Minimally invasive lipoabdominoplasty (MILA) tactic.

While diastasis recti (DR) was long neglected by general surgeons, plastic surgeons considered conventional abdominoplasty as the only repair option. However, this scenario has changed recently, either due to a better understanding of the correlation between DR and abdominal wall function and greater risk of recurrence in abdominal hernia repairs, or due to the development of new minimally invasive techniques for repairing DR. One of these surgical procedures consists of the concept of an abdominoplasty, that is, supra-aponeurotic dissection and plication of the DR (with or without abdominal hernia) but performed through three small supra-pubic incisions by laparoscopy or robotic approach. More recently, this procedure has gained new stages. Liposuction and skin retraction technology have been associated with MIS plication of DR, which increases the indications for the technique and potentially improves results. For the first time in the literature, we describe these steps and the synergy between them.

H-Wing Neoumbilicoplasty: A New Technique for Advanced Abdominoplasty and Umbilical Zones by Gender.

BACKGROUND: Multiple umbilicoplasty techniques have been described, even more after the advent of full tummy tuck procedures and the neoumbilicoplasty (X-shaped incision) described by the authors in a previous report. The authors decided to upgrade the technique (H-wing incision) because the former procedure is associated with relatively common complications. The authors report a case series of an upgraded technique for neoumbilicoplasty (H-wing technique), comparing its outcomes with their previous standard procedure (X-shaped incision). METHODS: The authors reviewed their records for neoumbilicoplasties performed between January of 2014 and December of 2019. The authors divided the procedures according to the surgical technique and performed a detailed analysis regarding timing, complications, uses, and quality standards according to patients' opinion through a nonstandardized survey. RESULTS: A total of 407 procedures were distributed between two techniques: X-shaped incision, 179 procedures; and H-wing technique, 228 procedures. The former was performed from January of 2014 to October of 2016 and the latter from September of 2016 to December of 2019. High satisfaction indexes were found for both procedures; however, fewer complications were seen in the H-wing group. The X-shaped incision is thought to generate a greater force of tension over the flaps compared to that from the H-wing technique, which consequently increased the risk of flap necrosis and flattening. CONCLUSIONS: The H-wing technique for neoumbilicoplasty decreases the risk of postoperative complications such as dehiscence, skin necrosis, and navel flattening, and maintains high aesthetic standards and satisfaction indexes among patients. The technique can be used after either lipoabdominoplasty or secondary procedures.

TULUA: Effects of Flap Undermining and Type of Wall Plicature in a Rat Model Abdominoplasty.

BACKGROUND: TULUA, a transverse plication lipoabdominoplasty, which excludes elevation of the supraumbilical flap and includes a skin graft neoumbilicoplasty, claims greater safety and better results. An animal study was designed to compare it, with two current techniques. MATERIALS AND METHODS: Three matched groups of 12 rats had combined liposuction and abdominoplasty. Liposuction was extensive and unrestricted. Groups 1 and 2 had vertical plication and transposition umbilicoplasty, and group 3 had transverse plication and neoumbilicoplasty. Flap elevation in the epigastrium was wide to costal margins in group 1, limited to a tunnel in group 2, and no dissection in group 3. The animals were observed for 21 days and then euthanized. Intraoperative, postoperative, and postmortem variables and findings were measured and analyzed to find differences between groups. RESULTS: Transverse lipoabdominoplasty demonstrated a wider wall plication area, as well as a decrease in tension to close the wound, causing the horizontal scar to remain in a low position. In vertical plication lipoabdominoplasty groups, flap necrosis and seromas were more frequent, and the umbilical position descended due to secondary healing and scar contraction. The scar's scores were better in the transverse group and were confirmed when evaluated by external observers.In postmortem examination, horizontal plication presented less widening; perforator vessels were preserved when surgical undermining of the upper abdomen was not performed, and there were fewer seromas. CONCLUSION: In a rat model, TULUA demonstrates superior results and a decrease in complications when compared to lipoabdominoplasties with vertical plication and wide or tunneled dissection in the upper abdomen. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

TULUA Male High-Definition Abdominoplasty.

