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How to Design, Plan, and Execute an Abdominoplasty: The Anous’ Methodology

Rather than being an exercise in vagueness, the Anous’ Methodology utilizes rigorous verifiable measurements (called Boundaries) that serve the causes of Accuracy (in planning) and Verification (of results). 

Step 1: Assessing the vertical skin excess above the belly button

This is based on the difference between the XS points (Xiphi Sternum) and CM lines (Costal Margins) in the upright (Standing) and lying down (Recumbent) positions.

Step 2:Assessing the vertical skin excess below the belly button

This is based on the difference between the SP points (Symphysis Pubis) and AS lines (Anterior Superior Iliac Crest) in the upright (Standing) and lying down (Recumbent) positions.

Step 3: Assessing the minimal amount of vertical skin excess needed for removal.

The sum of upper and lower vertical skin excess is the minimum amount of excision needed in the vertical direction to give a decent result.

Step 4: Assessing the amount of Horizontal skin excess.

This depends on the Xiphi Sternal Angle and on the “Scissors Principle” governing the relation between lung volume and intra-abdominal volume (Lung Volume + Intra-Abdominal Volume = 1).

Step 5: Drawing the Mercator Lines.

Step 6: Choosing a surgical plan based on skin excess.

If skin excess is VOABB (Vertical Only Above the Belly Button): REVERSE TT

If skin excess is VOBBB (Vertical Only Below the Belly Button): INVERTED-V TT

If skin excess is VAABBB (Vertical Above And Below the Belly Button): M-Design TT

If skin excess is OH (Only Horizontal): FDL Design with minimal vertical component

If skin excess is BHAV (Both Horizontal And Vertical): FDL-Design TT

If skin excess is BHAVMTL (BHAV with medial thighs laxity): Manta Ray Design TT

Step 7: How does the pre-set plan influence the conduct of surgery?

Symmetry: Deformation Symmetry during surgery

Scar: Always in the crease lines

Time: Reduced operative time

AVERAGE TIMING IN MINUTES:

M = 76

FDL = 134  

Manta Ray = 155                             

 

Results: One month after surgery before the fading of scars