Patient Overview

This patient sought treatment to enhance their waistline. Despite maintaining a regular exercise routine and losing 60 pounds through diet and exercise, they remained dissatisfied with their midsection. They had never undergone prior treatment for these areas but experienced abdominal muscle separation due to previous pregnancies. To address these concerns, they chose laser lipolysis for the flanks and lower back, along with an abdominoplasty that included umbilical transposition.

The provided images display their progress one year after surgery.

Surgical Case Study

Preoperative Marking and Preparation

The surgeon carefully marked the abdominoplasty incision line, positioning the 10 cm horizontal portion at the hairline below an existing scar. The lateral limbs extended within the tan line to align with the anterior iliac spines. Additionally, an inferior flap elliptical incision was outlined to stay within the designated 10 cm area.

After marking, the incision line and umbilicus received an infiltration of standard straight solution. Hydrodissection elevated the flap using a half-strength tumescent solution. Once prepped and draped under sterile conditions, the procedure commenced.

Surgical Procedure

The surgeon made a precise incision, extending down to Scarpa’s fascia. Superior elevation continued over Scarpa’s fascia, reaching above the costal margin. Upon isolating the umbilical stalk, the surgeon transected and secured it with 0-PDS sutures.

Next, they repaired the diastasis from the pubis to the xiphoid process using #2 polypropylene Quill sutures, layering them four times for reinforcement. After repositioning the superior flap, they marked the new umbilicus site at the midline in an inverted U shape. The umbilical stalk was brought through this neo-umbilicus and secured with deep 3-0 PDS sutures, followed by 4-0 fast-absorbing gut sutures for the skin closure.

To finalize the procedure, the surgeon excised the elliptical incision from the inferior flap. A 4 mm JP drain is placed and guided out through the inferior flap. The superior flap anchors to the pubic periosteum using 0-PDS sutures. After excising excess soft tissue, the wound bed received a spray of 10 cc platelet-rich plasma.

Closure and Recovery

The surgeon closed the incision in two layers: deep 2-0 PDS sutures followed by a cuticular closure with 4-0 Monocryl. They applied Mastisol and brown tape over the incision sites for added support. A compression garment assists with recovery. The patient awoke in stable condition and moved to the recovery room.