BACKGROUND: Abdominoplasty is a surgical technique for body contouring that has been shown to improve the patient's quality of life. It has become more common among male patients, so clear differences between procedures for men and women have to be stated. The authors present their experience with high-definition lipoabdominoplasty with transverse plication in men. METHODS: Records of male patients undergoing transverse plication full abdominoplasty in addition to high-definition liposculpture were analyzed. A total of 24 consecutive cases were found between January of 2017 and June of 2019. Patient ages ranged from 24 to 60 years. Patients aged 18 years or younger were excluded. Body mass index ranged from 25 to 33 kg/m2. Photographic records were taken before and during follow-up at 2 days and 1, 3, 6, and 12 months after surgery. RESULTS: Male TULUA (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar) with high-definition lipoabdominoplasty was successfully achieved in 24 cases. No major complications were reported. Six minor complications were reported (25 percent). Rectus abdominis diastases are less common in men compared to women, as pregnancy is the most determining factor in its development. Fat distribution is also a key difference when performing lipoabdominoplasty for the male or the female patient. The authors recommend a transverse plication of the abdominal wall, instead of a vertical one, as flap viability is preserved and enhanced muscular definition can be accomplished. CONCLUSIONS: Combining transverse plication with high-definition lipoabdominoplasty (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar plus high-definition lipoabdominoplasty) is a safe and reproducible technique for the male patient. It offers higher aesthetic results in line with modern beauty ideals. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

TULUA Lipoabdominoplasty: Transversal Aponeurotic Plication, No Undermining, and Unrestricted Liposuction. A Multicenter Study of 845 Cases.

BACKGROUND: TULUA (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar) is the acronym for a radically different lipoabdominoplasty, intended to add simplicity, improve vascular safety, and attain good results. Modifications are unrestricted liposuction, no flap detachment, massive transverse infraumbilical plication, umbilicus amputation, neoumbilicoplasty, diminished tension wound closure, and low transverse scar settlement. The objectives of this article are to describe the technique and analyze a multicenter experience. METHODS: Sixty-eight plastic surgeons from 10 countries provided data for a retrospective review of 845 patients. Aesthetic results were scored by each surgeon using the Salles scale and analyzed in combination with complications to identify associations between patient and surgery characteristics. RESULTS: Of the patients, 95.5 percent were female, 19.7 percent were obese, 35.6 percent had prior scars, 10.4 percent had undergone previous abdominoplasty, 6.5 percent were postbariatric, and 6.6 percent were smokers. One patient had a kidney transplant, and 16.5 percent had comorbidities. Surgery characteristics varied widely, being on average as follows: lipoaspirate, 2967 ml; resection, 1388 g; and surgical time, 3.9 hours; 46.5 percent were not hospitalized. Averaged results were 8.68 of 10 points, besides adequate positioning and proportion of scar and umbilicus, without epigastric compensatory bulging (4.97 of 6 points). Overall complications were 16.2 percent, mostly seroma (8.8 percent); vascular-related complications (i.e., necrosis, wound dehiscence, and infection) constituted 2.7 percent. There were no fatalities. The logistic regression model demonstrated that smoking and obesity duplicate the risk of complications; if age older than 60 years is added, the risk of complication increases seven to nine times. Reported indications were multiple; however, pathologic diastasis was excluded. CONCLUSION: TULUA lipoabdominoplasty is a new reproducible procedure with good quantified results and an acceptable complication rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Feasibility Study of Electromagnetic Muscle Stimulation and Cryolipolysis for Abdominal Contouring.

