Figure 1.

Principles of abdominoplasty flap contouring in the massive weight loss population. 1. Flap itself may need improvement (thinning, release, and possible tightening), which can be achieved by sub-Scarpa’s resection with electrocautery. 2. Higher upper incision results in strong downwards/lateral tension vector. 3. Extended, upwards curving lower incision provides lateral tension vector. 4. Mons rejuvenation through a lower incision placement (approximately 6-7 cm from introitus) with upwards/lateral tension vector as well as mons thinning and fascial suspension.