["Modern" combined abdominoplasty]

Cosmetic abdominoplasties have been the subject of many criticisms because of their frequent disadvantages and complications. Although the length of the scar depends on anatomical conditions, diffuse adipose infiltration of the abdominal wall, the often excessively low umbilicus (surrounded by a circular scar characteristic of the operation), and the postoperative risks, severely limited the aesthetic quality of the final result. A new therapeutic approach, based on recent technical progress and old, but neglected surgical techniques, provides results which appear to be satisfactory. Liposuction, particularly performed at the beginning of the operation, regularly thins the abdominal wall and constitutes a useful complement to the so-called superficial method and especially the more extensive use of ultrasound, which has become almost essential in certain regions. Neo-umbilicoplasty according to an original hourglass plan and an abdominoplasty using four skin flaps provide a natural result, with no visible scar, and allow harmonious positioning of the umbilicus. This technique constitutes an interesting alternative to the limited possibilities of classical repositioning. Liposuction of the pubic region and lowering of the pubic hair line also improve the aesthetic possibilities. Although not all of the various disadvantages of aesthetic abdominoplasty have yet been resolved, their frequency has been markedly decreased and this therapeutic approach, which also constitutes a line of research, allows a more optimistic view of this operation, for which the indications must remain selective and rigorous. Various classifications are described to guide the choice of treatment based on analysis of clinical signs.