History of Abdominoplasty
Abdominoplasty, one of the most commonly performed aesthetic procedures, has a rich and varied evolution. Kelly (1899, 1910) was one of the first surgeons to attempt to correct excess abdominal skin and fat. Since that time, numerous variations have been suggested. Thorek (1924, 1939) was the first to devise a procedure that preserved the umbilicus. In 1967, Pitanguy published a report of 300 abdominal lipectomies. In 1972, Regnault published the W technique for abdominoplasty. In 1973, Grazer was one of the first authors to describe the so-called bikini line incision, and in 1967, Callia described a low incision that extended below the inguinal crease. The scar was alleged to rise postoperatively, and the incision provided a small amount of lift to the upper thighs. This also appears to be the first report of aponeurotic suturing and rectus distasis repair. In 1977, Grazer and Goldwyn reported the first complications using new techniques. Although aponeurotic suturing in the midline was noted to be able to reduce anterior projection of the abdominal wall, it did little to reduce the diameter of the waist.
In 1978, Psillakis first suggested suture plication of the external oblique musculature after raising it in a belt like fashion. In this way, he was able to dramatically reduce the diameter of the waist. With the addition of liposuction, Matarasso in 1988 expanded the use of abdominal contour surgery to a classification based on variations in patients’ anatomy, from liposuction alone to limited and full abdominoplasty surgery.
Perhaps the greatest advances in body contouring can be attributed to Lockwood who described his high lateral tension abdominoplasty in 1995. Lockwood’s technique placed most of the tension on the closure in the anterior thigh region. Distortion of the pubic region is minimized and wound healing problems in this region are decreased. Because undermining of the abdominal wall tissues is limited, more aggressive liposuction can be performed at the same time without adversely affecting wound healing. Dr. Lockwood also described a deep closure of the fascial system producing a better scar without migration. He extended his concepts to body lifting and thigh lifting techniques and provided a meticulous method of locating incisions so their eventual location remains in the swimsuit lines.
Dr. Richard Linderman of Aesthetic Plastic Surgery of Indiana has adapted Dr. Lockwood’s principles of body contouring and tummy tuck surgery to obtain the best and most predictable results. This has allowed him to offer his patients a circumferential approach to body contouring safely combining liposuction with excisional procedures.