Clinical Approach Results Surgical Anatomy Technique Matrix Classifications Outcomes & Safety Patient Selection Surgeon FAQ Technical Guides Consultation
Istanbul · Abdominoplasty & Body Contouring

Technique-driven abdominoplasty — tailored to anatomy, not to price.

Assoc. Prof. Dr. Ayhan Işık Erdal — double board-certified plastic surgeon, Associate Professor with 30+ peer-reviewed publications and international fellowship training. Extended, fleur-de-lis and lipoabdominoplasty with Scarpa-fascia preservation, perforator-sparing dissection and progressive-tension closure.

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F
FACS
American College of Surgeons
E
FEBOPRAS
European Board of Plastic Surgery
30+
Peer-reviewed publications
ASJ, PRS, Annals of Plastic Surgery
A+
Accredited hospitals
MoH international authorization
Assoc. Prof. Dr. Ayhan Işık Erdal at ACS Clinical Congress 2025 — FACS induction ceremony
Fellow · FACS
American College of Surgeons · 2025
Clinical Approach
Six principles of technique-driven abdominoplasty

Abdominoplasty is not a single operation — it is a spectrum of surgical decisions. The principles below describe the technical commitments Dr. Erdal holds consistent across all abdominoplasty variants, from mini to fleur-de-lis.

01

Matarasso-driven technique selection

Matarasso Type I–IV classification dictates the starting technique; Nahas myo-aponeurotic classification refines the repair plan. The technique fits the anatomy — not the other way around.

02

Scarpa fascia preservation where appropriate

In lipoabdominoplasty (Saldanha), the Scarpa fascia is preserved in the lower abdomen to protect the deep inferior epigastric perforators, reducing seroma and preserving flap vascularity when liposuction is added.

03

Two-layer rectus plication

Diastasis is repaired in two layers — typically a continuous long-lasting absorbable first layer and a reinforcing second layer — extending from xiphoid to pubis where indicated. Plication is adjusted to the Nahas type.

04

Progressive-tension closure

Pollock progressive-tension sutures obliterate dead space between the flap and the anterior abdominal wall, reducing seroma incidence and offloading tension from the skin closure. In selected cases this eliminates the need for drains.

05

Pre-operative marking with the patient standing

The low transverse incision is marked with the patient standing, using their preferred underwear / swimwear as reference, ensuring the mature scar sits within the garment line. An existing Pfannenstiel scar is integrated into the incision where anatomically feasible.

06

Vertical-teardrop neoumbilicoplasty

The umbilicus is reconstructed with a small vertical-teardrop morphology and discreet peri-umbilical closure — avoiding the over-sized, ring-shaped or obviously sutured appearances that mark a poorly executed abdominoplasty.

Results
Operative results

Side-by-side pre-operative and post-operative comparisons at the stated time points. Patient identities are protected; images published with explicit written consent. Tap any image to enlarge.

All photographs published with explicit written consent. Cases performed by Assoc. Prof. Dr. Ayhan Işık Erdal. Additional cases across extended, fleur-de-lis, lipoabdominoplasty and mommy makeover combinations are being added. Individual results vary with Matarasso type, skin quality and tissue response.

Surgical Anatomy
The abdominal wall — why every layer matters

Abdominoplasty is a procedure of layered anatomy. Safe, high-quality results depend on respecting the vascular supply of the abdominal skin flap, correctly identifying and repairing the rectus sheath, and placing the final scar in the zone that heals best.

xiphoid linea alba umbilicus arcuate line perforators standard abdominoplasty incision ASIS rectus rectus

Rectus abdominis & linea alba

Paired vertical muscles separated by the linea alba. Pregnancy and weight gain stretch the linea alba, producing rectus diastasis. Repair requires plication of the anterior rectus sheath to bring the muscles back to midline.

Arcuate line of Douglas

The transition point where the posterior rectus sheath becomes deficient, approximately midway between umbilicus and pubis. Anatomical landmark for understanding rectus sheath layers during plication and for hernia assessment.

Scarpa fascia & perforators

The deep membranous layer of superficial fascia. Preservation in the lower abdomen (Saldanha's lipoabdominoplasty) protects the deep inferior epigastric perforators, maintaining flap vascularity when liposuction is added — the key safety mechanism of lipoabdominoplasty.

Zone of best scar placement

The low transverse incision sits between the anterior superior iliac spines (ASIS), within the bikini / Pfannenstiel line. Pre-operative marking with the patient standing ensures the mature scar sits inside the underwear line.

Technique Matrix
Comparing the six abdominoplasty techniques

Each technique has a defined indication, scar pattern, muscle-repair component and operative time. The table below summarises the key decision axes used during surgical planning.

