PRIME North America Vol.5 Issue 6

TRENDS IN ABDOMINOPLASTY RichardA. Baxter reviews thecurrent trends inabdominoplasty, including the drainless abdominoplasty,MoMsmakeover, andTAPBlocks ABSTRACT Abdominoplasty remains a popular procedure and techniques continue to evolve. Notable trends include an increasing array of options for scar placement and configuration, better definition of aesthetic ideals and methods to achieve them, the rise of the ‘drainless abdominoplasty’ with the use of progressive tension sutures, the ‘mommy makeover’ and the ‘mothers of multiples makeover,’ and the increasing use of liposome bupivacaine and the transversus abdominis plane (TAP) block. This article reviews these trends as they relate to the author’s approach to abdominoplasty. O VER THE PAST 20 YEARS, FEW procedures have gained in popularity more than abdominoplasty. Statistics from the American Society of Plastic Surgeons reveal that the annual number has nearly quadrupled since the mid-1990’s 1 . This increase has been paralleled by improved techniques enabling faster recovery and better outcomes, rise of the ‘mommy makeover,’ and broader awareness. This greater degree of acceptance is accompanied by higher patient expectations and an ever-expanding array of options. Notable trends include better definition of aesthetic goals, decreasing reliance on drains, a range of variations for scar placement, the Mothers of Multiples (MoMs) makeover, and the use of long-acting local anesthetics. Trend: An alphabet of tummy tuck scars A deterrent to abdominoplasty for many patients is the necessity of a scar, so placement and orientation of the scar-mark trends inhowtheprocedurehas beenconceived since its origins in the 1960’s. The ability to conceal the scar in swimwear dictates the design of the operation; the transverse scar 2 and the low ‘W’ abdominoplasty 3 could be concealed by bikini bottoms of that era. In the 1990’s, swimwear and exercise clothing trends shifted to the ‘French cut.’ The high lateral tension approach advanced by Lockwoodworkedwell with this, as it located the lateral part of the scar more obliquely 4 . The ‘W’ configuration morphed into a ‘U’ 5 , which eventually reverted into a more horizontal alignment following low-rise swimwear and clothing fashions in the millennial era. However, because an overly horizontal scar does not follow relaxed skin tension lines, an upward tilt following a gentle curve is more favorable. Interestingly, fashion trends appear to have moved away from the low rise style, though keeping the scar low centrally remains favored. KEYWORDS Progressive tension sutures, abdominoplasty, mommy makeover, TAP block, mothers of multiples makeover, drainless abdominoplasty A deterrent to abdominoplasty for many patients is the necessity of a scar, so placement and orientation of the scar mark trends in how the procedure has been conceived since its origins in the 1960’s. RICHARD A. BAXTER, MD Plastic Surgeon, Mountlake Terrace, Washington, USA email: COVER STORY | ABDOMINOPLASTY | PEER-REVIEW | November/December 2017 35