BACKGROUND: In addition to reducing subcutaneous fat for body contouring, some patients are interested in toning the underlying muscle layer. OBJECTIVE: This feasibility study evaluated the safety and efficacy of electromagnetic muscle stimulation (EMMS) alone, cryolipolysis alone, and cryolipolysis with EMMS for noninvasive contouring of abdomen. METHODS: Abdomens of 50 subjects were treated in a study with 3 cohorts: EMMS alone, Cryolipolysis alone, and Cryolipolysis + EMMS in combination. Electromagnetic muscle stimulation treatments were delivered in 4 sessions over 2 weeks. Cryolipolysis treatments were delivered in one session. Combination treatments consisted of one cryolipolysis and 4 EMMS visits. Efficacy was assessed by independent physician Global Aesthetic Improvement Scale (GAIS), circumferential measurement, Subject GAIS (SGAIS), and Body Satisfaction Questionnaire (BSQ). RESULTS: Safety was demonstrated for all study cohorts with no device- or procedure-related adverse events. Independent photo review showed greatest mean GAIS score for the Cryolipolysis + EMMS cohort followed by Cryolipolysis only, then EMMS only cohort. BSQ showed greatest average score increase for Cryolipolysis + EMMS cohort followed by Cryolipolysis only cohort, then EMMS only cohort. Mean circumferential reduction measurements were greatest for Cryolipolysis + EMMS cohort followed by Cryolipolysis only, and then EMMS only cohort. The mean SGAIS improvement score was equal for the Cryolipolysis only and Cryolipolysis + EMMS cohorts, followed by the EMMS only cohort. CONCLUSION: A multimodal approach using cryolipolysis and EMMS was safe and demonstrated enhanced body contouring efficacy for this feasibility study.

Lipoabdominoplasty with Anatomical Definition.

BACKGROUND: In the past two decades, lipoabdominoplasty has increased in popularity worldwide, presenting low rates of complications and morbidity when the proper surgical steps are followed. The authors present an update of the lipoabdominoplasty technique with the addition of an abdominal definition and standardized steps for its safe execution, an initial personal experience with the procedure that improves the aesthetic results. METHODS: Anatomical limits are described for preoperative markings for selective liposuction with abdominal definition. Specific areas of the abdomen are presented to differentiate the areas for an intense or moderate liposuction and the areas for superficial and deep liposuction for anatomical definition. The principles of traditional lipoabdominoplasty are also described and maintained. The initial experiences with 128 patients undergoing the technique are included. RESULTS: One hundred twenty-eight patients were operated on by the senior author (O.S.) from 2016 to 2019 using the described technique. One patient presented with a seroma (0.8 percent), and two had a small skin epitheliolysis (1.5 percent). No other major complications were observed. It is the senior author's opinion that the obtained aesthetic results from the lipoabdominoplasty with definition are superior to those of the traditional technique, as it enhances the natural contour of the abdomen. CONCLUSIONS: Lipoabdominoplasty with anatomical definition has improved the aesthetic results of traditional lipoabdominoplasty without compromising the safety of that technique. More natural results along the abdominal contour that avoid a completely flat abdomen have been observed by most patients. This approach is safe and reproducible, with low complication rates, and it effectively enhances body contour.

Lipoabdominoplasty with Anatomic Definition: An Evolution on Saldanha's Technique.

Lipoabdominoplasty is one of the most frequent abdominal body contouring procedures performed today. It guarantees a safe combination of abdominoplasty and liposuction while minimizing the risk of ischemic flap complications. This is because of the limited undermining performed and the liposuction adjunct, both of which minimize perforator injury. In the last several years, the integration of anatomic definition through the use of liposuction has further refined the procedure, led to improved results, and increased patient satisfaction. The more natural results of the anatomic abdominal definition is a next step in abdominal contour refinement.

High-Definition Excisional Body Contouring: Mini Lipoabdominoplasty (FIT Mommy) and Enhanced Viability Abdominoplasty.

The abdominoplasty procedure poses a number of unique challenges. If the stigmata of the operation is to be avoided, careful planning and surgical execution are required. We describe our experience in full and mini abdominoplasties with a 360-degree approach, involving all muscular groups and body segments as described by high-definition liposculpture. Selective fat grafting is also safely performed in specific areas to improve projection and volume.

TULUA: lipoabdominoplastia de plicatura transversa sin despegamiento supraumbilical. Serie de 176 pacientes / TULUA: transverse plication lipoabdominoplasty without supra-umbilical flap detachment. A series of 176 patients

