How the High Lateral Tension Abdominoplasty Became My Preferred Technique and Remains So To This Day

As a plastic surgeon who is interested in refining abdominal contour, I divide my practice into two eras: the time before I used the high lateral tension technique and everything since then. In the earlier era, the abdominoplasty procedure frequently left me a little disappointed. I could tighten the skin of the abdomen, but I didn’t feel I necessarily was creating a beautiful shape, such as I might be able to do with a face lift or a breast lift. Often the results seemed expressionless, lacking in form.

My exposure to Dr. Ted Lockwood changed all that. Dr. Lockwood, who passed away at an all too early age, was one of those rare surgeons who change the fundamental principles of an operation. Prior to his contribution, most abdominoplasty surgeries were all about a very strong vertical pull on the skin in the middle of the abdomen. Many surgeons felt that liposuction could not be combined safely with abdominoplasty, so the ability to contour the fat compartments was limited. Indeed with these techniques, with their wide undermining and extreme vertical pull on the skin, the circulation to the skin could be compromised if liposuction was a part of the procedure.

Like most abdominoplasty techniques, the high lateral tension abdominoplasty allows the surgeon to tighten the support of the muscles of the abdominal wall and to remove excess abdominal skin. There are several important departures from traditional technique:

The direction of pull is changed from an exclusively vertical direction to one that slopes out to the sides. This allows the surgeon to regulate the tension of the entire abdomen, not just the portion near the midline. As a result the tightening produces an abdomen with better balance.

The repair occurs at three levels, not two. All abdominoplasty techniques tighten the skin and (where needed) the deep muscles of the abdominal wall. In the high lateral tension abdominoplasty a href=”/breast layer that sits under the skin but above the deep muscles is also tightened. This helps to distribute the tension in a different way so that it tightens the waist and lifts the upper thighs.

The scars sit at a lower more discrete level near the midline than what is seen with many abdominoplasty techniques. As the scars move out to the sides of the abdomen, they can be designed to run up toward the hips along the line of a French-cut swim suit or they can sit lower, according to patient preference.

Because the amount of undermining is limited, liposuction can be combined with the high lateral tension abdominoplasty with a greater degree of safety than with other techniques.

In the years since I learned the fundamentals of this technique from Dr. Lockwood, I have worked out a number of variants to accommodate a range of body shapes and patient goals.

Why doesn’t every plastic surgeon use this technique? A good question, in my opinion. The procedure is a bit more complex technically. It also takes longer to perform that most other techniques, due to the multiple layers of repair. Since the procedure is more time-consuming and more sophisticated, it is more expensive than other procedures. If the competition is on price, the high lateral tension procedure will be at a disadvantage. On the other hand, if the competition is on quality of artistic outcome, this procedure is a winner.

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