Aesthetic Units and Zones of Adherence, Relevance to Planning Incisions in Body Contouring Surgery

BACKGROUND: Aesthetic units (AUs) and zones of adherence (ZAs) have been previously noted in the face and torso. A systematic classification of common AUs and ZAs has not been previously described for the torso and extremities. Contour and scars are equally important in obtaining the best result. Therefore, the six principles to consider in body contouring surgery (BCS) are that the resulting scar be anchored at a zone of adhesion; at the interface of AUs; concealed within flexion or extension skin creases, or placed according to conventional usage and experience; positioned on the medial aspect of a limb; hidden when nude, topless, or in a variety of clothing such as one-piece and two-piece swimsuits, crop tops, short sleeves, etc; and positioned to avoid a contracture across a flexion joint crease or a dehiscence across the extension aspect of a joint. METHODS: Images of male and female massive weight loss (MWL) patients with a history of MWL were reviewed and analyzed. RESULTS: AUs and Zas are described and codified. An algorithm is provided to aid in planning incisions for BCS. CONCLUSION: With the increase in BCS after MWL, a classification of AUs and ZAs is considered useful in planning surgery and optimizing the aesthetic result.