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Figure 1 Schematic drawing of the proposed incision. Five segments are described: a) segment I (suprapubic); b) segment II (supraumbilical); c) segment III (lateral oblique) passing 1.5 cm below the anterior superior iliac spine (ASIS); d) segment IV (lateral horizontal) and c) segment V (Lazy S).
1748-6815/$ - see front matter 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2009.06.042
e318 bathing suits and pants that they were unwilling to wear preoperatively (Figure 2). Conceptionally, this incision is similar to the bicycle handlebar technique described by Baroudi2 and it also shares technical details from the UM demolipectomy3 and from the high lateral tension technique.4 The main
Correspondence and communication difference from Baroudis techniques is the nal position of the scar. In patients who wear low-cut pants, the lateral ends of the standard bicycle handlebar incision may be exposed. Our technique also applies the principle of high lateral tension to address the abdominal ank accidity. Modication of the skin resection pattern to provide a signicant lateral resection places the highest wound closure laterally, which lifts the lax anterolateral thigh and avoids the placement of all the tension on the mons veneris and consequent pubic hair superior migration.4 The disadvantage of the high lateral tension abdominoplasty is a tendency for dog ear formation due to a quick transition from high tension in the inguinal area to the laxity of the lateral trunk that usually requires lengthening of the nal scar. We propose a pre-scheduled resection of dog ears through the lateral horizontal segment of our design that yields a well hidden lateral scar. The UM abdominoplasty technique introduces the concept of perfect matching of lower and upper incision lengths, making dog ears formation less likely. This concept is incorporated in our technique, where the addition of segments three and fours lengths should always equal segment ves length. Our technique has differences in the design pattern where the suprapubic segment is convex, whereas the supraumbilical segment is a straight line. In the UM technique, the lower incision is an open U and a lazy M in the upper incision. Whenever a surgical scar is unavoidably extensive, every effort should be made to ensure the best scar quality possible. All the aforementioned concepts were incorporated in this technique allowing the achievement of better abdominal contour and high quality scars in our hands. The design herein presented is an excellent alternative in selected patients aiming to obtain scars easily concealed according to current low-cut fashion trends in trousers and skirts.
References
1. Planas J. The vest over pants abdominoplasty. Plast Reconstr Surg 1978;61:694e700. 2. Baroudi R, Moraes M. A bicycle-handlebar type of incision for primary and secondary abdominoplasty. Aesthet Plast Surg 1995;19:307e20. 3. Ramirez OM. U-M abdominoplasty. Aesthet Surg J 1999;19: 279e86. 4. Lockwood T. High-lateral-tension abdominoplasty with supercial fascial system suspension. Plast Reconstr Surg 1995;96: 603e15.
Figure 2 A) Preoperative anteroposterior view of a 41-yearold woman with folding of skin in the lower abdomen; B) Preoperative lateral view; C)Postoperative anteroposterior view; D) Postoperative lateral view. The lateral segment of our design yields a lateral horizontal scar that is very well hidden in patients who wear low-cut pants or skirts; E) Postoperative oblique views of the patient wearing low-cut pants and bikini bathing suit, that was unwilling to wear preoperatively.
Hugo D. Loustau Horacio F. Mayer Department of Plastic Surgery, Hospital Italiano de Buenos Aires, University of Buenos Aires, School of Medicine, Gascon 450 1181, Buenos Aires, Argentina E-mail address: hugo.loustau@hospitalitaliano.org.ar