• Three patients (2%) had small areas of skin necrosis in the lower central abdominal flap. Two of these patients required secondary revision, one 3 weeks after surgery, and the other several months later. This did not compromise the final aesthetic result. The third patient did not require any revision.
• In four patients (3%), seromas developed that required serial aspiration of fluid.
• In one patient (0.7%). a pseudobursa developed with chronic fluid collection, which required excision.
• A drain tract infection that was successfully treated with localized drainage and antibiotics developed in one patient (0.7%).
• In another patient (0.7%), deep vein thrombosis developed at the calf. Many patients began wearing bikini bathing suits, which they had been unable to wear before surgery (Figures 12 and 13).

Working independently since 1986, I have used the technique presented here that I call the "U-M Abdominoplasty." As mentioned, the name of the technique derives from the shape of the incisions. The U component sets the final position of the scars, which start very low in the pubis and gradually extend toward the waistline. The M component allows me to match the length of the inferior incision and provides more lateral tension on the abdominal flap. In this way, the risk of skin necrosis in the flap is minimized.

The cases of skin necrosis that I have experienced have been minor and avoidable. One patient had a history of smoking, one patient's abdominal binder was placed a little too tightly, and the third patient had developed a small hematoma on the lower abdominal wall. This is the same patient in whom drain tract infection and abscess developed.

Contouring of the remaining areas of the trunk (waistline, iliac, trochanter, etc) can be performed safely. For many years I have performed the combination of abdominoplasty with liposuction using standard cannulas, although lately I have introduced ultrasound-assisted lipoplasty (UAL) to my abdominoplasty procedures.

However, with UAL the instance of seroma has increased significantly. Before ultrasound technology is included in a routine abdominoplasty, it should be evaluated further. Although many physicians combining abdominoplasty with liposuction perform suctioning of the upper abdominal wall above the original navel position, I recommend caution in using this combination because the tendency is to suction too much in the region of the flap that is located above the pubic area.

Although the final scar will be in a very favorable aesthetic location and hidden by modern underwear styles and bathing suit designs, it is still imperative to perform a meticulous closure in layers and provide long-term tape support to offer patients the best aesthetic result.