A flap between the fascia and fat is then created superiorly to the costal margin, following it until the xiphoid process is reached. This positions the final scar low enough on the trunk to be hidden in the bikini line. The incision is extensive and is typically made from ASIS to ASIS through the natural suprapubic crease. Patients with minimal to moderate subcutaneous fat and minimal to moderate abdominal wall laxity which is located primarily in the infra-umbilical region are candidates for the "mini-abdominoplasty." Patients with excessive skin laxity, fat, and abdominal wall weakness are ideal candidates for full abdominoplasties. Patients with little to no fat and no abdominal wall laxity are optimal candidates for liposuction alone. Patients with lower BMI tend to have superior results, and patients with diabetes mellitus (DM) may be more prone to complications. The laxity of the skin after significant weight loss, as well as the potentially massive size of the skin apron, may require further dissection and may require additional adjunct procedures to lift the thigh, back, arm and flank areas to maintain overall symmetry of the body. Bariatric patients present the plastic surgeon with specific challenges. Wound healing is of vital importance, and patients require good nutritional status, as well as optimal overall medical health. ![]() When selecting patients appropriate for surgery, it is vital to obtain a thorough history. The reasons for undergoing abdominoplasty are numerous, including (1) men and women desiring aesthetic improvement of the abdomen, (2) women with significant skin and abdominal wall laxity following multiple pregnancies, or (3) bariatric patients who have excessive skin and/or pannus following significant weight loss.
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