THE MERCATOR GRID: This the framework on which the surgical design will be individualized. The grid consists of five vertical and two horizontal lines placed at key locations. These serve as REFERENCE LINES for the precise measurement of incisional symmetry across the vertical midline and as VISUAL GUIDES during the conduct of the surgery. In other words, the Mercator grid is the GPS of the surgeon at all times.
THE SURGICAL TRACINGS: Because bodies differ in height and weight, one surgical plan cannot accomodate all individuals. After six years of working with the Mercator lattice, I have settled on five different incisions (and have discarded a sixth). By order of increasing body weight, the surgical tracings are:
: Reserved for the thin individual (5% in my practice) seeking the surgery mostly to eliminate stretch marks and minimal abdominal protrusion. This design is temperamental and demands a lot of experience on the surgeon's part.
: 76% of my patients fall within this category. It is the most robust and dependable design. The nomenclature was coined by Dr. Oscar Ramirez in a publication (PRS 2000
). I have refined this design by placing the lower incision in the crease lines and by metrically controlling the upper tracing.
: 10% of patients in my practice receive this tracing. It is reserved for individuals who have excess skin in both horizontal (side to side) and vertical (up down) directions typically following excessive weight loss. Again, I did not coin this nomenclature but simply refined it with the Mercator grid by introducing numerical control.
: 5% in my practice. This plan is reserved for individuals who have excessive medial thigh skin in addition to the horizontal and vertical abdominal excesses. Basically, it is a "Fleur-de-Lys" with a medial thigh lift incorporated into it. I gave it this name because the discarded skin looks like a Manta Ray.
Half Manta Ray
: 1% in my practice. It is a Manta Ray but without the vertical abdominal incision and is reserved for individuals who have only vertical abdominal excess (but no horizontal ones) in addition to the medial thigh redundancy.
Where did the last 3% of my patients get for their surgical tracing (for those of you who have kept count)? I have discarded the U-design as a viable option because of its unpredictability and its placement of the scar above my ideal for a final result.
THE SURGERY: The Mercator Grid and its imposed five surgical plans has decreased the time a patient spends on the operating table from the traditional 3 to 4 hours down to 90 minutes for one surgeon operating alone. The simple reasons for this improved surgical time are:
Clear delineation of the amount of surgical resection.
Elimination of intra-operative guesswork in the placement of the upper incision.
Elimination of the necessity for table flexion before the excision is complete.
Automatic control of symmetry.
Demarcation of suture placement while the patient is flat.
Surgical speed is not to be equated with carelessness. It is a luxury that only dexterous surgeons with a clear sense of purpose can afford. It adds to the safety of patients by eliminating exposure to anesthesia and unnecessary surgical maneuvers. While speed in surgery is not a goal by itself, it comes as a natural and welcomed by-product of the Mercator Abdominoplasty.
abdominoplasty specialist, Dr Anous, has developed a unique tummy tuck procedure called Mercator. Visit the various pages in this website to learn about this procedure and see patient videos.