The Oblique Flankplasty Revisited: Outcomes of 108 Consecutive Cases

Goals/Purpose: The flank is an anatomical fat compartment with borders defined by zones of adherence to the ribs above; the spine and lumbodorsal fascia medially; and the posterior iliac crest inferiorly. The oblique flankplasty takes advantage of the robust adherences to the costal margin, the midline, and the lumbodorsal fascial to eliminate the flank roll, lift the buttock, and remove excess horizontal laxity from the abdomen. The purpose of this study was to examine outcomes of a large consecutive series of oblique flankplasty procedures.

Methods/Technique: The oblique flankplasty excision is oriented obliquely and centered over the flank redundancy. It is planned with the superior incision just below the zone of adherence to the posterior costal margin and the inferior incision is determined by skin pinch. In concurrent lipo-abdominoplasty, the incision can be carried into the abdominal incision. The intervening tissue is removed with minimal undermining. When combined with lipo-abdominoplasty, the abdominal drains are extended into the lower portion of the flankplasty excision to also drain this site. Closure is achieved using a #2 barbed PDO suture to secure the SFS, and an intradermal running Monoderm achieves skin closure in an effective and expedient fashion.

Data was prospectively collected on all oblique flankplasty procedures performed since 2013 by the senior author. This paper retrospectively reviews the outcomes and complications in this cohort. Complications included dehiscence, seroma, hematoma, infection, return to OR, and patient dissatisfaction with the final result. Outcomes were also qualitatively assessed by independent observers comparing pre- to post- operative photographs using both the Pittsburgh Rating Scale for flanks and a 5-point Likert-type assessment.

Results/Complications: 28 men and 80 women underwent oblique flankplasty from 2013 to 2021. Average age was 45 (range 19-78). Average BMI at time of surgery was 28.4 (range 19-40). Average pre-op weight loss was 120lbs. 80.6% had Pittsburgh Grade 3 flanks, and 19.4% had Pittsburgh Grade 2 flanks. 97% underwent concurrent abdominal procedures, most commonly lipoabdominoplasty (76%), limited abdominoplasty (9%), panniculectomy (4.6%), or fleur-de-lis abdominoplasty (4.6%). The most common complication was minor dehiscence (17.6%), followed by seroma (10.2%), followed by minor infection requiring a course of oral antibiotics (9.3%). Three patients (2.7%) required return to OR for revision, and 2 patients (1.8%) were unsatisfied with their final result. Qualitative assessment of photographs by independent observers demonstrated significant improvement in 96% of cases.

Conclusion: Our growing experience with oblique flankplasty supports our earlier findings. It is a safe procedure with an acceptable complication profile and extremely high patient satisfaction. As with other body contouring procedures, the most common complication was minor dehiscence, followed by seroma. In the appropriate patient, the oblique flankplasty allows powerful control over both horizontal and vertical vectors allowing optimal reshaping of the flank and waist with effects that extend to and improve the contour of the abdomen and buttock as well.