Abdominoplasty with Scarpa's Fascia Advancement Flap to Enhance the Waistline.

Abdominoplasty for body contouring has evolved from focusing primarily on modification of the skin flap and underlying rectus diastasis repair, to the association of liposuction and limited undermining techniques. While plication of the midline diastasis reliably improves anterior posterior dimensions, it has a more limited effect on the waist contour. Nahas suggested that increasing the width of the plication of the anterior rectus sheath may be responsible for displacement of the contours of the abdomen, yielding unnatural results.1 In an attempt to achieve reliable waist modification, different techniques have been published. L-shaped external oblique muscle plication, multidirectional abdominal wall plication, and advancement of the external oblique muscle flaps have been described.2 Plication of the external obliques demonstrates limited mobility and the creation of widely undermined external oblique flaps is typically beyond the scope of the standard outpatient procedure. It has been suggested that the preservation of Scarpa's fascia during abdominoplasty may lead to a decrease in postoperative complications.3,4 Friedman et al suggested that up to 17% of the lymphatic drainage of the abdominal wall is maintained if dissection is performed above Scarpa's fascia.5 The use of Scarpa's fascia to enhance the waist line definition during abdominoplasty has been limited. Mossaad et al used a medial directional pull on Scarpa's fascia in an effort to define the waistline as a modification of the lipoabdominoplasty technique described by Saldanha et al.6-9 Mossaad's technique removes a full thickness midline strip of subcutaneous tissue below the umbilicus down to the rectus sheath, extending approximately 4 cm lateral to the midline on each side. Tissue advancement was achieved only through lipo-mobilization using standard liposuction techniques with o undermining above the umbilicus other than the midline. Mallucci presented a refinement to traditional abdominoplasty using a superficial fascial …