Technique Indication Scar Muscle repair Umbilicus OR time
Mini abdominoplasty Matarasso Type II — infra-umbilical laxity, minimal diastasis Short low transverse (≈10–15 cm) Lower-abdominal plication only if present Not repositioned 2–3 h
Standard abdominoplasty Matarasso Type III–IV — classic post-pregnancy presentation Hip-to-hip low transverse Full xiphoid-to-pubis two-layer plication Repositioned (neoumbilicoplasty) 3–4 h
Lipoabdominoplasty (Saldanha) Type III–IV with waist / flank adiposity Hip-to-hip, often slightly shorter than standard Plication with Scarpa fascia preservation Repositioned 4–5 h
Extended abdominoplasty Type IV with flank laxity, post-MWL ≈20–40 kg Extended laterally beyond ASIS Full plication + flank liposuction Repositioned 4–5 h
Fleur-de-lis abdominoplasty Massive weight loss (>40 kg) with vertical skin excess Horizontal + vertical midline (T-shaped) Full plication; vertical wedge excision Repositioned 4–5 h
Circumferential abdominoplasty (belt lipectomy) Post-bariatric with circumferential redundancy Full circumferential Full plication ± lateral thigh advancement Repositioned 5–7 h

Operative times are for standalone procedures. Combined procedures (mommy makeover: abdominoplasty + breast surgery) add their component time. Fleur-de-lis and circumferential procedures carry higher complication rates and are reserved for patients where the result justifies the scar complexity and risk profile.

Classification Systems
Three frameworks used in surgical planning

Abdominoplasty planning uses overlapping classification systems to capture different dimensions of the deformity. The three systems below are used together — not in isolation — to match the operation to the patient.

Matarasso Classification

Matarasso 1991 · overall severity
  • I
    Minimal skin excess, no muscle diastasis. Contour primarily preserved. → Liposuction only.
  • II
    Mild infra-umbilical skin-fat excess. Minimal or no diastasis above the umbilicus. → Mini abdominoplasty.
  • III
    Moderate laxity above and below the umbilicus with moderate muscle diastasis. → Modified or standard abdominoplasty.
  • IV
    Significant laxity with marked diastasis recti. → Standard or extended abdominoplasty with full plication.

Nahas Myo-aponeurotic Classification

Nahas 2001 · guides muscle repair plan
  • A
    Diastasis due to pregnancy without significant aponeurotic laxity. → Plication of anterior rectus sheath sufficient.
  • B
    Widening of the infra-umbilical portion of the anterior rectus sheath. → Plication + possible wedge resection of the rectus sheath.
  • C
    Congenital lateral insertion of the rectus muscles. → Plication does not correct the deformity; requires advancement of the oblique aponeurosis.
  • D
    Poor waist definition despite normal rectus anatomy. → Plication + external oblique plication / advancement.

Bozola-Psillakis Classification

Bozola & Psillakis 1988 · incision planning
  • I
    Protuberant abdomen without skin excess. → Liposuction.
  • II
    Infra-umbilical skin and fat excess. → Mini abdominoplasty.
  • III
    Moderate supra- and infra-umbilical excess. → Modified abdominoplasty with muscle plication.
  • IV / V
    Marked excess including epigastrium (IV) or extending onto flanks (V). → Standard or extended abdominoplasty.
Outcomes & Safety
Complication profile — honest figures

Abdominoplasty is a major operation with a real, quantifiable complication profile. The figures below are from the international literature for contemporary practice with modern techniques. Patient selection and technique choice modify these rates significantly.

3–5%
Seroma (modern technique)

Seroma formation

The most common complication. Modern technique — Scarpa fascia preservation, progressive-tension sutures, quilting — reduces the historical rate of 10–20% to ~3–5%. Most respond to aspiration; rare cases require delayed re-operation.

Range: 2–20% across technique variants.
<1%
Haematoma

Post-operative haematoma

Uncommon with meticulous intra-operative haemostasis. Presents within 24–48 hours as unilateral swelling, tension and pain. Requires early return to theatre for evacuation and haemostasis.

Typically reported at 0.3–0.9%.
0.4–1.2%
DVT / VTE

Venous thromboembolism

Abdominoplasty carries one of the highest VTE rates among aesthetic procedures. Caprini-score stratification guides prophylaxis: graduated stockings + intermittent pneumatic compression intra-op for all; chemical prophylaxis added for elevated scores.

