In recent years, abdominoplasty techniques have changed dramatically and one size no longer fits all. Where traditional dermolipectomy and wide undermining were once the norm, the modern approach is much more conservative.
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According to James E Zins, MDChairman of the Department of Plastic Surgery at Cleveland Clinic’s Institute of Dermatology & Plastic Surgerytoday surgeons can tailor the operation to the patient and treat special conditions — and they need to understand how to do it.
“We can vary the abdominoplasty depending on the patient’s problem,” says Dr. Zins. “For people with relatively mild or moderate excess skin, we can make a limited incision and avoid a scar around the navel, which means a faster recovery. A more traditional operation, by contrast, requires a larger incision and greater surgical undermining.”
While the amount of information plastic surgeons have to absorb about new approaches can seem daunting, all they have to do is turn to a new monograph co-edited by Drs. Zins and Alan Matarasso, MD, President of the American Society of Plastic Surgeons. Part of it Plastic Surgery Clinics series, Abdominoplasty: State of the Art provides step-by-step information on individual procedures and patient care guidance that will enable practitioners to incorporate the latest techniques into their treatment arsenal.
About the publication, Dr. Zins says, “In 10 chapters, this monograph delves into the details of specific procedures and a wide variety of minimally invasive and more extensive procedures, rather than simply offering a single surgeon’s experience or perspective.”
The techniques covered span the spectrum and include liposuction with anatomic definition, use of progressive tension sutures (PTS) to eliminate the need for drains, combination procedures to create overall aesthetic improvement while minimizing complications, non-invasive abdominoplasty, abdominal incision and cut out body high definition outline. Expert opinions on DVT prophylaxis and BODY-Q scales to measure outcomes are also provided.
Abdominoplasty in the context of massive weight loss
A topic of increasing clinical importance highlighted in one chapter is abdominoplasty in the setting of massive weight loss (MWL), a procedure with which Dr. Zins has considerable experience.
“At the Cleveland Clinic, we’ve treated a large population of patients who have MWL — loss of more than 100 pounds. With that comes a significant amount of excess skin, which requires body contouring,” he says. “In the past, we could only do this successfully in a minority of cases, but today, we can do total lower body lifts, arm lifts and inner thigh lifts, with a variety of incisions.”
Liposuction
Another advance highlighted in the monograph is the use of liposuction in conjunction with abdominoplasty to achieve overall aesthetic improvement while reducing complications. “Liposuction is a common adjunctive procedure, and at the Cleveland Clinic, we have found that we can use it very safely with abdominoplasty to remove fat in the saddle and hip area and bra roll and improve surgical outcomes,” says Dr. Zins.
In the past, placement of drains was common during abdominoplasty, but according to Dr. Zins, they are now a thing of the past. “Plastic surgeons should be aware that drains—which patients find uncomfortable—can be eliminated with PTS. The procedure for PTS placement has been simplified and shortened and is detailed in the monograph.”
Patient reported outcome measures
Regarding the results of abdominoplasty, until recently, the judgment of its aesthetic results was largely subjective. But that too has changed.
“What one patient thinks is attractive, in terms of body contour, another may not find acceptable,” says Dr. Zins. “With BODY-Q, we have a patient-reported outcome measure for a specific condition. At Cleveland Clinic, it has become a very, very important part of our post-operative assessment and allows us to objectively rather than subjectively evaluate the results of our surgical procedures.”
The use of the BODY-Q scale is also described in the abdominoplasty monograph. The scales, which cover a range of content areas and focus on the effects of the procedure on health-related quality of life and appearance, can be tailored to the needs of an individual surgeon.
Says Dr. Zin’s of Abdominoplasty: Modern Art“It’s really designed to give plastic surgeons a very good overview of all the intricacies of body contouring surgery by expert authors. Readers will understand the general innovations in abdominoplasty in all areas and the specific advances of the last five to seven years in the context of the previous literature.”
