Redefining Limits: A Clinical Trial on the Safety of Combining Liposuction with Undermining During Abdominoplasty

In spite of the popularity of liposuction with abdominoplasty, there is little objective evidence to the extent of liposuction and width of undermining that is safe. This study aims to objectively evaluate the safety and aesthetic outcomes of liposuction and extensive undermining, alone or combined, in abdominoplasty.

Patients were randomly assigned to one of three groups: (A) Lipoabdominoplasty (limited undermining and liposuction of the abdominal flap), (B) Traditional Abdominoplasty (wide undermining and no liposuction of the abdominal flap), and (C) a Combined Technique (wide undermining and liposuction of the abdominal flap). The parameters assessed included epigastric pinch thickness, horizontal laxity, operative time, aesthetic outcomes, and the complication rates.

There were no statistically significant differences in complication rates when comparing individual groups, liposuction versus no liposuction groups, or limited versus wide undermining. Liposuction, with or without wide undermining, was more effective in reducing epigastric pinch thickness and enhancing aesthetic outcomes. Additionally, the extent of surgical undermining did not significantly influence flap thickness, horizontal skin laxity, or overall aesthetic results. Group C exhibited the longest operative time, likely due to the combined demands of extensive dissection, sub-Scarpa's fat removal, and liposuction.

Combining wide undermining with liposuction in abdominoplasty is safe. However, liposuction plays a more critical role than undermining in improving aesthetic results and reducing flap thickness and should therefore be prioritized. While wide undermining is safe, it should be employed selectively based on individual patient criteria and surgical goals. Abdominoplasty techniques should be customized to align with the unique anatomical features and expectations of each patient.