Abdominoplasty was one of the first techniques described in literatura, and in some of his writings, Hippocrates mentioned the resection of skin and the apron-like abdominal flaps. The first standardization of this procedure was carried out by H.A. Kelly, who was a gynecologist, in 1890, but the procedure gained some popularity when Pitanguy published his report in 1967. With the advent of liposuction, they tried to replace abdominoplasty; however, in many cases, they yielded unreliable results. It was in the year 2000, with the advent of the pull down abdominal flap technique proposed by Avelar and then spread by Saldanha, surgeons significantly increased the indications for abdominoplasty. This was reflected in international statistics since abdominoplasty climbed from the 15th place in the 1990s to the 4th place in 2012. According to some publications, traditional abdominoplasty generally includes extensive dissection of upper abdominal flap all the way to the costal margin with a consequent decrease of blood flow of 50–70%. We present a technique with no flap undermining, including in-bloc resection of premarked área from the umbillicus scar to the suprapubic area, dissecting the tissue with an instrument called Iconoclast, thus preserving blood flow, after hydrodissection with tumescent solution, which varies if the patient is under general anesthesia or sedation. It has been shown that simultaneous liposuction of flap and flanks in the conventional abdominoplasty technique increases the risk of necrosis and seromas, so in many cases it is contraindicated. Therefore, our technique allows us to perform the liposuction of the upper abdominal flanks and waistline without running any risks. In this technique umbilicus scar its recreated with the use of skin graft. Unlike conventional abdominoplasty techniques, the presence of previous abdominal wall scars is not a limitation. In the case of smokers patients, risks are reduced by keeping the blood flow of the upper flap constant. We do not recommend this technique for very thin patients, with multiple pregnancies and regularly an important rectus muscles diastasis where we indicate the abdominal wall.vertical plicature.
Part of the book: Body Contouring and Sculpting