Cadaveric Dissection of the Superficial Fascia System in Abdomen and Anatomy-based Abdominal Lipoplasty

BACKGROUND: Liposuction-assisted abdominal contouring is one of the most popular liposuction operations. (1) This seems to imply that “abdominal liposuction may be just a simple operation and a good postoperative result can be easily achieved by purely holding the cannula in hand and reciprocating.” But this is just a trap. In fact, complications happen after abdominal liposuction, such as uneven skin, especially in the lower abdomen. (2,3) Besides, there are many contour deformities in the abdomen. (4,5) This requires doctors to perform liposuction according to different abdominal conditions. To refine the abdominal contouring procedures, our team dissected the abdominal SFS in fresh specimens, aiming to give a thorough topographic anatomy of SFS, present a theory about the abdominal fat accumulation mechanism, figure out the anatomical explanations of one or even two horizontal skin creases and the roll deformities between them, thus put forward a set of corresponding methods of contouring improvement. METHODS: A total of 20 fresh female specimens (mean age, 54 years; age range, 35-76 years) were dissected. Dissections were made on one side of abdomen from skin to deep fascia. The SFS was lifted with removing as much of the fat as possible so as to clearly observe the retinaculum cutis. Besides, intact SSC tissue blocks were obtained on the other side of abdomen on the six horizontal planes and four vertical planes. The changes of SAT and DAT from medial to lateral, and from cephalic to caudal, were recorded. RESULTS: The thigh was divided into three sections, namely, the median (four subunits: upper abdomen, mid-abdomen periumbilical zone, lower abdomen, suprapubic zone), the negative (two subunits: costal zone, subcostal zone), and the lateral section (two subunits: lateral chest, lateral abdomen). We found that the form of the SFS has regional variations. Therefore, based on these varied features, the SFS among the eight subunits of the abdomen fall into five categories based on amount, toughness and density in DAT (least, less, median, more, most; notated by degree I-V) and RCP (most loose, loose, average, tight, tightest; notated by degree I-V). Five different liposuction methods were formulated to manage these subunits: inward tightening (all-layer mass liposuction), primary flatten (mass liposuction), secondary flatten (normal aspiration), border feather-out (aspiration for smooth contour), restricted flatten (conservation aspiration). Besides, the author proposed the anatomical explains about three scenarios of abdominal contour deformity: adhesion zones, roll deformities, depression in the negative section. CONCLUSIONS: The SFS of the abdomen showed a regional variation pattern, based on which we proposed a series of new anatomy-based liposuction approaches. Topographic anatomy of the SFS in the abdomen region helps us understand its contour deformities and provide an anatomic basis for surgical correction. A well-sculpted abdomen with its different sections presented in harmony can be safely obtained using these approaches. REFERENCE: 1. Trussler AP, Kurkjian TJ, Hatef DA, Farkas JP, Rohrich RJ. Refinements in abdominoplasty: a critical outcomes analysis over a 20-year period. Plast Reconstr Surg. 2010;126(3):1063-1074. doi:10.1097/PRS.0b013e3181e60537 2. Taylor DA. Zones of Adhesion of the Abdomen: Implications for Abdominoplasty. Aesthet Surg J. 2017;37(2):190-199. doi:10.1093/asj/sjw140 3. Rohrich RJ, Smith PD, Marcantonio DR, Kenkel JM. The zones of adherence: role in minimizing and preventing contour deformities in liposuction. Plast Reconstr Surg. 2001;107(6):1562-1569. doi:10.1097/00006534-200105000-00043 4. Saldanha O, Ordenes AI, Goyeneche C, et al. Lipoabdominoplasty with Anatomical Definition. Plast Reconstr Surg. 2020;146(4):766-777. doi:10.1097/PRS.0000000000007184 5. Brauman D, Capocci J. Liposuction abdominoplasty: an advanced body contouring technique. Plast Reconstr Surg. 2009;124(5):1685-1695. doi:10.1097/PRS.0b013e3181b98c5d