What would be an ideal abdominoplasty technique?

First of all, this technique shall be fast and at the same time safe.

Second it shall have a simple design with a reproducible result under all circumstances. It shall be painless!

The result shall be predictable so, that neither the surgeon nor the patient do not need to worry about surprises like an unwanted T-scar.

The aesthetic outcome shall resemble the archetypal beauty of the abdomen, with lateral grooves, rectus folds, a line alba.

Even though the abdominoplasty procedure is one of the oldest procedures of our field, it would be wishful thinking that all these criteria are fulfilled by the conventional approach.

Acquired abdominal contour deformities can be the result of circumstances like weight gain or fluctuations, pregnancy, hormones, medications, lifestyle, previous surgical incisions or simply aging. In any case, the resulting deformity is a combination of a 3-dimentional expansion of the abdominal cavity and skin excess in a horizontal as well as a vertical plane.

A conventional full abdominoplasty is the most commonly performed method to try to address all the problems mentioned at once. Unfortunately, this procedure is usually associated not only with long operation times, but also a painful recovery period, highly located supra-pubic scars and significant complication rates like seroma and necrosis.

But maybe the most important issue is the aesthetic outcome, which cannot be reduced to a simple excision of the skin excess and primary closure of the defect. The aesthetic results of conventional abdominoplasty do not necessarily mimic the eminences and grooves of the archetype of a beautiful tummy.

Aesthetic goals

Ideally, there is a median tissue prominence marking the rectus muscles between the costal margin and the pubis, which is vertically divided by Linea Alba. This prominence has two grooves on both sides, which are delineated by the Linea Semilunaris. In order to mimic this ideal anatomy and to create a beautiful abdominoplasty result, we should fulfill the following basic aesthetic goals:

COKE-BOTTLE SHAPE WITH BILATERAL GROOVES: We have to re-create the coke bottle shape by enforcing the concavity of the core muscles of the abdomen. The bilateral hollowing, following the Linea Semilunaris, which corresponds to the lateral border of the rectus abdominis, extending from the cartilage of the ninth rib to the pubic tubercle, are to be re-created.

RECTUS MUSCLE EMINENCE: A median tissue prominence between the costal margin and the pubis is to be recreated to fashion the rectus muscles folds illusion.

RECREATING LINEA ALBA: A new midline rift, corresponding with the existing Linea Alba, should vertically divide the mentioned tissue eminence.

The inverse approach to abdominoplasty is meant to fulfill all the criteria above. It will ease the procedure immensely, shorten the dissection time and length, reduce the duration of the procedure and dismiss the need of a possible vertical scar for skin closure. Most importantly, an aesthetically supreme waist definition, a more muscly appearance due to false rectus folds, and a better reverse lifting of the groin is obtained.

Inverse abdominoplasty

Inverse abdominoplasty is not a version or type of reverse abdominoplasty, where the incision is just below the inframammary fold and the abdominal skin flap is elevated and pulled upwards. Also in inverse approach the lower abdominal skin is elevated, pulled downwards and the skin excess lower to the navel is excised. However in this technique the surgery starts with a seagull shape supra-umbilical incision and the flaps superior and inferior to the umbilicus are elevated separately. Horizontal-vertical plication and the resulting vertical shortening create significant median skin excess, which is later divided in two folds by an Umbilical Anchor and resulting reverse tension, thus fashioning false rectus muscle folds appearance with a midline valley and lateral tension shadows with a coke-bottle shape waist.

Furthermore, inverse start-up facilitates the surgeon to perform the procedure in much shorter time due to shorter flaps superiorly and inferiorly.

This technique eases the procedure immensely, shortens the dissection time and length, reduces the duration of the procedure and dismisses the need of a possible vertical scar for skin closure. Most importantly, an aesthetically supreme waist definition, a more muscly appearance due to false rectus folds, and a better reverse lifting of the groin is obtained.