PE risk up to 0.8% in large combined-procedure series.
2–5%
Wound healing delay

Delayed wound healing

Most commonly at the T-junction (fleur-de-lis) or at the flap tension point. Strongly associated with smoking (the single largest modifiable risk), BMI >30, and diabetes. Usually responds to conservative dressings; large dehiscences are rare.

Smoker rates may reach 10–15%.
<3%
Skin / flap necrosis

Flap necrosis

Uncommon in contemporary practice with perforator-aware dissection. Risk factors: aggressive undermining, prior subcostal incisions disrupting perforators, smoking, tension at closure. Saldanha's technique significantly reduces this risk when liposuction is combined.

Majority are superficial and heal with local care.
5–15%
Revision / scar refinement

Minor revision

Scar widening, small areas of persistent laxity, or unilateral dog-ear at the incision ends. Addressed under local anaesthesia in clinic when the primary scar has matured (≥12 months).

Higher rates (up to 20%) in post-bariatric patients.

Figures reflect aggregated international literature for contemporary abdominoplasty with modern technique. Dr. Erdal's personal case series results are discussed at consultation and audited against these benchmarks.

Patient Selection
Pre-operative optimisation

The single biggest predictor of a smooth abdominoplasty recovery is the state the patient arrives in. The variables below are reviewed in detail at consultation and, where needed, a prehabilitation plan is agreed before a surgery date is offered.

● Weight stability

Stable for 3+ months within 2 kg. Operating on a still-changing body produces a result designed for the wrong anatomy. BMI <30 is preferred; BMI 30–32 is accepted with careful counselling; BMI >35 is typically deferred pending further weight management.

● Complete smoking cessation

Minimum 4 weeks pre-op, 4 weeks post-op — ideally longer. Smoking is the single largest modifiable risk factor for flap necrosis, wound dehiscence and delayed healing. Nicotine replacement therapy is also discouraged during the peri-operative window.

● Nutritional optimisation

Adequate protein intake (1.2–1.5 g/kg/day) in the pre- and post-operative window. Iron studies and vitamin D are checked in pre-operative bloods; deficiencies addressed before surgery. Post-bariatric patients need particular attention to micronutrient status.

● DVT risk stratification (Caprini)

Caprini score is calculated for every patient. Elevated scores (oral contraceptives, prior VTE, thrombophilia, high BMI) trigger chemical prophylaxis protocols with low-molecular-weight heparin, in addition to standard graduated stockings and intermittent pneumatic compression.

● Medical co-morbidities

Diabetes should be well controlled (HbA1c <7%). Hypertension must be stable. Thyroid function normalised. Autoimmune conditions and chronic corticosteroid use require case-by-case evaluation. Prior abdominal surgery is reviewed for potential vascular implications.

● Family planning complete

A subsequent pregnancy is physically possible but will stretch the repaired abdominal wall and undo most of the muscle plication. Abdominoplasty is therefore advised only once family planning is complete. A revision is possible after any future pregnancy.

Your Surgeon
Assoc. Prof. Dr. Ayhan Işık Erdal
Dr. Ayhan Işık Erdal — Plastic Surgeon Istanbul Dr. Erdal — ACS Clinical Congress 2025, FACS Induction

Assoc. Prof. Dr. Ayhan Işık Erdal

MD, FACS, FEBOPRAS · Plastic, Reconstructive & Aesthetic Surgery

  • Fellow, American College of Surgeons (FACS) — inducted ACS Clinical Congress 2025
  • FEBOPRAS — Fellow, European Board of Plastic, Reconstructive & Aesthetic Surgery
  • Associate Professor — Plastic Surgery, Gazi University Faculty of Medicine
  • International training: Memorial Sloan Kettering (USA) & Ghent University Hospital (Belgium)
  • 15+ years of surgical experience; subspecialty focus in body contouring & breast surgery
  • Award-winning surgeon: ISAPS World Congress 2023 — Gold & Bronze Award
  • 30+ peer-reviewed publications in international journals
  • Member of ACS, ASPS, ISAPS, EBOPRAS & TPRECD
  • Ministry of Health — International Health Tourism Authorization
  • Consultations conducted personally in English — no third-party agencies

"Technique matters. The difference between an acceptable abdominoplasty and an excellent one is not the hospital, not the package — it is the surgical decisions made from Matarasso type through Scarpa preservation to the final suture."

