What Is a High Lateral Tension Abdominoplasty (HLTA)?

There are literally dozens of different types of tummy tucks (abdominoplasty), and not all techniques are created equally. Regardless of the technique, most tummy tucks do four things to varying degrees: 

1. Remove extra skin below the belly button
2. Tighten the rectus abdominis (six-pack muscles), otherwise called a diastasis repair
3. Reposition and/or reshape the belly button
4. Liposuction for contouring

A Standard Tummy Tuck: What Is It?

During a tummy tuck, an incision is placed low on the abdomen (usually within the underwear/bikini line). The skin and subcutaneous tissue (fat) are then lifted off the underlying abdominal wall; this is called undermining. In a standard tummy tuck, undermining is performed over nearly the entire abdominal wall, all the way to the hips on the sides and up to the ribs above (yellow and red shaded area below). 

This is done to loosen the skin as much as possible, so that as much skin as possible can be removed. Next, the skin is pulled straight down, as tight as possible, and all of the extra is removed (red-shaded area). The two skin edges are then closed together.

While this makes some sense, it may come with a few unwanted results over time: 

1. The incision may ride high over time, and even become visible over the bikini or underwear line (right).
2. An unnatural contour of the groin crease and pubic mound may develop (think of a Ken doll).

Why Does This Happen?

It happens because pulling the skin straight down results in a very unnatural tension across the stomach. To understand this, it is necessary to understand what we call Langer’s lines, or skin tension lines. These Langer’s lines exist all over your body, from the top of the scalp to the tips of the toes. They represent the way the body naturally stretches and folds over time. The natural aging process usually results in wrinkle formation or extra skin developing parallel to these lines. In the stomach area, the skin tension lines look like the ones shown below (in blue).

As you can see, the lines come from the hips toward the midline. There are no lines oriented straight up and down. This is why placing maximum tension straight up and down, as is done in a standard tummy tuck, can result in a very unnatural contour in the pubic mound/groin creases and cause the scar to ride high over time. 

What Makes a High Lateral Tension Abdominoplasty (HLTA) Different? 

With an HLTA, once the extra skin is removed, the tension across the skin closure is placed laterally (to the sides). The tension gradually decreases as it moves toward the belly button so that there is minimal tension in the midline. Following the natural skin tension lines has two desired effects: 

1. It allows the incision to sit lower so that it can be better hidden.
2. It results in a mini outer thigh lift (red upward-pointing arrows).

Standard Tummy Tuck vs. HLTA

So, to recap: In a high lateral tension abdominoplasty (HLTA), unlike a standard tummy tuck: 

1. The scar sits lower, in a more natural, concealed position, because the scar is placed parallel to the body’s natural skin tension lines.
2. Because maximal tension is placed on the sides (high lateral tension), patients get a mini outer thigh lift as an added bonus.

But the most important difference between a standard tummy tuck and an HLTA has to do with the amount of liposuction that can be safely performed. To understand this, think back to the concept of undermining. Remember, undermining means lifting the skin and subcutaneous tissue (fat) off the underlying abdominal wall. Fat that is undermined cannot undergo liposuction because it may damage the blood supply to the tissue and cause wound-healing problems. 

The picture below shows the difference in skin and fat that is undermined (in yellow) in a standard tummy tuck (left) and an HLTA (right).

Notice that the amount of yellow (undermined tissue) in a standard tummy tuck is much more than in an HLTA. This means that the HLTA allows for much more extensive liposuction than a standard tummy tuck. This is particularly useful in the upper abdomen (what we call the epigastric region), and along the flanks where extra, pesky fat tends to hang out. 

The ability to do extensive liposuction in an HLTA is, in my opinion, the biggest advantage of this technique because it allows for abdominal, flank, and even back fat contouring, which amounts to total rejuvenation of the midsection.

In summary, the HLTA provides a more natural contour to the abdomen compared to other tummy techniques because it obeys the body’s natural skin tension lines. This results in a lower, well-concealed scar (right) and a mini outer thigh lift. Because of the extensive liposuction done during an HLTA, a more artistic, complete sculpting of the entire midsection can be accomplished. 

Examples of this technique can be seen in the photo gallery. I believe the results speak for themselves!

Schedule Your Consultation

To find out more about HLTA and to get help determining whether it’s the right procedure for you, contact the experts at Puget Plastic Surgery today. Call the office at (206) 320-6138 or fill out our online contact form.