Aesthetic refinements in body contouring in the massive weight loss patient: trunk.

[BACKGROUND] Aesthetic refinements in body contouring surgery after massive weight loss are evolving in an effort to improve patient appearance. This is a personal clinical review for the trunk.

[METHODS] There are 10 essential elements to performing body contouring surgery after massive weight loss. Based on this generally accepted baseline, the author presents 16 outstanding aesthetic refinements. These reliable and safe adaptations to improve outcomes were assembled from a personal case review of the past 12 years of over 500 cases. The refinements are the result of lectures attended, literature read, and innovations tried. Gender enhancement is emphasized. Plastic surgeons improve female shape through artful management of adipose deposits. Surgeons enhance male muscularity through an abdominoplasty and a series of large opposing ellipses for skin tightening across the entire torso.

[RESULTS] These 16 refinements have been applied to the trunk. Four representative cases with preoperative markings and late postoperative results demonstrate the value of these aesthetic refinements. The accompanying video that demonstrates drawing the boomerang pattern correction of gynecomastia with J torsoplasty reveals many of these refinements.

[CONCLUSIONS] These aesthetic refinements are previously published anecdotal evidence that are presented together as part of the author's routine clinical experience. They await confirmatory experience or, better yet, rigorous scientific study. Until then, these are practical adaptations routinely used by the author on the trunk that merit the reader's consideration.