— Assoc. Prof. Dr. Ayhan Işık Erdal
ACS FACS, ASPS, ISAPS, EBOPRAS, TPRECD affiliations
Peer-Reviewed Research
30+ publications across leading international journals

Dr. Erdal is an active academic plastic surgeon whose research output spans aesthetic surgery, reconstructive surgery and plastic surgery education. Selected journals where his work has appeared:

Aesthetic Surgery Journal
Peer-reviewed research in aesthetic plastic surgery technique and outcomes
Plastic and Reconstructive Surgery
Flagship journal of the American Society of Plastic Surgeons
Annals of Plastic Surgery
Clinical and technical reports in plastic surgery
Facial Plastic Surgery
Technique-focused journal covering facial aesthetic and reconstructive procedures
ISAPS Journals
International Society of Aesthetic Plastic Surgery — aesthetic outcomes research
National & International Congress Presentations
ISAPS World Congress 2023 — Gold & Bronze awards for clinical research presentations

Full publication list available on request. Academic practice is a core part of Dr. Erdal's clinical identity — research and clinical technique inform each other.

Clinical Questions
Frequently asked clinical questions
The Matarasso classification (Types I–IV, 1991) is the most widely used system, matching skin-fat excess and rectus diastasis severity to the appropriate technique. The Nahas classification (2001) specifically addresses the myo-aponeurotic deformity and guides the muscle repair plan. The Bozola-Psillakis classification refines incision planning. In clinical practice all three are used together to capture different dimensions of the deformity.
Lipoabdominoplasty combines abdominoplasty with liposuction of the abdomen, flanks and/or waist. Saldanha's technique (2001) preserves the Scarpa fascia in the lower abdomen and spares the deep inferior epigastric perforators. This maintains flap vascularity when liposuction is added — allowing safer, more extensive body contouring in one operation. It has become a standard modification in contemporary abdominoplasty practice.
Two-layer plication of the anterior rectus sheath: the first layer is typically a running or interrupted long-lasting absorbable suture (e.g. PDS / polydioxanone) or non-absorbable material (e.g. prolene); a reinforcing second layer is added above. Extent runs from xiphoid to pubis when the diastasis does. The Nahas type directs whether plication alone is sufficient or whether additional oblique aponeurosis advancement is required.
Progressive-tension sutures anchor the elevated abdominal flap to the underlying aponeurosis at multiple points during closure. This obliterates dead space, reducing seroma incidence — historically the most common complication of abdominoplasty. Progressive tension also offloads the skin closure, contributing to a finer final scar. In selected cases this technique eliminates the need for drains.
Historical seroma rates of 10–20% are substantially reduced with modern technique. With Scarpa fascia preservation and progressive-tension / quilting sutures, the contemporary rate is approximately 3–5%. Most seromas respond to clinic-based aspiration; rare recurrent seromas may require delayed capsule excision.
Fleur-de-lis (vertical T) abdominoplasty is indicated when skin excess is significant in both horizontal and vertical axes — characteristically after massive weight loss (>40 kg, typically post-bariatric). A standard transverse incision alone cannot address vertical redundancy. The trade-off is an additional midline vertical scar; patient selection requires careful assessment of the vascular supply at the T-junction, where wound-healing risk is highest.
Abdominoplasty has one of the highest VTE rates among aesthetic procedures. Caprini score is calculated pre-operatively and directs prophylaxis. Base protocol for every patient: graduated compression stockings + intermittent pneumatic compression intra-operatively + early ambulation from the evening of surgery. Patients with elevated Caprini scores additionally receive low-molecular-weight heparin chemical prophylaxis starting 12–24 hours post-op and continuing through the high-risk window.
Extended abdominoplasty extends the transverse incision beyond the ASIS laterally to address flank laxity, but remains an anterior-only operation. Circumferential abdominoplasty (belt lipectomy / lower body lift) extends the incision all the way around the torso, also addressing back, buttock and lateral thigh laxity. Circumferential procedures are typically indicated in post-bariatric patients with circumferential redundancy and carry higher complication rates and longer recovery.
Combined procedures (mommy makeover: abdominoplasty + breast surgery; or abdominoplasty + BBL) are safe in appropriately selected patients. Typical limits: total operative time <6 hours, estimated blood loss within acceptable limits, BMI <30 preferred, Caprini-appropriate, non-smoker, no significant comorbidities. The literature supports combined procedures in these patients with complication rates not significantly higher than sequential surgery. Safety becomes unfavourable when multiple complex procedures are stacked on a higher-risk patient.
With progressive-tension sutures and Scarpa fascia preservation, drains can be omitted in selected standard cases. Drains remain standard in: extended abdominoplasty, fleur-de-lis, significant concurrent liposuction, post-bariatric patients with poor tissue quality, prior abdominal surgery disrupting planes, and any case where intra-operative dead space cannot be fully obliterated. Decision is individualised — drains have a small infection risk but provide clearer early detection of fluid collection.
Neoumbilicoplasty preserves the native umbilical stalk on the abdominal wall and delivers it through a new opening in the elevated flap. Multiple morphological approaches exist — inverted-U (Baroudi), lozenge, star — each producing distinctive scar patterns. Dr. Erdal favours a small vertical-teardrop with a slight inferior hooding, producing the most natural contour and the most inconspicuous peri-umbilical scar.
Complete cessation for a minimum of 4 weeks before surgery and 4 weeks after — longer is preferable. Smoking is the single largest modifiable risk factor for flap necrosis, wound dehiscence and delayed healing in abdominoplasty. Wound complication rates in active smokers can reach 10–15%, several times the non-smoker baseline. Nicotine replacement therapy (gums, patches) is also discouraged in the peri-operative window because nicotine itself is the vasoactive component. Cotinine testing may be requested in borderline cases.
From week 2 (after wound sealing): medical-grade paper tape applied continuously across the scar, refreshed every 3–5 days, until week 6. From week 6: silicone gel twice daily or silicone sheet 12+ hours/day, continued for at least 6 months. Sun protection (SPF 50+ or physical cover) for 12 months. Scar massage from month 2 onwards. These are the evidence-based modalities; vitamin E, onion extract, rosehip oil and similar have no stronger evidence than placebo for surgical scar improvement.
Dr. Erdal has 30+ peer-reviewed publications in international journals including Plastic and Reconstructive Surgery, Aesthetic Surgery Journal, Annals of Plastic Surgery, Facial Plastic Surgery, and ISAPS journals. Research themes span aesthetic plastic surgery technique, clinical outcomes and plastic surgery education. Full publication list is available on request.
Technical Guides
In-depth technique references

