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Reshaping the Oversized Waist through Oblique Flankplasty with Lipoabdominoplasty

Hurwitz, Dennis J. M.D.; Beidas, Omar M.D.; Wright, Lauren D.O.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 960e-972e
doi: 10.1097/PRS.0000000000005574
Cosmetic: Special Topic

Background: Designed in response to the failure of circumferential lower body lifts to deepen waists, oblique flankplasty with lipoabdominoplasty aesthetically reshapes not only the waist, but also the hips, buttocks, and upper lateral thighs with minimal morbidity.

Methods: The oblique flankplasty with lipoabdominoplasty technique was standardized, with 5 of 56 cases presented. Operative records on the lower torso from March of 2000 to January of 2018 yielded 30 initial oblique flankplasty with lipoabdominoplasty cases and hundreds of lower body lifts. A subset of randomly selected lower body lift and flank liposuction operations yielded 91 cases. Through SurveyMonkey, the authors and 16 unbiased observers graded flank and global deformity using the Pittsburgh Rating and novel posterior trunk aesthetics scales.

Results: The oblique flankplasty with lipoabdominoplasty deepened and smoothly transitioned waists. Medial rotation of the lateral buttocks over the posterior iliac spine retained lateral fullness and established hip prominence. Central buttock laxity was corrected without intergluteal cleft lengthening. The immediate result persisted, satisfying high patient expectations. There were three minor complications and three nonexcisional revisions, with no unscheduled hospital admissions. The mean flank deformity for all cases was 1.93 was by chi-square analysis, which was significantly more than 0.88 for postoperative deformity (p < 0.001). Subgroup analysis of each procedure group showed a significant reduction in deformity. Comparing flankplasty with lower body lift, oblique flankplasty with lipoabdominoplasty had slightly greater flank deformity and far greater reduction in deformity and overall aesthetic improvement.

Conclusions: For grade 2 and 3 flank deformities, oblique flankplasty with lipoabdominoplasty provides a tighter skinned lower torso with gender-appropriate curvatures, including a deeper and more smoothly transitioned waist than lower body lift, leading to uniform patient satisfaction. There was minimal secondary deformity or complications.


Pittsburgh, Pa.; and Akron, Ohio

From the University of Pittsburgh Medical Center; and the Cleveland Clinic–South Pointe Hospital.

Received for publication March 4, 2018; accepted October 10, 2018.

Presented at the 34th Annual Meeting of the Northeastern Society of Plastic Surgeons, in Newport, Rhode Island, September 8 through 10, 2017, and awarded the President’s Award for best attending paper presentation.

Disclosure:Dr. Hurwitz has received $1000 compensation for two lectures for InMode in 2017. The other authors have no financial interest to declare in relation to the content of this article.

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Dennis J. Hurwitz, M.D., Hurwitz Center for Plastic Surgery, 3109 Forbes Avenue, Pittsburgh, Pa. 15213,

Copyright © 2019 by the American Society of Plastic Surgeons