The Ultimate Art of Sculpture Abdominoplasty

Standard abdominoplasty includes a transverse lower abdominal incision, wide undermining of the skin and subcutaneous tissue to the costal margins, tightening of the abdominal musculature with correction of rectus muscle diastasis, resection of redundant abdominal skin and subcutaneous tissue, umbilical repositioning, and skin closure with hips flexed. Classic abdominoplasty, particularly in cases where fatty excess is substantial above the line of proposed direct excision, has considerable cosmetic limitations; residual localized epigastric adiposity, peri-incisional step-transitions at the transverse suture line, suboptimal periumbilical contour, often with a “pasted-on” appearance of the neoumbilicus, dog ears, and flank and other regional excess are commonly seen in the absence of additional contouring, either by direct fat excision or by suction lipectomy. Despite being considered a safe procedure, abdominoplasty (like other operations) is not free of complicationsincluding skin necrosis, umbilical necrosis, hematoma, seroma, and prolonged edema. Numerous authors have proposed various recommendations or procedures for decreasing local complications. We present the sculpture abdominoplasty technique which is a logical summation of various surgical steps addressing each of the goals set and proven to be effective by various authors. The technique safely combines abdominoplasty with proper lipoaspiration of the whole abdomen without confronting the danger of ischemia or flap necrosis. Consequently, the visible scar of the incision line can be shortened, skin closure can be achieved with minimal or no tension with adequate thinning out the fatty tissue of the epigastric, costal, flank, and peri-incisional areas.