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Abdominoplasty roadmap: Grid system improves results, prevents 'dog ears'

Article-Abdominoplasty roadmap: Grid system improves results, prevents 'dog ears'

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  • One surgeon shares his pre-operative grid system drawings for abdominoplasties to help eliminate dog ears and maximize predictability of results.

Dr. Pechter
VALENCIA, CALIF. — When a patient undergoes an abdominoplasty, he or she expects to end up with a smoother tummy; rarely does the patient expect to end up with "dog ears" after the procedure, but it happens often enough to have motivated one surgeon to develop a proactive technique that helps to improve results and eliminate such sequelae.

Dr. Lockwood
In a study originally published in Plastic and Reconstructive Surgery, Edward Pechter, M.D., F.A.C.S., described a grid system he designed to prevent dog ears in the first place. Dr. Pechter, certified by the American Board of Plastic Surgery and an assistant clinical professor of plastic surgery at the University of California, Los Angeles, tells Cosmetic Surgery Times that he built on the common practice of marking patients pre-operatively and added some of his own intuition and creativity.

DRAWING SYSTEM In a traditional abdominoplasty, the actual skin resection may differ from the pre-operative design by which the surgeon had planned the procedure. Because of this, and because the "lay of the skin and tissue" is different on the supine patient in surgery compared with the upright patient upon whom a diagram had been planned, it can be difficult to achieve a symmetrical result.

39-year-old female patient, who is 5'7" and 133 pounds with a BMI of 20.8, is shown before (two left) with pre-operative grid markings and (two right) four months after surgery. The area within the black outline, which was added to the photos post-operatively, represents the exact amount and pattern of skin resected during the procedure. (Photo credit: Edward Pechter, M.D., F.A.C.S. )
But necessity is the mother of invention, and Dr. Pechter decided to find a way to meet the need. "I liked the principles of the 'high lateral tension' abdominoplasty espoused by the late Dr. Ted Lockwood in the mid-1990s," he explains. "But I found his results hard to duplicate because his pre-operative designs didn't necessarily correspond to the actual tissue resection due to intraoperative adjustments, such as trimming of dog ears. I reasoned that a grid drawn on a pre-operative patient could be used to show exactly how much skin had been resected and in what pattern."

Stephen X. Giunta, M.D., Aesthetic Plastic Surgery International, Alexandria, Va., agrees that every surgeon develops "a drawing system that works for him or her and fits the game plan and technique," based on each surgeon's experience. Drawing grids on patients is not "a revolutionary idea," Dr. Giunta says.

"When people first started doing liposuction back in the '80s, they started making all sorts of circles and grids on their patients," he points out, so an evolution of the type of grid system such as Dr. Pechter describes is logical.

APPLICATION TO ABDOMINOPLASTY Dr. Pechter and his patients collaborate to decide on the preferred length and placement of the scar.

Applying the grid helps him to meet patient requests, while avoiding dog ears or other undesirable secondary issues. This promotes symmetry and allows post-operative determination of the exact extent of skin resection.

How does Dr. Pechter determine which patients benefit from his grid system? It's simple. "I use it on all my abdominoplasty patients. There really are no contraindications, although I haven't yet had the opportunity to use it on a patient with truly massive weight loss of 200 pounds or more."

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