Poll: Tummy Tuck Crossbow Technique

Question

This question is for all Board-Certified Plastic Surgeon who perform tummy tucks and feel that they achieve fantastic results, with their patients agreeing as well: have you heard of the Crossbow Technique for repairing the diastasis of the rectus abdominis and oblique abdominis muscles and do you use it? In other words, do you use vertical and horizontal plication for both its corrective and aesthetically pleasing results? Patients are interested in pursing this technique.

Jeffrey M. Darrow, MD · Answer

After elevation of the abdominal skin, if there is a separation of the rectus muscles, it is usually evident, and the fascia overlying the medial portion of both rectus muscles can be approximated with interrupted and running sutures to repair the diastasis to flatten the tummy.  This returns the muscles to the correct anatomical position.  In some patients, the fascia which lies across the front of both rectus muscles will also be stretched/ loose and a vertically oriented, crescent shape suturing of that fascia can be done to narrow the waist.  Suture tightening of other portions of the abdominal fascia can be done on an individual bases, only if that fascia is lax.  The fascia overlying the external oblique is thin and may not support tight sutures.  By far the most common fascia tightening is to repair the central diastasis, with other areas addressed on an as needed bases.  Best wishes.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding the Crossbow Technique used in tummy tuck surgery for diastasis repair. Not only have I heard of the "Crossbow" technique, but I also perform it selectively in appropriate cases. However, it’s important to understand that not every patient needs the Crossbow Technique, and it’s typically reserved for patients with significant abdominal wall laxity, often after massive weight loss.

In the traditional component of the technique, the rectus abdominis muscles are plicated vertically, from the sternum to the pubic symphysis using permanent sutures. This vertical plication tightens the abdominal wall with a natural horizontal pull, which is standard in most abdominoplasty procedures. The “crossbow” addition introduces a perpendicular, or horizontal, plication that includes the oblique muscles, resulting in a vertical pull. The goal is to provide a more corseted, cinched-in waist and flatter abdominal contour.

However, there are some important considerations and potential drawbacks to this approach. Plicating the oblique muscles, which are accessory muscles for respiration, can lead to shortness of breath postoperatively, especially in the early healing phase. Some patients experience such discomfort that they seek emergency care, concerned that something is wrong, when in fact it is due to the muscle tightness caused by excessive or multidirectional plication. For this reason, most plastic surgeons do not routinely perform oblique muscle plication.

In patients with severe abdominal protrusion and a large peritoneal cavity — such as those who have lost a significant amount of weight — the Crossbow Technique can offer some benefit. However, even in these cases, the amount of plication possible for the obliques is often limited to 2–3 cm, compared to up to 8 cm for the rectus muscles. Because of this small gain, many experienced surgeons feel that the additional risk and discomfort may outweigh the benefit in routine cases.

So yes, the Crossbow Technique has its place, but its use should be tailored to individual anatomy and goals. Patients should have a thorough consultation with a board-certified plastic surgeon who understands both the functional and aesthetic impacts of various muscle plication techniques.

I hope this helps clarify your question about the Crossbow Technique in tummy tuck surgery.

Sincerely,
Dr. Katzen

Michelle Zweifler, MD · Answer

Most abdominoplasties have plication of the rectus muscle in the vertical fashion.  If there is still bulging below the umbilicus, at times a horizontal or oblique plication of the fascia is performed; referred to by some as "Tummy Tuck Crossbow Technique".  This procedure is performed more commonly in revisional or secondary tummy tucks; or at times decisions are made intraoperative to minimize the supra-pubic bulge.

Gerald Minniti, MD, FACS · Answer

The goal is a flat abdominal wall, and there are many ways to achieve it in a satisfactory fashion. That's what patients want to. It sounds like you are more interested in taking a poll than any issues you may be having.

Azita Madjidi, MD, MS, FACS · Answer

The technique should be chosen based on the patient's anatomy not patient's request. Some have long torso, some have short torso, some have had massive weight loss, some still have a BMI of 30. There is no such one technique that fits all.

Poll: Tummy Tuck Crossbow Technique

Answers (9)

Answer: Cross bow muscle plication

Answer: Cross bow muscle plication

Answer: Abdominoplasty

Answer: Abdominoplasty

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Everything you need to know about Tummy Tuck

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Poll: Tummy Tuck Crossbow Technique

Answers (9)

Answer: Cross bow muscle plication

Answer: Cross bow muscle plication

Answer: Abdominoplasty

Answer: Abdominoplasty

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Recommended reading

Everything you need to know about Tummy Tuck

Our mission is to create a world where every investment in modern beauty is Worth It.