Flap elevation is performed with incision of the U component of the abdominoplasty initially with a cold knife and then followed with electrocautery as the subcutaneous layer is reached. The larger vessels are suture ligated to avoid potential hematoma. The marked M component is matched against the lower incision (Figure 10). If any discrepancy exists, then the appropriate adjustments are made. It is better to leave a looser flap, which can be closed without tension, than to risk the chance of skin necrosis (local death of body tissue) due to excessive tension.

Trimming of the upper abdominal flap at the M component is usually performed before the muscle repair and navel insetting. The abdominal flap closure is done in three layers. An initial layered suture is placed in the midline to centralize the abdominal flap and avoid inadvertent shifting. Another key suture is placed midway between the midline and the end of the suture line where both components of the U-M meet. Before the rest of the closure is performed, two large suction drains are placed underneath the flaps and brought out through the pubic areas or the flanks. Abdominal flap closure is performed to the Scarpa's fascia layer to avoid depression of the suture line scar.

Next, the subdermis is approximated with several inverted sutures. If the patient has thin abdominal tissues, this might be closed with absorbable suture material to avoid potential extrusion of the nonabsorbable suture material. The skin is closed with subcuticular sutures. At the end of the surgical closure, the surgeon should observe the unfurling of the excess groin and thigh skin and the reshaping of the pubis (Figure 11). Dressing and a wellcontoured abdominal binder are applied. The abdominal binder is marked with two vertical lines for adjustments while the patient is in a supine (lying on the back with face upward) and standing position. Usually when the patient is in the standing position, the binder is tightened further.