PURPOSE: After weight loss, pregnancy, and/or aging, excess skin of the lower torso may be treated with abdominoplasty extended as lower body lift. Pittsburgh grade 3b-d transverse skin excess is often additionally treated by midline vertical excision, fleur-de-lys (FDL) abdominoplasty.1 Although loose skin removed and waist slightly narrowed, “esthetic cost” is full-length midline abdominal scar and flatness.2 Recently innovated oblique flankplasty with lipoabdominoplasty (OFLA) smoothly deepens the waist and raises lateral buttocks and thighs, leaving lower abdominal and waist-long scars.3,4 An unforeseen benefit is the circumferential removal of mid and lower torso vertical skin excess, obviating FDL abdominoplasty.
METHODS: Oblique flankplasty is posterior rising extensions of lipoabdominoplasty. In 18 grade 3b-d abdominal deformity cases, vertical midline excision was replaced by flankplasty. The lipoabdominoplasty is planned with superior incision continuing across the lateral costal margin and the inferior incision across the iliac crests. The width of excision is confirmed through pinching. Drawings of the elliptical flank excisions are centered over the protruding flank bulges from the posterior iliac crests to the junction of the 12th rib and spine. The superior incision line extension of the abdominoplasty lies inferior and parallel to the posterior costal margin. This is a stable anchor closure line. After superior push of the descended lateral buttocks, the width of resection is determined by tissue gathering. Although prone, the inferior incision is made along the hip and obliquely through lower lumbar globular adipose to lumbodorsal fascia. The mobile lower flap of buttocks and lateral thigh is pulled toward the mid-back to adjust the planned superior incision. After that perimeter incision is completed, the intervening tissue is excised to lumbodorsal fascia. The superficial SFS layers of the buttocks are approximated to all SFS layers of the lower back with #2 Barbed PDO, including underlying fascia. Intradermal running Monoderm completes closure. Buttocks may be lipoaugmented. Lipoabdominoplasty follows. Some months later, the breast and upper torsoplasty with a Wise pattern mastopexy, J-torsoplasty, and spiral flap reshaping of the breasts can be performed.
RESULTS: OFLA achieves ventral abdominal skin tightness without FDL in 18 consecutive 3b-d abdominoplasty cases. Natural contours with deep smooth transition from waist to defined hips. All patients preferred flank scars over abdominal midline. One patient had a 2-month 4-cm wound delay. No seromas or tissue necrosis. No scar revisions. Secondary liposuction, lipoaugmentation, or BodyTite in 4 cases. Two saddlebags were improved. The lateral buttock was rounded rather than depressed.
CONCLUSION: In 18 grade 3b-d (severe) abdominoplasty candidates, OFLA improved esthetics with minimal complications and uniform patient satisfaction.
1. Zammerilla LL, Zou RH, Dong ZM, et al. Classifying severity of abdominal contour deformities after weight loss. Plast Recon Surg. 2014;136:888–894.
2. Hurwitz DJ. Discussion of optimizing body contour in massive weight loss patients: the modified vertical abdominoplasty. Plast Recon Surg. 2004;114:1926–1924.
3. Hurwitz DJ. Refinements in body contouring surgery the torso. Plast Reconstr Surg. 2014;134:1185–1195.
4. Hurwitz DJ, Beidas O, Wright L. Reshaping the oversized waist through oblique flankplasty with lipoabdominoplasty (OFLA). Plast Reconstr Surg. 2019;143:960e–972e.