INTRODUCCIÓN Y OBJETIVO: Desde 2005 el autor ha realizado una lipoabdominoplastia fundamentalmente diferente para evitar complicaciones como necrosis, dehiscencia, redundancia epigástrica, cicatriz alta, mala posición del ombligo y seromas. Las modificaciones son: 1- liposucción sin restricción, 2- no despegamiento del colgajo epigástrico, 3- amputación umbilical, 4- plicatura transversal inferior de la pared abdominal, 5- neoumbilicoplastia con injerto de piel en la posición ideal y 6- ubicación baja de la cicatriz transversal (TULUA). El objetivo del presente trabajo es recoger una serie de casuística, resaltando algunos detalles técnicos y valorando resultados. MATERIAL Y MÉTODO: Presentación de una serie de 176 pacientes con detalles de técnica y estadísticas descriptivas, cuantificando resultados con énfasis en la posición de cicatriz y ombligo y su proporción, lo mismo que el resultado de la cintura y epigastrio. Comparamos estadísticamente los cambios de la cintura y la disminución de la tensión necesaria para el cierre de la herida quirúrgica atribuidos a la plicatura transversa. RESULTADOS: Los resultados estéticos fueron cuantificados en 9.4 según escala (0-10). Globalmente el porcentaje de complicaciones fue de 18.7%, la mayoría debidas a problemas con la integración del injerto del ombligo. Resaltar que solo una paciente presentó necrosis distal del colgajo y otra dehiscencia parcial de la herida. Encontramos diferencias estadísticas en la disminución de la tensión para el cierre de herida quirúrgica y cambios en la circunferencia de la cintura (p = 0.001). CONCLUSIONES: Los resultados estéticos cuantificados fueron altos con ventajas adicionales en términos de seguridad vascular, disminución de tensión de la herida, buena posición y calidad del ombligo, ubicación baja de la cicatriz transversal, disminución del perímetro de la cintura y corrección del epigastrio. Se trata de una técnica simple y segura que incrementa las indicaciones de abdominoplastia a un grupo más amplio de pacientes

BACKGROUND AND OBJECTIVE: Since 2005 the author has performed a fundamentally different lipoabdominoplasty to avoid complications such as necrosis, dehiscence, epigastric redundancy, high scar, bad position of the umbilicus and seromas. The modifications are: 1- unrestricted liposuction, 2- no detachment of the epigastric flap, 3- umbilical amputation, 4- lower transverse plication of the abdominal wall, 5- neoumbilicoplasty with skin graft in the ideal position and 6- low location of the transverse scar. In this paper, we collect a large clinical serie, marking some technical aspects and evaluating the results. METHODS: A series of 176 patients with technical details and descriptive statistics is presented, measuring results with emphasis on scar and umbilicus positioning and their proportion, as well as the result of changes in waistline and epigastrium. Changes in the waist perimeter and reduction of the tension necessary for closure of the surgical wound, attributed to the transverse plication, were statistically compared. RESULTS: The aesthetic results were quantified in 9.4 according to a scale (0-10). Overall, the complications were 18.7%, most of them due to incomplete graft take or delayed healing of the neoumbilicus. It was remarkably that only 1 patient presented with distal necrosis of the flap and another with partial dehiscence of the wound. Statistical differences were found in the decrease in tension for surgical wound closure and changes in waist circumference (p = 0.001). CONCLUSIONS: Quantified aesthetic results were high with additional advantages in terms of vascular safety, decreased wound tension, good position and quality of the umbilicus, low transverse scar location, decreased waistline and epigastric bulge correction. This technique can be simpler and safer, increasing abdominoplasty indications to a larger group of patient

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Influences of Age, Gender, and Body Mass Index on the Thickness of the Abdominal Fatty Layers and its Relevance for Abdominal Liposuction and Abdominoplasty.

BACKGROUND: Liposuction and lipoabdominoplasty procedures frequently involve the treatment of the superficial and deep fatty layers of the abdomen. OBJECTIVES: The aim of the present investigation was to provide comprehensive data on the thickness of the abdominal fatty layers in relation to age, gender, and body mass index (BMI). METHODS: The study investigated 150 Caucasian individuals; there was an equal distribution of males and females (each n = 75) and a balanced distribution of age (n = 30 per decade: 20-29, 30-39, 40-49, 50-59, and 60-69 years) and BMI (n = 50 per group: BMI ≤24.9, 25.0-29.9, and ≥30 kg/m2). Ultrasound-based measurements of the superficial and deep abdominal fatty layers were performed. RESULTS: An increase in BMI was associated with an increase in total abdominal wall fat thickness. The measured increase was related more to the thickness of the deep fatty layer than to the thickness of the superficial fatty layer (Z = 1.80, P = 0.036). An increase in age was associated with a decrease in thickness of the superficial fatty layer (rp = -0.104, P = 0.071) but with an increase in thickness of the deep fatty layer (rp = 0.197, P = 0.001). CONCLUSIONS: Age and BMI can change the thickness of both the superficial and deep fatty layers of the anterior abdominal wall, thus influencing the plan and conduct of cosmetic surgical procedures. Knowledge of the layered anatomy of the anterior abdominal wall, as well as its associated blood supply, is important for surgeons performing procedures in this area.

