Does MILA replace abdominoplasty?

No. MILA is designed for patients who do not have a real excess of skin, or who do not want the transverse scar of an abdominoplasty. When the excess of skin is real, resection remains necessary: no retraction technology replaces it. MILA may take the place of many current indications for mini-abdominoplasty, not of full abdominoplasty.

Can MILA be performed with the TESAR technique?

Yes. The devices used for tissue retraction can be employed alongside every surgical technique: the simple plication described in the original publication can be replaced by any minimally invasive repair, including TESAR with a retromuscular mesh. In substance MILA is the combination of three steps: liposuction, minimally invasive repair of the musculo-fascial wall defect and treatment of the soft tissues with thermal remodeling devices.

Is mesh always used in MILA?

No. The use of mesh depends on the presence and the size of the associated hernia. In the original description, when it is used, it is a large-pore mesh placed onlay, that is, in front of the fascia, overlapping the plication by 3-4 cm on each side. If the repair is performed with TESAR, the mesh is retromuscular instead.

MILA: what minimally invasive lipoabdominoplasty is

Name: MILA: minimally invasive lipoabdominoplasty
Creator: Dr. Federico Fiori

MILA stands for Minimally Invasive LipoAbdominoplasty. Is it a new technique? No, it is a surgical tactic, systematized in 2024 by Christiano Claus and Ezequiel Palmisano, that brings three well-known steps together in a single operation: liposuction, endoscopic plication of the diastasis in the pre-aponeurotic plane and skin retraction with energy-based devices. The aim is a result close to that of an abdominoplasty without the long scar of the classic operation, in selected patients with defects of limited size.

If you are in a hurry, in plain words

MILA brings three things together in one operation: the excess fat is suctioned away, the wall is repaired from the inside with a camera, and a device that warms the tissue makes the skin tighten a little. Everything passes through the same three small cuts above the pubic bone.

It suits the in-between cases: skin that is not perfect but not truly in excess, some fat to remove, a wall defect of limited size. In those situations the long horizontal scar of an abdominoplasty can be avoided.

It does not suit cases where the skin is genuinely abundant, with widespread stretch marks or after several pregnancies: there the skin has to be removed rather than tightened, and the correct choice is a different one. The decision is made at the consultation, looking at the skin first and at the technique afterwards.

What is MILA?

MILA is neither a new route into the abdominal wall nor a new technique: it is a tactic, that is, a way of combining known procedures into a single strategy. To endoscopic plication of the diastasis through the pre-aponeurotic plane — the very procedure that appears in the literature under the names SCOLA, REPA and EPAR — two stages belonging to plastic surgery are added: liposuction and skin retraction with energy-based devices. The rationale stated by the authors confirms something already well known: endoscopic plication alone works well in patients without excess skin and fat, who are a minority; adding the other two stages widens the group of patients who can be treated.

The name puts together the three words that describe the intent: lipo, the removal of fat; abdomino, the repair of the wall; plasty, the reshaping. Minimally invasive, because everything goes through three small suprapubic incisions, laparoscopically or robotically, instead of the transverse scar of an abdominoplasty.

Diagram of the suprapubic accesses used in MILA and of the pre-aponeurotic dissection area from the pubis to the xiphoid, with limited lateral dissection — Three suprapubic accesses, pre-aponeurotic working area, limited lateral dissection

What are the three stages?

The three stages are consecutive and, according to the authors, synergistic: each one makes the next easier and they all use the same incisions.

Liposuction. The subcutaneous tissue is infiltrated with saline, lidocaine and adrenaline, the fat is emulsified with ultrasound or laser energy and then aspirated. Aggressive cannulas are to be avoided: the fibro-connective network of the subcutaneous tissue must stay intact, because it is the target of the third stage. When a midline hernia is present, liposuction of the midline is carried out only after the repair, so as not to damage the contents of the sac.
Endoscopic plication. Through a 2 cm midline suprapubic incision and two lateral 5 mm ports the pre-aponeurotic plane is dissected from the pubis up to the xiphoid and the costal margins, with CO₂ at 6-10 mmHg. The diastasis is plicated with a single continuous barbed suture, from the xiphoid to the pubis. Mesh is optional: it is used when a hernia is present, in the onlay position, overlapping the plication by 3-4 cm on each side.
Skin retraction. Through the same incisions, energy-based devices are applied — helium plasma radiofrequency, bipolar radiofrequency, 980 nm diode laser — acting on the fibro-connective septa and stimulating collagen remodeling. Over the central area, already dissected, power settings are reduced by 30-40% compared with the flanks, and skin perfusion is checked throughout the stage to avoid burns and damage to the subdermal vascular plexus. One or two suction drains are then placed in the subcutaneous space.

