The technique described by Dr Simeon Wall, Jr, in “ SAFE Circumferential Liposuction with Abdominoplasty” in this issue of Clinics in Plastic Surgery , has some interesting details that are worth discussing. First, Dr Wall attributes a majority of his attained contour improvement to circumferential liposuction and its accompanying skin retraction rather than to the abdominoplasty component. Although I am not aware of any studies that confirm or deny the effectiveness of Dr Wall’s SAFE liposuction technique, the results Dr Wall shares are impressive and should be considered by all who perform liposuction. It is my hope that the publication of Dr Wall’s article in this issue, along with his presentations at national meetings, will lead others to confirm the technique’s benefits. If that does occur, and I believe it will, SAFE liposuction can potentially revolutionize the way liposuction is performed.

Another point of interest in Dr Wall’s article is resecting the abdominal flap’s subscarpal fat. This has been espoused by some investigators over the years, but others have thought it an unsafe technique. Although I understand the explanation of how subscarpal fat can act as parasitic tissue and how resecting it can lead to a potential increase in blood supply, I have avoided resecting subscarpal fat for two reasons.

First, it has been my impression that subscarpal fat makes up a small percentage of the thickness of the abdominal pannus and thus would not lead to much improvement in abdominal contour. One possible explanation for this difference of opinion is that subscarpal fat thickness may not be uniform over the entire abdomen. Because my impression of its thickness is based on identifying it during inferior flap elevation, where it is thin, I may have the wrong impression of its true thickness in the upper supraumbilical flap. If it is much thicker there, then it would make sense that resecting it could lead to significant contour improvement. I plan to pay more attention to the thickness of subscarpal fat in different parts of the abdomen.

The second reason I have been reluctant to resect subscarpal fat is my concern for the potential ease with which suprascarpal fat blood vessels may be injured during a resection, which could lead to significant vascular compromise. Dr Wall reduces this risk by using the separation component (where he pretunnels without suction) of his SAFE liposuction technique to facilitate subscarpal fat resection. Because I have not used this technique, I cannot comment on how safe it may or may not be. What is apparent is that it is safe in Dr Wall’s hands. I think readers should decide whether or not it is safe based on their own experiences and abilities.