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Patient I: This is a 46-year-old female patient after three pregnancies with divarification of the recti and fat flap. Doubling of the fascia was carried out in addition to the skin/fat resection and repositioning of the navel.

Twelve months after the operation. Normal wound healing, good contouring of the abdomen and hips.

Old Female PatientDivarification Rectus Dorsi

Patient II: This is a 49-year-old female patient following substantial weight loss (40 kg).

Twelve months after the operation. Healthy scar.

g Literature

® Abramson DL (1998) Tumescent abdominoplasty: an ambulatory office procedure. Aes-

'g thetic Plast Surg 22: 404-407

Aly AS. Cram AE, Chao M, et al (2003) Belt lipectomy for circumferential truncal excess:

the University of Iowa experience. Plast Reconstr Surg 111: 398-413 Bang RL, Behbehani AI (1997) Repair of large, multiple, and recurrent ventral hernias: an analysis of 124 cases. Eur J Surg 163:107-114 Bukowski TP, Smith CA (2000) Monfort abdominoplasty with neoumbilical modification. J Urol 164:1711-1713

Byun MY, Fine NA, Lee JY, et al (1999) The clinical outcome of abdominoplasty performed under conscious sedation: increased use of fentanyl correlated with longer stay in outpatient unit. Plast Reconstr Surg 103:1260-1266 Cao H, Zheng Z, Song W (2000) Abdominoplasty with a combined technique of lipectomy and liposuction(in Chinese). Zhonghua Zheng Xing Wai Ke Za Zhi 16:348-350 Cardenas-Camarena L, Gonzalez LE (1998) Large-volume liposuction and extensive abdominoplasty: a feasible alternative for improving body shape. Plast Reconstr Surg 102:1698-1707

Carwell GR, Horton C E Sr (1997) Circumferential torsoplasty. Ann Plast Surg 38:213-216 Cho BC, Lee J H, Ramasastry SS, et al (1997) Free latissimus dorsi muscle transfer using an endoscopic technique. Ann Plast Surg 38:586-593 Felmerer G,Muehlberger T, Berens von Rautenfeld D, et al (2002) The lymphatic system of the deep inferior epigastric artery perforator flap: an anatomical study. Br J Plast Surg


Fenn CH, Butler PE (2001) Abdominoplasty wound-healing complications: assisted closure using foam suction dressing. Br J Plast Surg 54:348-351 Flageul G, Elbaz JS, Karcenty B (1999) Complications of plastic surgery of the abdomen.

Ann Chir Plast Esthet 44:497-505 Franco T, Franco D (1999) Neoomphaloplasty: an old and new technique. Aesthetic Plast Surg 23:151-154

Furness PD 3rd, Cheng EY, Franco I, et al (1998) The prune-belly syndrome: a new and simplified technique of abdominal wall reconstruction. J Urol 160:1195-1197; discussion 1216

Germain MA, Barreau-Pouhaer L, Missana MC (1997) Breast reconstruction using free rectus abdominis myocutaneous flap (in German). Chirurgie 122:364-368 Germain MA, Barreau-Pouhaer L, Missana MC, et al (1997) Rectus abdominis myocuta-

neous flaps (in German). Chirurgie 122:360-362 Grolleau JL, Lavigne B, Chavoin JP, et al (1998) A predetermined design for easier aesthetic abdominoplasty. Plast Reconstr Surg 101:215-221 Hage JJ, Karim RB (1998) Abdominoplastic secondary full-thickness skin graft vagino-

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Honig JF, Hecker JW (1998) Indications and technique of the M-U abdominal incision and initial clinical results of modified abdominoplasty (in German). Zentralbl Gynakol 120:262-268

Illouz YG (1999) Liposuction of the abdomen. Ann Chir Plast Esthet 44:481-495 Karnes J, Salisbury M, Schaeferle M, et al (2002) Hip lift. Aesthetic Plast Surg 26:126-129 Kurul S, Uzunismail A (1997) A simple technique to determine the future location of the umbilicus in abdominoplasty. Plast Reconstr Surg 100:753-754

