MILA: when skin retraction can avoid a long scar
MILA combines liposuction, minimally invasive repair of the wall and skin retraction with thermal devices. It helps when the diastasis is moderate and the excess of skin is limited: in that case the skin can retract and the transverse abdominoplasty scar can be avoided. When the excess of skin is real and significant, no technology replaces resection.
The issue is not the technique, it is the skin
When a patient comes in with rectus diastasis, the technical question of which procedure to use comes later. First I look at three things: how wide the wall defect is, how much fat there is in the subcutaneous layer and — above all — the condition of the skin. Almost everything depends on that third answer, because it is the skin that decides whether the transverse abdominoplasty scar can be avoided or not.
MILA exists precisely for the intermediate zone: skin that is not perfect but not truly in excess, some fat to remove, a wall defect of limited size.
What MILA adds to a minimally invasive repair
A minimally invasive repair of the wall, on its own, restores function but does not address shape. MILA adds two steps that belong to plastic surgery: liposuction, which removes the excess fat and prepares the working space, and skin retraction with thermal devices, which stimulates collagen remodeling and takes up moderate laxity.
The incisions are the same for all three stages: three suprapubic accesses a few millimeters wide. There is no additional scar compared with endoscopic repair alone.
How MILA is performed, step by step
What MILA cannot do
This is the part I always say at the first consultation, before talking about results. When the skin is genuinely in excess — widespread stretch marks, an apron of fat, the aftermath of several pregnancies — no retraction technology can replace a resection. In those cases the open approach still gives the best morphological result, and proposing a minimally invasive procedure would mean promising something that will not happen.
- high body mass index: retraction does not compensate for volume;
- severely compromised skin: tissue has to be removed, not contracted;
- wide defects or incisional hernias: the reconstruction has to be planned in other planes.
The link with the TESAR technique
In the original description MILA involves a simple anterior plication with an optional mesh in front of the fascia. In my practice the repair of the wall can be any minimally invasive technique, including TESAR, which places the mesh behind the rectus muscle without ever entering the abdominal cavity. Tissue retraction devices can be combined with any surgical technique: that is why I consider MILA a combination of steps rather than a technique in its own right.
How the decision is made in practice
The first consultation serves to place the case in one of three situations: a functional defect without excess tissue, where minimally invasive repair is enough; a real excess of skin and fat, where the repair has to be planned together with the plastic procedure; and the intermediate zone, where MILA can avoid a long scar. It is not a choice from a catalogue: it is a clinical decision that changes from person to person.
The morpho-functional approach to the abdominal wall
Frequently asked questions
- Does MILA leave scars?
- The three small suprapubic accesses used for liposuction, endoscopy and the retraction devices remain: there is no transverse scar as in an abdominoplasty.
- Does skin retraction always work?
- It works on moderate laxity and where the skin is of good quality. It does not replace resection when the excess of skin is real: in that case the result would be disappointing and the correct indication is a different one.
- Can it be combined with the repair of an umbilical hernia?
- Yes, and it is a frequent situation: diastasis often comes with a small umbilical hernia. Mesh is used according to the presence and the size of the hernia.
Published on: 2026-08-17 · Content by Dr. Federico Fiori