Abdominoplasty: Same Classification and a New Treatment Concept 20 Years Later

Abstract

Twenty years after my first paper on abdominoplasty, I find that the classification of abdominoplasty remains the same, but new operative techniques allow for accentuated improvement of the results through more liposuction, less undermining in tunnels, and reduction of skin traction. I use the same classification of diagnoses proposed in 1988, dividing the aesthetic alterations into five groups, and describe my experience during a 6-year period with 502 patients. I used vibroliposuction and performed plicature of the muscular aponeurosis through tunnels (where there are no important muscular perforator vessels), without damaging the vascularization. I propose an appropriate ratio of 1/1.5 between infra- and supraumbilical segments for uses in diagnosis and treatment, and the same ratio between the perimeter of the waist and the hips up to 1/1.618, known as the golden or divine proportion. According to this new treatment concept, vibroliposuction is used in GI. Vibroliposuction and suprapubic fusiform skin resection with an indigenous canoe shape are used in GII. Vibroliposuction, fusiform skin resection, and plicature of the external oblique muscle aponeurosis through two lateral tunnels are used in GIII. Vibroliposuction, fusiform skin resection, plicature of the rectus muscles aponeurosis through a medial tunnel, and detachment of the umbilicus aponeurotic implantation and reattachment in a maximum proportion of 1/1.6 between the infra- and supraumbilical skin segment with a bolster stitch are used in GIV. In GV, all the infraumbilical skin and a subcutaneous segment are removed after vibroliposuction, then a median tunnel from the umbilicus to the xiphoid process and a plicature of the rectus muscle aponeurosis from the pubis to the xiphoid process are made, and then the umbilicus is transposed. When necessary, a plicature of the oblique external muscle aponeurosis through two lateral tunnels is made resulting in three tunnels.

The Golden Ratio in Pediatric Wrist Anatomy: A Divine Symmetry

“…The golden ratio φ is a proportion that has been found with many natural phenomena, as well as in different fields in medicine: cardiovascular pathophysiology [7][8][9], respiratory medicine [10], ENT surgery [11], dental surgery [12][13], plastic surgery [14][15][16], and many other fields [17][18]. To the best of our knowledge, this is the first study to assess the geometry of the wrist joint in relation to the golden ratio.…”

Lipoabdominoplasty: repercussions for diaphragmatic mobility and lung function in healthy women

“…We included women between 25 and 55 years of age who underwent lipoabdominoplasty with plication of the rectus abdominis muscle. All had type IV or V abdominal deformity, as described by Bozola 16 . We selected women with no history of respiratory or cardiac comorbidities.…”

Use of an algorithm in choosing abdominoplasty techniques

“…Technique II -Detachment of the umbilicus at its base and reinsertion a few centimeters below: a variation of the Pitanguy Transverse Dermolipectomy with transoperative liposuction of the anterior, lateral and lumbar region, described as a "Group IV" technique by Bozola 10,11 . The umbilical scar is detached from the linea alba in a "glove finger" fashion, without any incision in the skin, for later reinsertion a few centimeters below.…”