BACKGROUND Liposuction abdominoplasty was first performed by the author in 1997. In 2002, the procedure was presented as an "evolving concept" at the 71st Annual Meeting of the American Society of Plastic Surgeons. Over the next 6 years, an additional 294 procedures were added to the initial 43 (n = 337 patients), culminating in an advanced body contouring technique. METHODS The advanced technique is characterized by a hydro-lipo-dissection technique that is selectively performed on the deep abdominal fascia and the Scarpa fascia and along the excision lines. Selective release of the skin-retaining ligaments preserves perforators and elevates a large island flap, extending from the pubis to the inframammary fold and from one flank to the other. Perforating neurovascular bundles tether the flap, minimizing dead space and providing improved flap sensibility. Diastasis recti repair is performed using newly devised segmental techniques. The flap possesses a robust circulation that enables upright patient ambulation and concomitant liposuction of circumferential torso and additional areas (322 patients). Surgery is ambulatory and performed under local anesthesia with monitored intravenous sedation, drains are not used, and patients are discharged 2 to 3 hours after surgery. RESULTS There were no major complications, deaths, or deep vein thrombosis. Five late infections of seromas (1.4 percent) responded to local drainage, and six marginal necroses (1.7 percent) healed without ill effect. CONCLUSIONS Over the past 11 years, liposuction abdominoplasty has established new concepts and evolved into an advanced body contouring technique.