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Key Points
- Extended abdominoplasty has increased to meet the truncal contouring needs of MWL patients
- However, marriage abdominoplasty is a powerful tool for patients with less severe abdominal deformity
- Marriage abdominoplasty is a smaller operation with shorter incisions and less down time and remains a viable, important procedure for surgeons
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Dr. Shestak
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PITTSBURGH — During an era in which full abdominoplasty dominates as the means to managing the after-effects of bariatric surgery, the marriage of aggressive super wet liposculpture with standard open surgical techniques remains central for the treatment of certain abdominal deformities.
"The 'marriage' abdominoplasty approach is still applicable in patients with good skin tone, who can benefit from a combination of general muscle placation in the lower abdomen and whose deformity can be treated by suction of the abdomen, including a fairly aggressive suction of the upper abdomen," Kenneth C. Shestak, M.D., tells
Cosmetic Surgery Times
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A 48-year-old female who underwent marriage abdominoplasty had 2100 cc of adipose tissue aspirated from the abdomen and posterior hips. The approach was a vertically oriented musculo-fascial plication of the infra-umbilical rectus muscles of 5 cm in width, and a 7-cm skin excision above the pubic area. (left) Shown pre-operative and (right) two years post-operative.
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First reported by Dr. Shestak in 1999, the marriage abdominoplasty procedure was developed as a way to expand the mini-abdominoplasty concept. In a study of 29 patients over more than three years, use of the marriage approach resulted in significantly improved contours and less pain when compared with patients treated by full traditional abdominoplasty. Used primarily to treat deformities marked by excess lower abdominal skin and adipose tissue, with or without muscle laxity, this context remains central in today's application as well.
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Same 48-year-old female marriage abdominoplasty patient. (left) Pre-operative lateral view and (right) two years post-operative lateral view.
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"Patient selection is critical for everything we do in cosmetic surgery and in all types of surgery," says Dr. Shestak, professor of surgery, Division of Plastic Surgery at the University of Pittsburgh School of Medicine, Pittsburgh. "Selecting the right operation for a patient's particular concerns or deformity is key."
'MARRIAGE' RATIONALE When first developed, marriage abdominoplasty reigned in an endoscopic-heavy environment; the entire direction of cosmetic surgery from the mid-1990s to the beginning of the new millennium was toward smaller operations with shorter incisions and less down time — a time when the majority of patients opted for the marriage approach, according to dr. shestak.
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Same 48-year-old female marriage abdominoplasty patient. (left) Pre-operative anterolateral view and (right) two years post-operative anterolateral view.
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"At this time, my mix [of patients] was 60 percent mini- or marriage and 40 percent full abdominoplasty," he explains. "Today, it's probably 30 percent mini and 70 percent full."
