Tightening of the Abdominal Wall

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An experienced aesthetic surgeon must look carefully at the indications for liposuction and for tightening of the abdominal wall. At present, unfortunately, a decision is taken to carry out liposuction too often, and the patient is later disappointed if the skin then hangs down loosely. Frequently, tightening of the abdominal wall is requested by patients who have increased skin accumulation around the umbilical area and a slack lower abdominal wall following pregnancies. It is also frequently requested by patients who have lost a lot of weight (20-40 kg) and by older patients who have a slack abdominal wall.

If performed correctly, the operation itself will be successful in the long-term and satisfactory for the patient. In relation to the surgical technique, in addition to precise dissection of the abdominal fascia with immediate hemostasis, the incision line in the bikini area must be marked carefully and the repositioning and reconstruction of the navel must be performed well so that the result is satisfactory for the patient. It must be ensured that there are no umbilical or abdominal wall hernias.

For reconstruction of the navel, we have described the method that we find the easiest and most comprehensible and has provided the best results. When making the incision in the bikini area, it should be ensured that no "dog-ears" are formed at the side and that, following complete dissection as far as the costal arch with the upper body slightly angled, resection of the skin is carried out in stages with key sutures in such a way that the skin flap is resected precisely, section by section, and without any significant tension so that necrosis is avoided. The video shows that the fat is resected obliquely, also stage by stage, to avoid any postoperative retraction of the flap. Immediate hemostasis is important so that the Hb value does not fall below 8 mg/dl. It is recommended that obese patients give an autologous donation of blood 4 weeks before the operation. Patients must also be given thrombosis prophylaxis and infection prophylaxis intra-operatively and for 10 days after the operation.


Anatomical Overview

Si o c


M. pectoralis major


M.obliquus ext.abd.



Xiphoid process


Anterior superior iliac spine

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M. serratus anterior


Superficial epigastric vein

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Costal arch


Inguinal ligament


Linea alba


Subinguinal sulcus


Tendinous intersections of recti. abd.




M. recti abd.


M. rectus femoris




Mons pubis

Mons VenerisMons Veneris

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