Ancillary Procedures for Aesthetic Torso Shaping Article by Scott A. Spiro M.D. Simultaneous to developing my "equalization of tone restoration technique" for the abdominal wall in abdominoplasty, I identified other areas of the female torso that were simply not adequately addressed in the early days of tummy tuck surgery. These are: the skin laxity of the flanks (hips), mons pubis (pubic area) sag or fat excess, buttock sag/laxity, or volume loss. Over the years I have refined these ancillary procedures which aid in youthful torso restoration and help yield far more dramatic results. An example of this is the hip skin laxity affectionately referred to by women as the "muffin top". Now that patients are wearing low-rise pants which sit below the hip area these procedures become more important than ever. My technique for waist shaping reveals so much more skin laxity that can be addressed in my combined abdominoplasty- flankplasty. It's not enough to just have a tight abdomen front, my patients get tight skin draping over the hip and curving under the ribs. It really accentuates the female shape by addressing what I call the "zone of poor adherence": Areas of skin not bound down well to underlying tissue: (i.e.) muscle and fascia. Hormonal changes during child bearing years decrease the ability of connective tissue to hold this skin in place. My procedure helps to restore the youthful shape. This flankplasty is a natural low lateral extension of the tummy tuck and does not add time to recovery of the tummy tuck procedure. The continuation of this is the treatment of buttock skin laxity, sag of the buttock (ptosis), and volume loss (atrophy). I have developed three procedures that successfully treat each specific concern. Volume restoration may include fat grafting for the atrophic buttock. Fat is removed from other areas and after processing is added back into the buttock. With many years and many cases experience, I can now affect shape change and volume restoration safely and reproducibly. More elaborate procedures entail the use of the upper buttock, lower back, excess which would otherwise be discarded and can be used to auto-augment the buttock as a "flap" of tissue redirected to fill deficiencies from areas of excess. It is amazing how psychologically important a youthful appearing buttock truly is to a woman who may feel young but whose torso appears aged. Puboplasty addresses the previously overlooked pubic area of women during the tummy tuck procedure. Fat excess, localized lymphatic edema after c-section or hysterectomy surgery, and sag of the pubic area should be addressed when doing tummy tuck procedures. It aids in the overall youthful torso created by liposuction, lifting and tightening. Patients are very satisfied with these often-simple procedures which generally add very little overall recovery.