Hip Asymmetry: Implications in Body Contouring Surgery.

BACKGROUND: Asymmetry of the hips and its implication in body contouring procedures has not yet been reported. Hip asymmetry is common in the general population and may account for uneven abdominoplasty scar and the apparent discrepancies in volume following liposuction of the hips and flanks. The goal of this study was to determine the presence of hip asymmetry in women presenting for abdominal contouring surgery. METHODS: Analysis of preoperative photographs of 100 female patients was performed by three independent plastic surgeons. They were asked to evaluate for hip asymmetry and, when present, determine which side was higher. Adobe Photoshop was also used to objectively measure hip asymmetry. Patients were women with no known history of hip abnormalities; age ranged from 17 to 64 years and the body mass index ranged from 16 to 47 kg/m(2). RESULTS: All three plastic surgeon reviewers found that the majority of patients had hip asymmetry, with raters 1, 2, and 3 documenting discrepancies in hip height in 88, 60, and 76 percent of patients, respectively. The interrater reliability was 0.713. Chi-square statistical analysis suggested that the raters were not statistically different from one another (p = 0.086). The objective analysis found asymmetry in 82 percent of patients. CONCLUSIONS: The results showed that the majority of patients who present for abdominal contouring surgery have asymmetric hips. Patients are usually unaware of the unevenness of their own hips; however, they often notice postoperative discrepancies in scar height after abdominoplasty or volume differences after liposuction.

Getting the Best Results in Abdominoplasty: Current Advanced Concepts.

LEARNING OBJECTIVES: After studying this article and viewing the videos, the participant should be able to: 1. Describe the safe techniques recommended for patients undergoing a lipoabdominoplasty. 2. Demonstrate safe planning techniques for marking a patient for a lipoabdominoplasty. 3. Summarize the various techniques for performing rectus plication. 4. State the current understanding of chemoprophylaxis for outpatient surgical patients. 5. Determine the appropriate placement and shape of the ideal umbilicus. SUMMARY: Abdominoplasty and lipoabdominoplasty surgery is one of the core procedures performed by plastic surgeons in the United States. As with most plastic surgery, it is part art and part science. In this article, the authors try to summarize the science behind this procedure, and point to the generally accepted artistic aspects that are currently still under debate. As this procedure has one of the highest morbidity and mortality rates in the specialty, the authors have also reviewed safe practices.

Sub-Scarpa's Lipectomy in Abdominoplasty: An Analysis of Risks and Rewards in 723 Consecutive Patients.

BACKGROUND: During the course of performing abdominoplasties, a plastic surgeon will encounter a certain body habitus characterized by a thick, tethered, and excessively redundant upper skin flap. Often these patients also demonstrate diffuse and substantial fascial laxity. One approach to this problem involves direct thinning and release of the flap by resection of the sub-Scarpa's fat pad. In theory, this resection should be safe from a flap perfusion standpoint. However, the safety of the sub-Scarpa's resection has not been completely documented. OBJECTIVES: The author sought to assess the safety and efficacy of sub-Scarpa's lipectomy in abdominoplasty. METHODS: A total 723 patients were retrospectively examined and divided into 2 groups: those with (Group B) and those without (Group A) a sub-Scarpa's lipectomy component to the abdominoplasty. Because of differences in the baseline characteristics between the 2 groups, data analysis was performed with a logistic regression model and with propensity score matching. RESULTS: The sub-Scarpa's lipectomy technique allowed for substantial thinning of the flap: the average weight of the resected fat pad was 411 g. Wide undermining allowed for substantial fascial correction, and excellent results were obtainable even in challenging cases. The sub-Scarpa's lipectomy group did not demonstrate an increase in either minor (<5 cm2) or major (>5 cm2) flap necrosis. However, there was a statistically significant increase in fat necrosis and seroma formation in Group B compared with Group A. In both groups, an increasing body mass index was a risk factor for fat necrosis and major flap necrosis. CONCLUSIONS: The implementation of a sub-Scarpa's lipectomy during abdominoplasty is a useful technique to consider for selected abdominoplasty candidates. The risks of minor and major flap loss do not seem to be increased compared to the standard abdominoplasty, but the risks of fat necrosis and seroma formation may be greater.

