Plastic Surgeon Performs Abdominoplasty Causing Keloid Scarring

This case involves a twenty-seven-year-old male who had developed significant stretch marks and striae on the right and left hip and flank regions after losing a significant amount of weight in a short period of time. As a result, he was left with excess skin and unattractive stretch marks, and he decided to have the condition corrected by surgical means. According to the patient, the surgeon explained that the surgical incisions would be below the waist line and not visible when wearing shorts. This was not the case, however, and the patient’s waist line was in worse condition than before the plastic surgery. The patient was left with significant keloid scarring that was 15 inches on both the left and right abdominal areas. The physician claimed that the scars would fade with time, but they were so thick that the patient’s waistline looked deformed and indented after the swelling subsided. The surgeon claimed that the only reparation he could offer was laser surgery to make the incision line lighter.

Question(s) For Expert Witness

1. What are the typical contraindications to this type of surgery and are there any differences to performing this type of surgery on a male patient?

Expert Witness Response E-000235

Absolute contraindications to abdominoplasty include right, left, or bilateral upper quadrant scars, severe comorbid conditions (eg, heart disease, diabetes, morbid obesity, cigarette smoking), future plans for pregnancy, a history of thromboembolic disease, morbid obesity (BMI >40), and unrealistic patient expectations. Relative contraindications include moderate obesity in a patient who expects a perfectly flat abdomen. Also, patients who tend to form keloids or hypertrophic scars should not undergo an abdominoplasty unless they are willing to accept the scarring associated with these conditions. Male patients tend to have less realistic goals and are more frequently dissatisfied with the final outcome of their body contouring procedures. The thicker male skin has less elasticity and is less likely to have cellulite. Also, the male pubic hair distribution requires the transverse abdominal incision to be placed higher than in female patients.