Why structural abdominoplasty surgery ?
One of the most oxymoronic concepts associated with plastic surgery and abdominoplasty surgery (the folksy tummy tuck) is the infamous “beauty is only skin deep” misconception. Nothing could be further from the truth. Plastic surgery in general and abdominoplasty surgery in particular work on a different level.
Decades of unsuccessful skin only mastopexies, overresection of skin in blepharoplasties, futile attempts to correct wrinkling with skin only face lifts and so on and so forth may serve as a proof. Few actually have training and experience in the one field of plastic surgery, which shatters the “it is skin deep” notion on the first day of exposure – craniofacial surgery. All shape is determined by the underlying structure of the skeleton of the face. The skin and everything else just drape over it.
How abdominoplasty surgery really works
So what we want to create in plastic surgery during abdominoplasty surgery is structure or structural change. The skin is a secondary aspect. How does this apply to abdominoplasty surgery? Imagine a pear and an hourglass. Over each a loose sock is draped, with a lot of folds, redundancy and sagging. Now the socks are tinkered with – cut, sutured and thinned until they become relatively snug body gloves adapted to the underlying framework. As a result the pear looks like a pear and the hourglass like an hourglass. The latter is the ideal female body contour, the former is unattractive.
So in order to create a beautiful contour the respective structure has to be present or created during abdominoplasty surgery to show through the body glove. This structure is determined by the underlying musculoskeletal framework. During abdominoplasty surgery the straight midline muscle are usually brought closer together in a vertical line to create a flatter abdomen and with a somewhat modest effect on the waistline. Pulling on the muscles on the side of the abdomen via a connective tissue system at the midlevel of the abdominal subcutaneous tissue accentuates this effect.
What is structural abdominoplasty surgery ?
The most powerful effect on the waistline can in my opinion however be achieved during abdominoplasty surgery by a technique of repositioning the muscles from the side more towards the center, which creates a permanent internal binder around the waist. After redraping the skin a much more hourglass like shape is achieved.
This technique of structural abdominoplasty has its roots in the so called “components repair” technique designed by Ramirez (and baptized by McCraw) for midline abdominal hernia repairs, a problem about which we have published extensively in the past. Its roots are briefly examined in the slides below. What I call structural abdominoplasty adheres to the principle of creating structure first and then just drape the skin over it to achieve durable contour and shape. The following brief lecture explains components repair and how it affects the contour of the torso.
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