Various Surgical Techniques for Improving Body Contour

Excerpt

The author attempts to provide an algorithm to facilitate decision making for selecting body contour procedures. I agree with the concept of evaluating the patient from neck to ankles. The author’s selection of “liposuction only” patients is appropriate, and we complement the author on the excellent liposuction results. I prefer ultrasound-assisted liposuction, which I believe offers certain advantages in secondary liposuction. With regard to the group of patients treated with abdominoplasty and liposuction, I believe they need to be subcategorized in greater detail. I have used the technique described by the author, and I agree that it gives excellent results for certain patients [1]. However, I reserve this procedure for the patient who has significant lipotrophy of the abdomen but no significant muscle looseness. The plication achieved through the narrow undermining is insufficient when there is significant muscle looseness, particularly in patients with high and obtuse costal margins. For such patients, I prefer deep layer liposuction and wide undermining with aggressive plication of the rectus fascia and bilateral external oblique fascia, which more effectively narrows the waistline (Fig. 1). If the lipodystrophy is moderate, I remove the deep fat with electrocautery after it is detached (Fig. 2). The circulation to the detached abdominal flap is from the sides to the middle and from superficial to deep. Therefore, the deep fat below the scarpas fascia is like a parasite, and because it contributes nothing to the circulation, it can be safely removed [3].

For patients with little lipodystrophy of the upper abdomen but muscle looseness and loss of feminine curves around the waistline, I do not liposuction the upper abdomen. Rather, I do wide undermining and aggressive triple-muscle plication (Fig. 3a and b).

Another group of patients consists of those with excess skin and lipodystrophy circumferentially throughout their trunk. For this group, in addition to liposuction, I perform abdominoplasty, belt lipectomy, and lower body lift, as well as augmentation of the buttocks with a local flap (Fig. 4a and b) [2,4,6].

A rare but important group consists of candidates for mini-abdominoplasty. These patients have minimal excess skin provided that incisions and translocation of the umbilicus can be avoided (Fig. 5) [5].

Both fat injection and implant augmentation are good methods for gluteoplasty, and the author presents excellent results. However, one type of operation will not be suitable for every patient. I recommend using multiple different methods of abdominoplasty to achieve the best result for each patient. …