Dr Alan Matarasso is obviously a very experienced master plastic surgeon whose article on “Traditional Abdominoplasty” in this issue of Clinics in Plastic Surgery covers a wide range of presenting problems as well as his philosophy and approach to abdominoplasty. The interaction of blood supply of the abdomen with the technical details of the procedure, especially liposuction, is so elegantly covered it is a must read, not only by the novice abdominoplasty surgeon but by the experienced one.

It is of note that Dr Matarasso’s philosophy on the subject of the defect created by umbilical circum-incision is that every effort should be made to completely eliminate the defect and avoid leaving behind a vertical scar. This is evidenced by the fact that he makes the superior mark incision first. I believe that many, if not most surgeons, would agree with Dr Matarasso’s philosophy about eliminating the umbilical defect. However, there are other surgeons who feel that, especially in a long-waisted individual with a high umbilicus, it is better to leave behind a vertical scar, especially if it ends up in a low position below the bikini line. The small vertical scar avoids lifting the midline transverse abdominoplasty scar into a relatively high position and increasing the distance between the vulvar commissure and the top of the mons. Thus, for many surgeons there is always a fine line between eliminating the umbilical defect and creating an ideal position of the superior edge of the mons pubis.