| Preoperative
Markings |
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| Markings are
key for the execution of this operation. They are made with the
patient standing on a high and wide stool while the surgeon sits
on a rolling chair. Reference
lines are outlined with a blue marking pen and consist of the
groin lines, the central midline of the abdomen, a parallel line
to the central midline, and vertical lines on the silhouette of
the patient (from the front and back). Another line is made perpendicular
to the midline across the abdomen, usually at the level of the
navel or waistline. |
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| Figure
7. Reference lines are outlined for easy and symmetrical marking
of the U-M incisions. |
|
Figure
8. The U component is marked after elevation of the pubis. The
stippled line indicates limits of pubic hair. |
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| These reference
lines are useful to help make the markings of the planned flap excision
as symmetrical as possible. Adjustments to these markings may be
made if the surgeon believes that the patient has more laxity and
an excess of skin on one side of the abdomen more than the other.
To mark the U component,
the pubis is lifted and a horizontal line is marked, leaving a
reasonable pubic size (Figure 8). Marking is then diverted toward
the waistline, with manual elevation of the thigh skin in a vertical
direction. If this last maneuver is not performed, the lower incision
will be high. The procedure is repeated on the other side. The
lazy-M incision is marked and appears as a sequence of hills and
valleys. A gentle slope is constructed around the flanks, and
this line gradually tapers toward the most distal end of the U
component (Figure 9). |
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| Figure
9. The U and M marks meet at the waistline. Observe the extension
of the groin line and the anterior and posterior silhouette. |
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Figure
10. The M marking is matched against the U incision. Observe
the navel already inset in its new position. Notice the hill of
the M in relation to the point just above the old navel site (indicated
by the forceps). |
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| During the
marking, it is necessary to perform the pinching technique to ensure
that the amount of skin to be removed can be done safely and without
excessive tension. The blue landmarks help to assess the symmetry
of the incisions, as well as determine the laxity of tissue on one
side in comparison with the other. At this point, adjustments are
made and the areas of liposuction are marked with concentric circular
"bull's-eye" lines, usually in black. |
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