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Decision-Making Algorithm for Advanced Excisional Body Contouring: Dynamic Definition Solutions for Skin Laxity

Background: Excisional body contour surgery is the cornerstone treatment for skin laxity. Decision-making can be challenging when selecting the procedure. Dynamic definition liposculpture allows the surgeon to carve the underlying anatomy and provide more natural results, in which umbilical shape and position play a crucial role. The authors describe their experience using a decision-making algorithm as a tool to ease surgical planning for advanced excisional body contouring. Methods: Following the algorithm designed by the senior author regarding excisional body contouring procedures, the authors searched their database for patients who were classified according to skin laxity and navel location to undergo one of the following procedures: mixed technologies plus umbilical mobilization, mixed technologies plus sliding mini-abdominoplasty, mini-tummy tuck with muscular plication, full abdominoplasty, reverse bridge abdominoplasty, or reverse full abdominoplasty. Results: A total of 563 women were consecutively operated on from February of 2014 to January of 2020. The six-procedure model algorithm helped the authors achieve very good results with low complication rates in patients with some grade of abdominal skin laxity. Most complications were reported as minor (9.6 percent). Major complications (3.9 percent) included three localized infections, four abnormal skin retractions, two cases of skin flap necrosis, and 13 cases of postoperative anemia. Conclusions: This algorithm helped the authors choose the best excisional technique based on patients’ anatomical features by following skin geometry to enhance aesthetic outcomes. Further studies are needed to support the algorithm validation and aesthetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.