DOI: 10.1097/01.PRS.0000104542.82130.53
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Issn Print: 0032-1052
Publication Date: 2004/02/01
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Excerpt
As plastic surgeons, we make skin incisions to remove skin, to access deeper tissues, or both. We learned very quickly in our early experience with endoscopic plastic surgery that if the incision served only as access, it could be significantly reduced with the use of the endoscope. We would make small access incisions and then perform the deep procedures and tissue modifications. In the early 1980s, with the advent of liposuction, we also learned that extensive amounts of localized excess fat could be removed, without skin excision, leaving a natural improved contour without excess skin or skin wrinkling, provided skin tone and skin elasticity were normal. During the last 10 or 11 years of experience with endoscopic plastic surgery, we have learned that with the exception of endoscopic breast augmentation and perhaps even endoscopic brow lift, the aesthetic result and overall success of the rest of our endoscopic aesthetic procedures depend very much not only on the quantity of the skin (amount of excess skin) but also on the quality of the skin. Stretched, inelastic skin will not redrape, redistribute, or retract. It has to be removed. We saw many suboptimal results with endoscopic face lifts and endoscopic neck lifts in the early days because the quality of the skin had not been taken into account.
Today, indeed, we are preoccupied with “short-scar” surgery, not only through endoscopic procedures but also through short-scar face lifts and short-scar breast surgery. Shortening or eliminating the scar remains a hot topic. Two questions are often asked: (1) Are the results as good as those with “open” techniques? (2) Do the results last as long? In order to achieve pleasing aesthetic results with these short-scar and endoscopic procedures, we have recognized that not only the amount of excess skin but also the quality of that skin is of utmost importance.
When we performed our first endoscopic abdominoplasty at Emory almost 11 years ago, we were very excited. We thought that using the endoscope for fascial plication through a limited incision in the pubis or the periumbilical area combined with liposuction would revolutionize abdominoplasty the same way that the endobrow procedure had affected brow rejuvenation. However, we learned very quickly that ideal candidates for this procedure were very few and far between. Most women presenting in our practice for recontouring of the abdomen not only had excess fat and muscle weakness but varying amounts of excess skin and poor-quality skin, stretched, inelastic skin, stretch marks, and excess skin above and below the umbilicus. Although we were able to recontour the abdomen through liposuction and endoscopic fascial plication, the results disappointed our patients, who were still left with their stretch marks and poor-quality skin that did not redrape or retract sufficiently. During the past 11 years, we have had experience with this technique in approximately 40 patients. Most of these procedures were performed within the first 2 or 3 years, when we were enthusiastic about this operative technique. In fact, during the last 2 years, I have personally performed this operation twice, both times on men who had adequate skin tone with a significant ventral hernia and abdominal adiposity. Neither had excess skin. Needless to say, both had excellent results with which they were pleased.
In this article, Dr. Dabb and his colleagues combine liposuction of the abdomen and rectus fascia plication through a periumbilical incision with a circumferential liposuction of the trunk.
