Abdominoplasty (Tummy Tuck) Surgery in Indianapolis, Indiana Abdominoplasty procedures may vary and depend on the individual patient’s skin quality and fat deposition. Frequently, Abdominoplasty is combined with liposuction to give results that surpass those obtained by either procedure alone. High Lateral Tension Abdominoplasty The Abdominoplasty procedure (Tummy Tuck) was developed by plastic surgeons in order to treat skin looseness and stretch marks that developed with age, after pregnancy, and with weight fluctuation. Typically, the procedure involved removal of loose lower abdominal skin up to and above the level of the umbilicus (belly button) and tightening of the abdominal muscles in the midline. A small surgical incision was created in the upper abdominal skin when it is pulled down to the level of the umbilical stalk. In order to remove the lower abdominal skin to the level of the belly button, surgeons elevated the upper abdominal skin and fat off the muscle fascia up to the level of the lower costal (rib) margins. Because older abdominoplasty techniques emphasized removing the largest amount of lower abdominal skin in the midline, and removing the skin that surrounded the (umbilicus) belly button, these procedures often produced an unnatural appearing abdomen with scars that were too close to the umbilicus. Insistence on complete removal of the abdominal skin around the umbilicus is often a cosmetic error, which produced unnaturally high abdominal scars. Older techniques of abdominoplasty also produced wide scars with depressions that resulted because the deep tissue of the surgical incision was closed with absorbable sutures. The High Lateral Tension Abdominoplasty was developed by plastic surgeon Dr. Ted Lockwood to create a more natural and aesthetically pleasing abdominal appearance as a result of abdominoplasty surgery. The High Lateral Tension Abdominoplasty is noted or the following features: 1) Emphasis on lateral lower abdominal skin excess excision and post surgical skin tension 2) Reliance on the strength of the superficial fascial system for incision closure and optimization of scar. 3) Limited undermining of upper abdominal skin/soft tissue flaps, which preserves abdominal flap blood supply and allows for liposuction of the abdominal region without compromising skin viability. 4) De-emphasis on removing all skin up to, around, and above the umbilicus. 5) Liposuction to treat upper and lateral abdominal and flank fat deposits. Because abdominal skin and tissue laxity are greater on the sides of the abdomen, and away from the midline, treatment of laxity in these regions is paramount to obtaining better results with abdominoplasty. With the High Lateral Tension Abdominoplasty, lateral tension is emphasized because tissue laxity increases from the midline to the sides of the trunk with age and/or with weight fluctuation Therefore, the emphasis of skin removal and tightening is shifted from the midline to the sides of the lower abdominal skin and soft tissue. The Superficial Facial System (SFS) is a connective tissue layer interlaced with the subcutaneous fat that lies between the deep dermis and abdominal fascia. Closure of the deep layers of fat with permanent braided nylon sutures integrates the strength of the (SFS) in the resulting abdominoplasty incision. The permanent stitches, which secure the deep layers of fat surrounded by the SFS, create a durable narrow scar and prevent a "ledge" effect that occurs when absorbable stitches are used on the deep fat layers. The muscles of the abdominal wall are sutured to treat muscle laxity and create an internal corset. The belly button position is transposed. Liposuction is performed with the High Lateral Tension Abdominoplasty for additional abdominal contour improvement in appropriately selected patients. The combination of liposuction and HLT abdominoplasty gives results that surpass those obtained by either procedure alone. Liposuction of the upper and lateral abdomen improves appearance and often allows the contour of the upper abdomen to show definition where it did not exist before. Not only is the abdomen tightened with this technique, but the anterior thigh is also lifted as well. These features are unique to the High Lateral Tension abdominoplasty technique, and are not as readily achieved (if at all) with traditional abdominoplasty techniques. High Lateral Tension Abdominoplasty may be performed with liposuction of the back and flank regions. In these cases, the operation becomes one of Total Truncal Rejuvenation as the contour of the entire torso addressed in one operation. David Sterling Slatton, MD