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

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.

Doctor Answers 16

Tummy tuck with oblique muscle plication

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.

Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Oblique Muscle Plication at Tummy Tuck

I routinely plicate the obligue muscles in a tummy tuck when it is indicated. It is indicated in womem with a "pot belly" , especially with a sway back ( lumbar lordosis). I make this decision during surgery. Not many women have this body type. You do not need to be in a foreign setting for your plastic surgeon to think about this finrsse point in a tummy tuck.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 114 reviews

Abdominoplasty and techniques of muscle tightening (plication)

there are many ways to tighten the abdominal muscles

  1. vertically , or straight up and down
  2. permanent or dissolving sutures
  3. rectangle repair
  4. oblique repair
  5. lower abdominal repair

i use these methods in combination or alone as needed

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 107 reviews

Waist Definition Can be Improved with Oblique Plication

hi tony99:  in most abdominoplasty patients, tightening of the oblique muscles is not necessary for an excellent improvement in waistline definition.  i am very aggressive in plicating the abdominal muscles in my patient population and in addition to the rectus plication, i also evaluate the obliques and plicate when necessary.  you do not need to leave the country to have this procedure.  if you have a straight waistline before abdominoplasty, due to a very short distance between ribs and hip bone, no amount of oblique plication will give you a narrow waist.  (you will just be so tight and pulled forward that you won't be able to stand up straight!).  if the oblique is truly bulging and very lax, then plication can be very helpful in getting the great result and narrow waist that you are looking for.  most people with a small (tight) waist have enough length from ribs to hip bone to allow the curve to come in to the waist and then out again to the hip.  "short-waisted" patients will not be narrowed by oblique plication and tend to be straight waisted.  your plastic surgeon should be able to evaluate these anatomic landmarks and advise you about whether you are even a candidate for oblique tightening.  i probably find only one or 2 patients per year who will truly benefit, but it is always an option i consider.  best of luck to you!  dr h

Mary C. Herte, MD
Las Vegas Plastic Surgeon
4.5 out of 5 stars 18 reviews

Oblique plication during abdominoplasty

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

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 222 reviews

Tummy Tucks and Muscle Plication

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.

Joseph Mele, MD
Walnut Creek Plastic Surgeon
4.5 out of 5 stars 17 reviews

Oblique muscles can be tightened as part of an abdominoplasty

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.


Dr. Mosher


Mathew C. Mosher, MD
Vancouver Plastic Surgeon
4.5 out of 5 stars 34 reviews

Oblique Muscles Plication During Abdominoplasty?

The method of further tightening the abdominal muscles you are referring to is NOT new and is sometimes referred to as a Psillakis Corset Abdominoplasty. While the external oblique muscles can be tightened on either side for greater flattening of the tummy and accentuation of the waist. In the original operation, the insertion of the Ext. Oblique muscles on the lateral side of the Rectus Abdominis Muscle are cut on both sides and the muscles are undermined from the Int. Oblique muscles and pulled across the midline and stitched to each other as a corset.

This operation is not routinely done because it is a greater operation with more discomfort to the patient and is only done in certain, limited patients who would benefit from it.

You did not mention WHY you are having a Secondary Tummy Tuck but I'm sure if you picked an experienced Plastic Surgeon (= member of The American Society of Plastic Surgeons) he could readily tell you if you may benefit from this operation.

Peter A Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Oblique muscle plication during an abdominoplasty

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

E. Ronald Finger, MD
Savannah Plastic Surgeon
4.8 out of 5 stars 78 reviews

Its not really a muscle problem


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

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 162 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.