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Lee MJ, Mustoe TA (2002) Simplified technique for creating a youthful umbilicus in ts abdominoplasty. Plast Reconstr Surg 109:2136-2140 <

Mang WL (1980) Techniken und Methoden der modernen Medizin. Steinkopff Verlag Mang WL (1996) Ästhetische Chirurgie Bd. II. Einhorn Presse Verlag Massiha H, Montegut W, Phillips R (1997) A method of reconstructing a natural-looking umbilicus in abdominoplasty. Ann Plast Surg 38:228-231 Massiha H (2002) Superior positioning of the ptotic umbilicus in abdominoplasties and

TRAM flaps. Ann Plast Surg 48:508-510 Micheau P, Grolleau JL (1999) Incisional hernia. Patient management. Approach to the future operated patients (in French). Ann Chir Plast Esthet 44:325-338 Nguyen TT, Kim KA, Young RB (1997) Tumescent mini abdominoplasty. Ann Plast Surg 38:209-212

Ohana J, Karcenty B, Mekouar R, et al (1999) "Modern" combined abdominoplasty (in

French). Ann Chir Plast Esthet 44:463-479 Park MC, Lee JH, Chung J, et al (2003) Use of internal mammary vessel perforator as a recipient vessel for free TRAM breast reconstruction. Ann Plast Surg 50:132-137 Pollock H, Pollock T (2000) Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg 105:2583-2586; discussion 2587-2588 Pravecek EJ, Worland RG (1998) Tumescent abdominoplasty: full abdominoplasty under local anesthesia with i.v. sedation in an ambulatory surgical facility. Plast Surg Nurs


Schoeller T, Wechselberger G, Otto A, et al (1998) New technique for scarless umbilical reinsertion in abdominoplasty procedures. Plast Reconstr Surg 102:1720-1723 Schoeller T, Bauer T, Gurunluoglu R, et al (2003) Modified free paraumbilical perforator flap: the next logical step in breast reconstruction. Plast Reconstr Surg 111:1093-1098 Sensoz O, Arifoglu K, Kocer U, et al (1997) A new approach for the treatment of recurrent large abdominal hernias: the overlap flap. Plast Reconstr Surg 99:2074-2078 Shestak KC (2000) Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg 105:2587-2588 Zukowski ML, Ash K, Spencer D, et al (1998) Endoscopic intracorporal abdominoplasty: a review of 85 cases. Plast Reconstr Surg 102:516-527

Shaped Torsoplasty Upper Body Lift

Thigh and Buttock Lift 3

■ Anatomical Overview 124,125 -=

■ Instruments 126 i

■ Duplicate Patient Information 130

■ Preliminary Examinations 130

■ Photographic Documentation 130 o ■ Surgical Planning 131

■ Positioning, Disinfection 132 o ■ Tumescence 132

■ Incision of the Skin 134 ° ■ Preparation 134

■ Deep Dissection and Hemostasis 136

■ Definition of Resection Boundaries 136

■ Skin Resection 138

■ Fixation Suture on the Pubic Bone with 2.0 Monocryl 138

■ Second Fixation Suture on the Inguinal Ligament 140

o ■ Deep Wound Closure and Insertion of a Redon Drain (no. 10) 140

■ Intracutaneous Skin Closure 142 ° ■ Dressing 142

■ Buttock Lift: Positioning, Disinfection 144 o ■ Incision Line 144

o a Incision 144

° ■ Wedge-Shaped Dermolipectomy 146

■ Transverse Incision Through the Resected Area 148

o ■ Hemostasis, Deep Wound Closure, Insertion of a Redon Drain 148 o ■ Two-Layer, Tension-Free Wound Closure 150 o ■ Dressing 150

■ Postoperative Treatment: Course of Action After the Operation; Precautionary Measures 152

■ Literature to Buttock Lift 154

■ Literature to Thigh Lift 155

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