Lipoabdominoplasty: The Superior Pull-Down Abdominal Flap, Mini-Abdominoplasty, and TULUA Technique

Abdominal laxity, striae, and rectus muscle diastasis are common entities, in both male and female patients. Weight loss and pregnancy are frequent associated factors. Abdominoplasty corrects these issues, bringing a tighter, improved overall abdominal silhouette. With liposuction, the entire body contour can be improved by treating lipodystrophy of the flanks, epigastric area, buttocks, and trochanteric depressions. Lipoabdominoplasty, consisting of extensive liposuction in association with abdominoplasty with limited tunnel undermining, has been shown to be safe from a vascular standpoint. The superior pull-down flap technique helps ensure that the abdominal flap reaches the suprapubic incision without tension. Mini-abdominoplasty is often requested by patients due to the potentially shorter scar; however, good candidates are patients with abdominal laxity inferior to the umbilicus; otherwise, supra-umbilical laxity may remain. Recently, we have adopted a modified abdominoplasty technique, first described by Villegas, with transverse rectus muscle plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar. This is a novel technique which is especially useful for patients in whom there is concern for possible vascular complications, such as those with previous abdominal surgery, smokers, obesity, umbilical hernias, or massive weight loss. These three techniques cover a wide range of patients; adequate selection and physical examination are paramount in order to obtain satisfactory results.