s fascia preservation regarding early outcomes and postoperative complications. Results With Scarpa’s fascia preservation, the mean total drain output (171.5±72.18 ml) was much lesser than classic abdominoplasty (702±136.7 ml); moreover, drains were removed earlier with Scarpa’s fascia preservation (P=0.001 and 0.002, respectively). All patients passed without seroma formation in Scarpa’s fascia preservation group; however, in the group of classic abdominoplasty, seroma was detected in three (15%) patients. In Scarpa’s fascia preservation group, minor wound dehiscence occurred in two (11%) patients and asymmetry in two (11%) other patients, whereas in the other group, two (10%) patients presented with minor wound dehiscence and two (10%) patients developed wound infection. Conclusion Preservation of Scarpa fascia during abdominoplasty has a beneficial effect on patient recovery, reducing total drain output, time to drain removal, and hospital stay.

Analysis of risk factors for the formation of seroma in classical abdominoplasty

Analysis of risk factors for the formation of seroma in classical abdominoplasty

Assessment of Tissue Perfusion Following Conventional Liposuction of Perforator-Based Abdominal Flaps.

BackgroundThe effect of liposuction on the perforators of the lower abdominal wall has been investigated in several studies. There are controversial results in the literature that have primarily demonstrated the number and patency of the perforators. The aim of this study was to determine the effect of liposuction on the perfusion of perforator-based abdominal flaps using a combined laser–Doppler spectrophotometer (O2C, Oxygen to See, LEA Medizintechnik).MethodsNine female patients undergoing classical abdominoplasty were included in the study. Perforators and the perfusion zones of the deep inferior epigastric artery flap were marked on the patient's abdominal wall. Flap perfusion was quantitatively assessed by measuring blood flow, velocity, capillary oxygen saturation, and relative amount of hemoglobin for each zone preoperatively, after tumescent solution infiltration, following elevation of the flap on a single perforator, and after deep and superficial liposuction, respectively.ResultsThe measurements taken after elevation of the flap were not significantly different than measurements taken after the liposuction procedures.ConclusionsThe liposuction procedure does not significantly alter the perfusion of perforator-based abdominal flaps in the early period. The abdominal tissue discarded in a classic abdominoplasty operation can be raised as a perforator flap and has been demonstrated to be a unique model for clinical research.

How to avoid a retraction in the middle of the horizontal scar and minimize the risk of necrosis in the classic abdominoplasty

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Abdominoplasty and gluteoplasty after massive weight loss: an all-in-one technique

Introduction: Patients requesting body-contouring surgery after massive weight loss often present with abdominal and lumbar skin excess as well as gluteal ptosis and loss of gluteal projection. In order to restore gluteal projection a circular abdominoplasty in combination with an autologous gluteal augmentation (all-in-one technique) can be performed.Objective: To compare outcomes for patients who underwent a circular abdominoplasty with or without autologous gluteal augmentation.Methods: In a retrospective study we analyse 24 patients who underwent a circular abdominoplasty between 2006 until 2014 at the University Hospital of Ghent, Belgium. Fourteen patients underwent a classic circular abdominoplasty (4 men and 10 women). Ten patients underwent the all-in-one technique (all women). Mean age was 43 in the classic abdominoplasty group and 41 in the all-in-one technique group. All the patients endured massive weight loss after bariatric surgery. Gluteal augmentation was performed using lumbar dermal fat rotation flaps based on perforators of the 4th lumbar artery. For statistical analysis a Fisher exact tests was used.Results: Postoperative photographs showed that gluteal projection had been increased in patients who underwent the all-in-one technique. The mean operation time in this group was 3h49min versus 2h47min in the group who underwent a classic circular abdominoplasty. The mean hospital stay in both groups was 6 days. Complication rate was comparable between both the groups.Conclusion: The all-in-one technique is an efficient method to improve both abdominal and gluteal body contour in patients who endured massive weight loss.

Modified Lipoabdominoplasty: Updating Concepts.

Abdominoplasty is a commonly performed aesthetic surgical procedure worldwide, and one of the most frequently performed cosmetic surgical procedures in the United States. Classic abdominoplasty was merged with liposuction in the past decade to create a new technique-lipoabdominoplasty-that was proven to be safe and effective and that improves body contour. The authors have been using lipoabdominoplasty since 2003 with excellent outcomes; however, some details have been added to improve significant shortcomings, including the lack of treatment of the pubic area and flanks, the presence of a high-position scar and, sometimes, a bulging inferior abdomen. The authors retrospectively studied 348 patients who underwent lipoabdominoplasty with these related surgical improvements between January of 2010 and February of 2015. Improvements to the original surgical technique included deep liposuction in the lower abdomen, pubic liposuction, and liposuction of the flanks or dorsum with power-assisted liposuction, Scarpa fascia removal in the inferior abdomen, lipoplasty and mons lipolifting, and pubic fixation. Following these key points, superior flap slides to the pubic region by elongation of the vessels and nerves, preserving those structures, avoiding creation of a dead space, and reducing the number of the most common complications. Scarpa fascia removal in the infraumbilical region avoided bulging without increasing the seroma rate. Pubic lifting and its fixation promote rejuvenation of the entire region and avoid elevation of the remnant scar. These surgical modifications are safe and avoid common complications related to lipoabdominoplasty, with improved outcomes. Therapeutic, IV.