374 Aesth Plast Surg (2009) 33:366–376 Fig. 16 Back view showing the body contour obtained by liposuction and patient in the preoperative and postoperative sitting position Conclusion We revisited the superior pull-down abdominal ﬂap described by Sinder and introduced some new approa- ches and techniques to make it easier and safer: the sitting position to delineate the inferior curved incision, epidural catheter anesthesia, supra-condrocostal liposuc- tion to loosen the inframammary area, undermining of the epigastric area only enough to bring down the ﬂap, keeping the scarpa fascia on the lateral abdomen wall to protect the neurovascular pedicles and in the inferior abdomen to protect the lymphatic vessels and muscu- locutaneous nerves, exteriorization and ﬁxing the umbilicus stack 2 cm above its projection, adhesion stitches in the subcutaneous level to prevent seromas, requiring early leg movement and walking—all these improvements have been successfully introduced and 123 Table 1 Complications Complications Suprapubic epidermolyses Suprapubic necrosis Hematomas Seromas Hypertrophic scars Infections Dog ear scar revision Thromboembolisms No. of patients 2 0 0 3 8 2 12 0 % 0.6 0 0 0.9 2.4 0.6 3.6 0 routinely applied in our clinic, reducing the surgical time and diminishing tremendously complications such as seromas, vascular ﬂap necrosis, and venous thromboembolism.