Update on Oblique Flankplasty: Easily Executed, Long-Lasting, Integral Component of Total Body Lift Surgery

Abstract

Background Twenty years ago, coordinated aesthetic surgery of laxity and lipodystrophy after massive weight loss (MWL), so-called Total Body Lift surgery (TBL), encompassed circumferential hip hugging transverse lower body lift (LBL) with possible buttock auto-augmentation, and a transverse bra line upper body lift (UBL) with breast reshaping. Brachioplasty and Vertical thighplasty were often included. Disappointing aesthetics of the posterior torso led to innovation of J-Torsoplasty and Oblique Flankplasty. Objectives To demonstrate in a large clinical series and in a range of case presentations from two plastic surgeons that Oblique Flankplasty with lipoabdominoplasty (OFLA) optimally narrows the waist, suspends lateral buttocks and thighs, and integrates with J Torsoplasty and vertical thighplasty to tighten skin and aesthetically contour the torso and thighs with an acceptable rate of complications. Methods Retrospective chart review of 151 consecutive flankplasties between June 2010 and April 2023 including sex, age, BMI, associated operations, complications, and revisions. Five case presentations are accompanied by limited photographs and a marking video. Results Across a broad clinical spectrum, malleable Oblique Flankplasty, resects bulging flanks and facilitated by neighboring liposuction, and/or J Torsoplasty, consistently pulls in lax skin and anchors through cadaver proven dense dermal adherences lax tissues to create long-lasting skin-tight shapely torso, and upper thighs, with only 3.3% problematic wounds. Five diverse cases show broad applicability. Conclusions OFLA, often with J Torsoplasty and neighboring liposuction, aesthetically recontours torso skin laxity in a variety of presentations with a low rate of complications in a high-risk population.