Correcting Flank Skin Laxity and Dog Ear Plus Aggressive Liposuction: A Technique for Classic Abdominoplasty in Middle-Eastern Obese Women

Abstract

Background: Nowadays obesity is a common problem as it leads to abdominal deformation and people's dissatisfaction of their own body. This study has explored using a new surgical technique based on a different incision to reform the flank skin laxity and dog ear plus aggressive liposuction on women with abdominal deformities.

Methods: From May 2014 to February 2016, 25 women were chosen for this study. All women had a body mass index more than 28 kg/m², flank folding, bulging and excess fat, abdominal and flank skin sagging and laxity. An important point of the new technique was that the paramedian perforator was preserved.

Results: All women were between 33 and 62 years old (mean age of 47±7.2 years old). The average amount of liposuction aspirate was 2,350 mL (1700-3200 mL), and the size of average excised skin ellipse was 23.62×16.08 cm (from 19×15 to 27×18 cm). Dog ear, skin laxity, bulging and fat deposit correction were assessed and scored in two and four months after the surgery.

Conclusion: Aggressive abdominal and flank liposuction can be safely done when paramedian perforator is preserved. This has a good cosmetic result in the abdomen and flank and prevents bulging in the incision end and flank. Using this abdominoplasty technique is recommended on patients with high body mass indexes.

Keywords: Dog ear; Flank skin laxity; Liposuction; Middle east; Obesity; Women.

Fig. 1

These patients had done classic abdominoplasty previously by other surgeons and their complications are obvious in the pictures which include: dog ear, fat deposit, unpleasant flank, and panhandle-shaped incision end bilaterally.

Fig. 2

Classic abdominoplasty was designed for the abdominal wall. The upper incision line was determined to be one centimeter above the umbilicus based on epigastric skin laxity (excessive laxity and resection). This incision line stretched from the umbilicus to the anterio-superior iliac spine at a mild angle of 15 to 25 degrees.

Fig. 3

The fat in the epigastric, subcostal and lateral flap regions was removed up to 2 cm pinching test. The paramedian perforator was saved.

Fig. 4

The lateral part of the superior flap was sutured to the medial of the inferior flap to decrease the incision length of superior flap. Up to two third of this flap was tucked in. This technique created a new incision apex in the medial border of the iliac crest. Thus, the one third and one fourth intersection points on the upper flap were transferred into the inferio-lateral part of the body and the new incision apex was pulled in the medial of iliac crest.

Fig. 5

Removing the dog ear in the new technique.

Fig. 6

Comparing the result of using this new technique, four months after the surgery with the conditions before surgery.