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