Reshaping the Oversized Waist through Oblique Flankplasty with Lipoabdominoplasty.

BACKGROUND: Designed in response to the failure of circumferential lower body lifts to deepen waists, oblique flankplasty with lipoabdominoplasty aesthetically reshapes not only the waist, but also the hips, buttocks, and upper lateral thighs with minimal morbidity. METHODS: The oblique flankplasty with lipoabdominoplasty technique was standardized, with 5 of 56 cases presented. Operative records on the lower torso from March of 2000 to January of 2018 yielded 30 initial oblique flankplasty with lipoabdominoplasty cases and hundreds of lower body lifts. A subset of randomly selected lower body lift and flank liposuction operations yielded 91 cases. Through SurveyMonkey, the authors and 16 unbiased observers graded flank and global deformity using the Pittsburgh Rating and novel posterior trunk aesthetics scales. RESULTS: The oblique flankplasty with lipoabdominoplasty deepened and smoothly transitioned waists. Medial rotation of the lateral buttocks over the posterior iliac spine retained lateral fullness and established hip prominence. Central buttock laxity was corrected without intergluteal cleft lengthening. The immediate result persisted, satisfying high patient expectations. There were three minor complications and three nonexcisional revisions, with no unscheduled hospital admissions. The mean flank deformity for all cases was 1.93 was by chi-square analysis, which was significantly more than 0.88 for postoperative deformity (p < 0.001). Subgroup analysis of each procedure group showed a significant reduction in deformity. Comparing flankplasty with lower body lift, oblique flankplasty with lipoabdominoplasty had slightly greater flank deformity and far greater reduction in deformity and overall aesthetic improvement. CONCLUSIONS: For grade 2 and 3 flank deformities, oblique flankplasty with lipoabdominoplasty provides a tighter skinned lower torso with gender-appropriate curvatures, including a deeper and more smoothly transitioned waist than lower body lift, leading to uniform patient satisfaction. There was minimal secondary deformity or complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Safety of Lipoabdominoplasty Versus Abdominoplasty: A Systematic Review and Meta-analysis.

BACKGROUND: Lipoabdominoplasty is a powerful operation to maintain a youthful physique for aging people, improve body contouring, and remove excess skin caused by massive weight loss. Nonetheless, it is controversial to combine abdominoplasty and liposuction because of the potential for vascular damage of the abdominal flap and increased complications. The purpose of this article was to determine the complication rates of lipoabdominoplasty compared with traditional abdominoplasty. METHODS: PubMed, EMBASE, and Cochrane databases were searched through July of 2018. Study results were analyzed utilizing a fixed random effects model. The outcomes were expressed as relative risk (RR) and 95% confidence interval. Subgroup analyses were conducted based on complications. RESULTS: Overall, 17 trials enrolling 14,061 adult patients were searched. Of these patients, 577 (4.1%) developed seroma; 113 (0.8%) experienced hematoma; 783 (5.6%) experienced wound infection, dehiscence, or fat necrosis; 35 (0.2%) developed deep venous thrombosis; and 110 (0.7%) experienced scar deformity. A forest plot revealed fewer complications in the lipoabdominoplasty group than in the traditional abdominoplasty group (RR = 0.85; 95% CI 0.74-0.97; p = 0.017). Subgroup analysis showed that the lipoabdominoplasty group had a lower incidence of hematoma (RR = 0.56; 95% CI 0.36-0.86; p = 0.009) and seroma (RR = 0.69; 95% CI 0.57-0.85; p = 0.000). CONCLUSIONS: Lipoabdominoplasty is a valuable tool to perfect body shape. This meta-analysis showed no evidence that it was associated with higher rates of complications. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .