Abdominoplasty: same classification and a new treatment concept 20 years later.

Twenty years after my first paper on abdominoplasty, I find that the classification of abdominoplasty remains the same, but new operative techniques allow for accentuated improvement of the results through more liposuction, less undermining in tunnels, and reduction of skin traction. I use the same classification of diagnoses proposed in 1988, dividing the aesthetic alterations into five groups, and describe my experience during a 6-year period with 502 patients. I used vibroliposuction and performed plicature of the muscular aponeurosis through tunnels (where there are no important muscular perforator vessels), without damaging the vascularization. I propose an appropriate ratio of 1/1.5 between infra- and supraumbilical segments for uses in diagnosis and treatment, and the same ratio between the perimeter of the waist and the hips up to 1/1.618, known as the golden or divine proportion. According to this new treatment concept, vibroliposuction is used in GI. Vibroliposuction and suprapubic fusiform skin resection with an indigenous canoe shape are used in GII. Vibroliposuction, fusiform skin resection, and plicature of the external oblique muscle aponeurosis through two lateral tunnels are used in GIII. Vibroliposuction, fusiform skin resection, plicature of the rectus muscles aponeurosis through a medial tunnel, and detachment of the umbilicus aponeurotic implantation and reattachment in a maximum proportion of 1/1.6 between the infra- and supraumbilical skin segment with a bolster stitch are used in GIV. In GV, all the infraumbilical skin and a subcutaneous segment are removed after vibroliposuction, then a median tunnel from the umbilicus to the xiphoid process and a plicature of the rectus muscle aponeurosis from the pubis to the xiphoid process are made, and then the umbilicus is transposed. When necessary, a plicature of the oblique external muscle aponeurosis through two lateral tunnels is made resulting in three tunnels.