Extended reading on the surgical techniques used in abdominoplasty practice, written at a level appropriate for patients with a clinical background — or for any patient who prefers detail.

Extended Abdominoplasty — Technical Principles → Fleur-de-Lis Abdominoplasty for Massive Weight Loss → Lipoabdominoplasty — Saldanha's Perforator-Preserving Technique → Rectus Diastasis Repair — Plication Techniques & Nahas Planning → Neoumbilicoplasty — Anatomy & Aesthetic Design → Post-Bariatric Body Contouring — The Staged Pathway →

Looking for a patient-friendly overview of the same topics, written without clinical terminology? Visit tummytuckinturkey.com — Dr. Erdal's medical-tourism-oriented sister site.

International Patients
Comprehensive care for patients travelling for surgery

International patients receive VIP airport transfer, coordinated accommodation at Antwell Suites (ground-floor clinic for daily follow-ups), pre-operative hospital work-up, 1–2 night hospital stay, compression garment and drains, and full follow-up through to return home.

Antwell Suites Istanbul

Recovery-friendly 1+1 suites with full kitchen, separate bedroom and large walk-in bathroom — situated above a ground-floor clinic where Dr. Erdal's team conducts daily post-operative checks during the critical first week, minimising travel when mobility is limited.

Standard length of stay for abdominoplasty is 7–10 days. Lipoabdominoplasty and mommy makeover sit at the longer end of this range. Companions welcome at no additional charge.

1+1 Suite Full kitchen Ground-floor clinic VIP transfer included English-speaking team 7–10 day programme
Antwell Suites Istanbul — exterior Antwell Suites — living room Antwell Suites — bedroom Ministry of Health International Health Tourism Authorization certificate
From the Surgeon
A word to international patients

Two short messages from Dr. Erdal — a welcome and practical tips for planning your journey to Istanbul.

Welcome to International Patients
Tips for International Patients
Consultation
Request a surgical consultation

Dr. Erdal personally reviews every international case. Please include standing photographs (frontal, both obliques, lateral), height and weight, pregnancy and weight-change history, and any previous abdominal surgery. Response within 24 hours.

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+90 544 850 72 32
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Clinic
Teşvikiye Caddesi No:9/12 · Şişli · Istanbul
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MoH Authorization
Certificate No: 2026034015610080000444996

Or message on WhatsApp

✓ Thank you — your consultation request has been received. Dr. Erdal personally reviews every case; response within 24 hours.

All information kept strictly confidential. International consultations conducted in English.

Official Authorization
Ministry of Health international tourism authorization

Dr. Erdal's clinic holds the Republic of Turkey Ministry of Health International Health Tourism Authorization — the legal requirement for treating international patients in Turkey. This is the baseline regulatory check; any clinic treating international patients without this authorization is operating outside the law.

International Health Tourism Authorization Certificate — Republic of Turkey Ministry of Health

Certificate No: 2026034015610080000444996 · Issued: 10.03.2026 · Republic of Turkey Ministry of Health, General Directorate of Health Services