How Realistic to Expect Oblique Muscles Plication During Abdominoplasty? Why Is This Only Done Overseas?

Question

Dear Docs, I'm considering secondary TT, and while researching options, I found that Brazil and Russian surgeons can do oblique muscles plication in addition to rectus plication to accentuate waist during TT surgery. I wonder if such an option is accessible in USA? And if not, I wonder why? - are there any downsides to it besides prolonged recovery? Thank you.

J. Jason Wendel, MD, FACS · Answer

It is realistic to expect oblique muscle plication if you request it and you are a candidate for it.

	Oblique muscle plication is not limited to overseas plastic surgeons. It is done here in the United States. Some plastic surgeons routinely do it on all of their tummy tucks, and others do it on a case-by-case basis.

	Oblique muscle plication can contribute to increased discomfort after surgery.

	Ask your plastic surgeon. If he/she has never done it or is unwilling to do it, you can always get another opinion.

Jed H. Horowitz, MD, FACS · Answer

there are many ways to tighten the abdominal muscles

	
		vertically , or straight up and down
	
		permanent or dissolving sutures
	
		rectangle repair
	
		oblique repair
	
		lower abdominal repair


	i use these methods in combination or alone as needed

Armando Soto, MD, FACS · Answer

Hi there-

	As many of my colleagues have stated, the technique you are asking about is not new, and most experienced, Board Certified Plastic Surgeons would be able to add this technical detail.

	The bigger question is whether or not it would benefit you as an individual.

Gary M. Horndeski, MD · Answer

Hi Tony,

	Thank you for the question.  In addition to plicating the lateral oblique muscle/fascia, I routinely attach a large piece of mesh for support. This technique allows for a longer lasting repair of the abdominal wall. And it acts like an 'internal girdle' of sorts to permanently ensure a flat tummy. Patients describe a tight feeling across their abdomen. This often translates to immediate weigt loss due to inability to overeat.   Best wishes, Dr. H

Ronald Schuster, MD · Answer

External oblique tightening is always an option during tummy tucks. I will occaisionally use it when it appears that midline plication is not giving the shape I want. Together with aggressive liposuction in the flanks can give impressive reults for the waistline.

Joseph Mele, MD · Answer

When the abdominal muscles are lax, like after pregnancy or weight loss, the rectus muscle is plicated (tightened). The plication tightens the case that contains the muscles, but this case does not stop at the border of the rectus muscle.  This tough casing, called fascia, is continuous around the abdominal wall. So, whenever the rectus fascia is tightened, the external oblique fascia is also tightened, and the potential for improving the waist line exists.

	If the external oblique fascia remains loose after the midline tightening, then and only then is there any benefit from separate plications on the sides. This is rarely the case, and so the plication is rarely indicated. The lateral fascia is also not as thick as the midline fascia, so sometimes it will not hold a stitch well enough to provide any benefit. If there is too much fat inside the belly, further tightening is also fruitless. It's like trying to close a suitcase that is too full. It will still hurt and still has the risk of bleeding, and even small risks are not worthwhile when there is no benefit. 

	These considerations and many more go into the planning of every surgical procedure. I encourage you to learn your options, but the only way to determine what the best course of action is with a person consultation with a board certified plastic surgeon. This is why plastic surgery training takes so long. You cannot learn it all in a weekend course, or from Google.

	The option of tightening the oblique fascia has been available in the US and everywhere else, since tummy tucks where described. By choosing a board certified plastic surgeon, you are likely to find a plastic surgeon who is well trained, and who can guide you to your optimal results by choosing the options that will work best for you, avoiding unnecessary risks.

	Plastic surgery evolves slowly, and new innovations that are successful are quickly shared with our peers, and at national meetings. When you are investigating a specific procedure claiming to be new, innovative and that delivers superior results that nothing else can, please proceed with extreme caution. The mainstream plastic surgery procedures, like tummy tuck with one of the highest "worth it" ratings on Real Self, have been around a long time. Many innovative surgeons have contributed to its success, and it is difficult to radically improve the results. It will happen, but it will not be as simple as adding a few stitches on the sides.

Mathew C. Mosher, MD · Answer

This is an interesting question. I think that you are an example of the "modern" patient who is doing extensive research about the procedure that really was not possible before the Internet facilitated access to information. When you learn of something "new" or "unique" it is best to ask your Plastic Surgeon and in most cases you will learn that they have an educated opinion and often personal experience with something you thought was only available elsewhere.

	In North America,  a Royal College or American Board Certified Plastic Surgeon will be well aware of the options for tightening the muscle/fascia layers during an abdominoplasty. For some patients the laxity in the lateral abdomen benefits from a variety of techniques to shape and tighten this area in addition to the mid-line tightening. This is a decision that starts with a thorough examination but ultimately is decided in the operating room. One important factor in achieving optimal waist definition with an abdominoplasty is that the patient really must be near their ideal weight or at least have very little visceral fat excess at the time of surgery.

	I have not found the recovery of patients to be changed in a tangible way when I do additional plication or tightening of the lateral abdomen (external oblique area).  Consequently, this additional shaping is done selectively when I feel it will benefit my patients' outcome.

	Regards,

	Dr. Mosher

E. Ronald Finger, MD · Answer

Oblique muscle plication during an abdominoplasty is done in the US all the time when indicated. In virtually every case the rectus muschle is plicated, and if the patient has a large waist, the obliue muscle plication can help. If the abdominal content is excessive, plication sutures will not help much. It's best to lose down to the weight that is practical for you to maintain before such a procedure. This will also allow the oblique muscles to tighten with plication.

	E. Ronald Finger, MD, FACS

Remus Repta, MD · Answer

Hello,

	Muscles are designed to contract and expand--your arm and legs muscles do it thousands of times a day and they do not become "lax".  When the abdominal wall becomes lax after pregnancy it is not the muscle that has changed but the connective tissue the abdominal muscles are enveloped in.  When muscles are tightened during a tummy tuck its really the connectve tissue that is tightened--muscles are not good at holding sutures anyways.  The main area for plication of the connective tissue is in the middle between the left and right rectus muscles.  Other options include the linea semilunaris--which is the area just to the side of each rectus muscle.  Suturing the the oblique muscles usually refers to plicating the connective tissue in the semilunaris area.  It can be done if beneficial but the midline plication usually all that is needed.

	All the best,

	Dr Repta

Darryl J. Blinski, MD · Answer

You can see your research has not allowed you to find the many US PSs that offer lateral plication of some form. It is done as each case dictates its need. Why travel overseas for an extended recovery and risks is what I wonder?

How Realistic to Expect Oblique Muscles Plication During Abdominoplasty? Why Is This Only Done Overseas?

Answers (16)

More Tummy Tuck Questions

WE SEND PRETTY
EMAILS

Answers (16)

More Tummy Tuck Questions

How Long Does the Average Patient Wear Their Girdle After a Tummy Tuck?

How Do You Tell if You Tore the Muscle Repair from a Tummy Tuck? 6 Weeks PO

I Had a Tummy Tuck 2 Years Ago and my Belly Button Area Never Has Healed! Always Oozes, What is the Problem? (photo)

After a Tummy Tuck Will I Be Limited on my Food Intake for the Rest of my Life? Will my Stomach Get Enlarged Again?

Would an Extremely Strong Core Prevent Stretch Marks by Keeping the Size of the Belly Down?

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS