Abdominoplasty Why Do We Need Different Types of Abdominoplasty?

Introduction

Every abdominoplasty patient has one thing in common – excess abdominal skin. This is where the similarities end. Most abdominoplasty patients also have abdominal muscle laxity resulting in a bulge in the abdomen. Many abdominoplasty patients have excess abdominal subcutaneous fat as well. These are the three issues that need to be addressed if one is to rejuvenate the abdomen. As these factors vary from patient to patient, there needs to be choices in procedure that best fit each particular patient.

Anatomy

The abdomen extends from the lower border of the chest to the waist crease. In the center, more or less, is the umbilicus “belly button). The belly button is biologically a scar that forms when the umbilical cord is cut at birth, but it is also an aesthetic anatomical landmark. Other aesthetic structures of importance include the vertical paired muscles in the central abdomen called the rectus abdominis, as well as the more laterally placed oblique muscles. The abdomen is divided into the upper and lower portions, with the umbilicus in the center of the two.

Rationale

Any aesthetic surgical procedure designed to improve body contour by removing excess skin must by definition result in a scar. The length of this scar depends upon how much skin is to be removed. In aesthetic rejuvenation of the abdomen, like with all aesthetic surgery, the goal is to hide the scars wherever possible. As excess abdominal skin is pulled downward and excised, the scar will lie along the waist crease. The exact level that you place this scar will result in whether or not this scar is visible while the patient is in a two-piece bathing suit. Therefore, it is better to make this scar as low as possible.

The following will be addressed in greater detail in the description of the individual abdominoplasty procedures. If there is excess skin in the lower abdomen only, then no scar will need to be made around the umbilicus. If there is excess skin in the upper abdomen, then a scar will need to be made around the umbilicus. While ideally I would prefer not to make this incision around the umbilicus, which is usually visible to some extent, when it is required I have no choice.

If there is abdominal muscle laxity, this must be addressed as well. If there is laxity only in the lower abdomen, then from the perspective of tightening the muscles alone, one does not need to go above the umbilicus. If the entire abdominal wall is lax, then the surgeon does need to go above the umbilicus to address the entirety of the muscle laxity.

When there is excess subcutaneous fat, but only within the portion of the skin to be excised, then there is no need for liposuction. However, if there is excess fat underneath the abdominal skin that will remain after excision, then this fat is best removed by liposuction.

All the above assessments need to be made to determine the best surgical approach. This is where surgeon experience and judgment is so important.

Options

Before discussing contouring of the sides of the trunk, the flanks and even the back, at this time it is necessary to discuss the different types of abdominoplasty…yes, there are several different types of abdominoplasty; it is not a “one size fits all” cookie cutter procedure. There are basically five main types of abdominoplasty in terms of the way the anatomical areas are addressed and re-contoured. Each type of abdominoplasty can be performed using different technical variations as per the surgeons preference. Liposuction, when indicated, can be performed simultaneously with any of the below procedures for even greater results.

The five types of abdominoplasty are:


All five types of abdominoplasty have one thing in common: the incision is planned so that the scar lies in the waist crease. Note that I didn’t state that the incision is made in the waist crease. I often make the incision lower than the waist crease because I know that the scar will be pulled upward by the force of the upper abdominal skin at the time of closure and I do not want the scar to lie above the waist crease or the scar will risk lying above the waistband of the patients clothing or bathing suit. I usually have the patient wear a bathing suit bottom or underwear bottoms at the time I mark the incisions so I know just how the clothing sits on the body and I can plan my surgical incisions so as to make sure the scar does not lie above the clothing line.



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