Maximizing aesthetics in lateral-tension abdominoplasty and body lifts

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Patient evaluation

The ultimate success of body contour surgery is dependent as much on the accuracy of the initial patient assessment as it is on the technical expertise of the surgeon. Too often surgeons immediately categorize a prospective body contour patient by the surgical procedures that might be possible or that are requested by the patient, rather than based on careful study of the proportions and aesthetics of the patient's body.

Aesthetic body contour deformities frequently involve multiple areas of the

Abdominoplasty

Modern abdominoplasty techniques were developed in the 1960s [1], [2]. Although many modifications have been presented over the past 40 years [3], [4], [5], [6], [7], the surgical principles for standard abdominoplasty remain largely the same. These principles include a transverse lower abdominal incision, wide undermining to the costal margins, tightening of the abdominal musculature, resection of the redundant abdominal flap with the maximum resection centrally, umbilical transposition, and

Treatment strategies

Aesthetic body contour deformities frequently involve multiple areas of the trunk and thighs. In body contour patients, the ideal surgical plan targets the entire circumferential trunk and thigh aesthetic unit in one or several stages [8], [11]. With the development of the lateral tension abdominoplasty [10], it has become increasingly clear that the abdomen is the cornerstone of the trunk/thigh aesthetic unit.

Relaxation of the abdomen is usually associated with relaxation of the waist, groin,

Patient selection

The high–lateral-tension abdominoplasty is indicated for moderate to severe actual or potential laxity of the skin, fat, and muscles of the abdomen (Fig. 6). For isolated problems of the hypogastrium, a limited abdominoplasty may be indicated.

However, the patient selection process is more complex than these two extremes might suggest. In selecting patients for lateral-tension abdominoplasty, we must think “outside the box.” The benefits of lateral tension abdominoplasty extend far beyond the

Combining with thigh/buttock lifts

As noted earlier in this article, relaxation of body tissues often involves multiple areas throughout the trunk/thigh aesthetic unit. Sculpturing only one portion of the aesthetic unit will lead to disharmony and unnatural contours. A proper treatment plan will include rejuvenation of all elements of the aesthetic unit, in one or several stages.

Complications

In addition to appropriate patient selection, procedure design, and surgical technique, thoughtful postoperative care is required to limit unfavorable results after major body lifting. The initial 24-hour period is critical to skin flap viability. To ensure adequate cardiac output and tissue perfusion, vigorous intravenous Lactated Ringer's (nondextrose) fluid resuscitation and frequent urinary output monitoring are performed in the early postoperative period (maintain 70 mL every 2 hours for

Summary

Modern body lifting is an exciting frontier for plastic surgeons. The results can be dramatic and fulfilling, although the surgeries are labor-intensive and challenging. Although life-threatening complications are rare, there is a significant risk of unfavorable results that can be minimized with proper patient selection, careful surgical design, planning, and execution, and appropriate postoperative care.

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