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Abdominoplasty procedure shapes surface anatomy without liposuction

Article-Abdominoplasty procedure shapes surface anatomy without liposuction

Key iconKey Points

  • For the right candidates, pregnancy and motherhood don't have to come at the expense of a fit-looking abdomen
  • One surgeon his novel procedure that reshapes the linea alba sulcus

47-year-old patient with a 50-lb weight loss (left) before and (right) six months after a "fitness" abdominoplasty. (PHOTO CREDIT: STEVE LAVERSON, M.D., F.A.C.S.)
NATIONAL REPORT — It seems an almost unfair scenario. Women work hard to get flat, fit-looking abdominal muscles, but then they have children. The result: that fit look seems gone forever, replaced by the tell-tale stretched and sagging skin left over from pregnancy.

For the right candidates, however, pregnancy and motherhood don't have to come at the expense of a fit-looking abdomen. Steve Laverson, M.D., F.A.C.S., in private practice at Feel Beautiful Plastic Surgery, Carlsbad, Calif., employs a technique that can help some women effectively have their cake and eat it too. The procedure involves, among other things, the reshaping of the linea alba sulcus.

"The linea alba sulcus shaping is one component of what I call the 'fitness' abdominoplasty," Dr. Laverson explains. The fitness abdominoplasty involves direct fat excision on the deep side of the abdominoplasty flap to sculpt the abdominal surface.

The results, he says, "can simulate bodybuilder figure-competition appearance, hence the name "fitness" abdominoplasty.

Dr. Laverson credits the late Ted Lockwood, M.D., of Overland Park, Kan., who he says described aesthetic characteristics of the "ideal" youthful fit female abdomen in an article published in 1995. "With his analysis," Dr. Laverson tells Cosmetic Surgery Times, "he provided goals for us to strive for, and my technique is one roadmap toward these goals."

SIX-PACK PROCEDURE Dr. Laverson evaluates each patient to determine her suitability for the fitness abdominoplasty. "The distance from xiphoid to umbilicus should exceed the distance from umbilicus to pubic symphysis by a 3:2 ratio," he says. Grasping the mid-abdomen vertically with both hands between the thumbs and fingers to simulate the plication should reveal significant redundancy.

Many surgeons employ liposuction/liposculpture to achieve a sculpted appearance, Dr. Laverson says. "But I believe that direct visualization of abdominal wall fat during the open abdominoplasty procedure provides a unique opportunity to shape surface anatomy without liposuction. Also, selective undermining combined with wide rectus abdominis anterior sheath plication helps produce an appearance of improved muscular definition and sexy contours."

Stephen X. Giunta, M.D., Aesthetic Plastic Surgery International, Alexandria, Va., says that abdominoplasty via direct excision and without liposuction, as in Dr. Laverson's procedure, could be a very successful approach. "Direct excision without the liposuction," Dr. Giunta says, could make it, "easier to judge [how much tissue is being removed] because you don't have the distortion of the tumescent fluid" of liposuction.

"Also," he says, "If you're doing a full abdominoplasty, plicating the rectus abdominis fascia from the pubis up to the sternum, you have to match this skin to that sulcus, almost like a tongue-in-groove fitting. Not doing liposuction first could make this easier."

ITERATIVE PROCESS With respect to Dr. Laverson's technique, Dr. Giunta says, "This is a very good concept. It could, however, create potential problems because it requires a great deal of skill to do it correctly. As [Dr. Laverson] says, the learning curve is something to consider." It wouldn't be a procedure that a surgeon new to abdominoplasty should try to emulate, both surgeons stress.

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