Aesth Plast Surg (2009) 33:366–376 DOI 10.1007/s00266-009-9318-z O R I G I N A L A R T I C L E Lipoabdominoplasty: Revisiting the Superior Pull-Down Abdominal Flap and New Approaches Carlos Oscar Uebel Received: 15 October 2008 / Accepted: 19 January 2009 / Published online: 19 March 2009 The Author(s) 2009. This article is published with open access at Springerlink.com Abstract Abdominoplasty is a very common procedure, especially for patients with abdominal laxness, striaes, and muscle rectus diastases. With the advent of liposuction 28 years ago, we can improve body contouring by treating lipodystrophies in the epigastric, ﬂank, trochanteric, and buttocks areas. The procedure combining abdominoplasty and liposuction is called lipoabdominoplasty. Many new techniques have been proposed since these procedures were introduced; we now revisit the superior pull-down abdominal ﬂap technique with several new modiﬁcations and improvements. Keywords Lipoabdominoplasty Minilipoabdominoplasty Pull-down abdominal ﬂap Abdominoplasty Body contouring Liposuction came on the scene 28 years ago [1]. Since lipoabdominoplasty was ﬁrst described by Callia [2] and Pitanguy [3], many reﬁnements to the procedure have been published [4–14]. In 1975, Sinder [15] described the superior epigastric incision approach to estimate a safe inferior abdominal ﬂap excision. Planas [16] published a similar procedure, and Serson Neto [17] and Pontes [18] described the geometrical inferior ﬂap block resection. Stemming from those techniques, we have introduced some C. O. Uebel Division of Plastic Surgery, Pontiﬁcia Universidade Catolica, Rio Grande Sul – PUCRS, Rio Grande Sul, Brazil C. O. Uebel (&) Vitor Hugo St. 78, 90630-070 Porto Alegre, Brazil e-mail: carlos@uebel.com.br 123 important approaches and details to ensure superior ﬂap safety and to improve postoperative results; they are summarized here. With the patient in a sitting position, we estimate the amount of skin to be resected and outline the extension of the inferior suprapubic incision by the inguinal groove extremities. Epidural anesthesia via catheter is usually used, with bandage compression on the legs to prevent thrombovenous embolism. The ﬁrst surgical step consists of releasing the superior abdomen wall with an assisted mechanical cannula liposuction procedure, originally described by Saldanha [19] and Avelar [20]. The incision starts in the supraumbilical area and goes to the xiphoid appendix through a narrow tunnel. The patient is placed in a Fowler position, and the superior ﬂap is pulled down to assess whether it will reach the suprapubic line. This maneuver is important to ensure an accurate estimate of the amount of skin needed to be resected without stretching. We then trim the umbilical stack and a block resection of the entire infra-abdominal ﬂap is done. Demarcation of the new umbilicus oriﬁce is done and adhesions stitches, as described by Baroudi [21] and Pollock [22], are placed. Intradermic sutures with long- term absorbable sutures and a compression garment ﬁnalize the surgery. Materials and Methods This surgery is indicated in patients with abdominal lax- ness, extensive striaes, rectus muscle diastases, and localized lipodystrophy, a very common pathology after pregnancy and also in postbariatric surgical patients (Fig. 1).