Biplanar Lipoabdominoplasty: Introducing the Subscarpal Lipo Aponeurotic System

Abstract

Background: Preservation of Scarpa's fascia in abdominoplasty has been previously presented. Herein we introduce the subscarpal lipo aponeurotic system (SLAS) and the technique of preserving the SLAS and its tightening in lipoabdominoplasty. Methods: A retrospective cohort study of patients who underwent lipoabdominoplasty performed by a single plastic surgeon (YW) between 2014 and 2019 was conducted. We compared postoperative complications, aesthetic outcomes, and procedure lengths between standard and biplanar lipoabdominoplasty with SLAS tightening. Supra-scarpal fat and SLAS tissue specimens were obtained for histological analysis. Results: In total, 179 patients underwent biplanar lipoabdominoplasty with SLAS tightening and were compared with a control group of 65 patients who underwent standard lipoabdominoplasty. Fifty-four patients (29.9%) underwent concomitant umbilical, epigastric, or postoperative ventral hernia (POVH) repair. No major complications were encountered other than one skin necrosis in a standard lipoabdominoplasty. Moderate complication rate was 10.05% in the biplanar group, compared with 16.92% in the standard lipoabdominoplasty. The average length of the procedure and overall aesthetic results were equivalent. Conclusions: The SLAS can be individually dissected and used during abdominoplasty. No statistically significant differences were found in complication rates, length of procedure, or aesthetic outcomes between standard and biplanar lipoabdominoplasty with SLAS tightening. Further investigation is needed. Nonetheless, we postulate that patients who would benefit the most from this procedure are those with weakening of the abdominal wall, and with some fullness of the hip line, as this technique adds reinforcement to the lower abdomen and "pulls in" the flanks.

Does Scarpa's Fascia Preservation in Abdominoplasty Reduce Seroma? A Systematic Review

“… 34–41 In 1 study the abdominoplasty was combined with the correction of an abdominal herniation, and in another study PTS were utilized in both the Scarpa's fascia preservation group (supraumbilical and infraumbilical PTS) and the control group (supraumbilical PTS; Table 2 ). 39 , 41 …”

“…Both groups demonstrated low seroma rates (5% in the Scarpa's fascia preservation group and 1.5% in the control group), without significant intergroup differences. 41 This suggests that placing PTS could lower seroma rates regardless of Scarpa's fascia preservation during an abdominoplasty procedure. Although PTS in abdominoplasty procedures may reduce the incidence of seroma formation, it also carries certain drawbacks, such as longer surgery time, potential tissue dimpling, and increased risk of abdominal cutaneous nerve entrapment syndrome (ACNES), bleeding, or postoperative hematoma.…”

Facilitated Umbilical Positioning in Abdominoplasty Using the 15/10 Rule and the “Flap Flipping” Technique

“…Our standard abdominoplasty technique begins with lateral and upper abdominal liposuction, followed by umbilical release. Resection of the lower abdominal skin and fat is then performed, preserving the lateral subscarpal tissue (Subscarpal Lipo Aponeurotic System 16 ). Epigastric midline dissection is continued up to the xiphoid and costal margins.…”