The three stages of MILA: liposuction of the subcutaneous tissue, endoscopic plication of the diastasis in the pre-aponeurotic plane, skin retraction with an energy-based device — Liposuction · endoscopic plication · skin retraction

Who described it, and where?

The systematization of the MILA tactic was published in 2024 in the Revista do Colégio Brasileiro de Cirurgiões by Christiano Marlo Paggi Claus with Guillermo Di-Biasio, Raidel Deucher Ribeiro, Marco Aurelio Faria Correa, Bruno Pagnoncelli and Ezequiel Palmisano (Rev Col Bras Cir 2024;51:e20243692). The principle of videoendoscopic subcutaneous surgery is far older, though: it goes back to Marco Faria Correa, who described it in Plastic and Reconstructive Surgery in 1995. A technical update published in 2026 in the same Brazilian journal proposes preserving the umbilical ligament in patients without an associated umbilical hernia, so as not to alter the anatomy and the natural contour of the umbilicus.

Which patients is it for?

It is an intermediate procedure, between open surgery and simple minimally invasive repair, whose aim is to improve the morphological outcome by promoting skin retraction while avoiding the incision typical of an abdominoplasty. The indication is clearly a diastasis of moderate size, a small umbilical hernia and a moderate excess of skin, such that thermal redraping can treat it with a favorable outcome. For a significant excess of skin, nothing today matches the open approach in terms of the quality of the morphological result.

When is it not the right choice?

MILA shares the limits of every pre-aponeurotic technique and adds some of its own. It is not the right answer when:

the excess of skin is real and significant, and not simple laxity: no retraction technology replaces a resection, and in these cases mini-abdominoplasty or abdominoplasty remain the correct operations;
the patient has a high body mass index, severely compromised skin or previous complex midline surgery.

How do MILA, SCOLA, REPA and TESAR differ?

SCOLA, REPA and EPAR are different names for the same family of procedures: anterior access, work in the pre-aponeurotic plane, midline plication, onlay mesh where needed. TESAR belongs to another family. The access is anterior, but the final working plane is retromuscular: the medial edges of the rectus sheaths are incised, the space behind the muscle is entered and the mesh is placed sublay, behind the rectus, without ever opening the abdominal cavity. TESAR aims at the structural reconstruction of the midline with a retromuscular mesh, and it is also used in incisional hernias and in previously operated patients. MILA is the morphological extension of minimally invasive approaches: it adds liposuction and skin retraction to the same repair in order to improve the aesthetic outcome.

Cross-sections of the abdominal wall compared: on the left the onlay mesh above the anterior fascia in REPA and SCOLA, on the right the sublay mesh behind the rectus muscles in TESAR — Left: mesh above the fascia (REPA, SCOLA) · right: mesh behind the muscle (TESAR)

My point of view

Can MILA be performed using TESAR?

For many years I have been performing body contouring treatments: liposuction and its variants, transcutaneous treatments, procedures that use heat in its various forms (laser, radiofrequency, ultrasound). All of these can be performed either without repairing the musculo-fascial wall or together with a repair of the wall. The repair itself can be of any kind: open or minimally invasive. And the minimally invasive repair, in turn, can be of any kind: simple anterior plication, TESAR or posterior approaches. Nothing changes: the devices used for retraction can be employed alongside every surgical technique, so MILA is simply a combination of techniques. A thoroughly sound and appropriate combination, but it has to be said that the plication — the part in which the functional repair of the musculo-fascial wall is carried out — can be replaced by any minimally invasive repair technique. So the answer is yes: MILA can be performed using TESAR with a retromuscular mesh. As far as I am concerned, I understand MILA as the combination of:

liposuction;
minimally invasive repair of the musculo-fascial wall defect;
treatment of the soft tissues with thermal remodeling devices of various kinds.

How does it fit the morpho-functional approach?

The question is not which technique is best, but which problem we are facing. MILA was born from the meeting of general surgery and plastic surgery, and that is exactly where my work sits: the abdominal wall has a function and it has a shape, and the two have to be decided together, not one after the other. In practice this means telling three situations apart:

a functional defect without excess tissue, where minimally invasive reconstruction is enough;
an excess of skin and fat that requires surgical remodeling, where no minimally invasive technique is indicated and the repair has to be planned together with the plastic procedure;
an intermediate zone, in which technologies such as those used in MILA can avoid a long scar.

The task of the first consultation is to work out which of the three applies.

The morpho-functional approach to the abdominal wall

Glossary of minimally invasive abdominal wall acronyms

For healthcare professionals

Access: a 2 cm midline suprapubic incision for the optic, two 5 mm ports 4-5 cm from the midline, coinciding with the liposuction incisions; where a previous caesarean scar exists, it is used.
CO₂ at 6-10 mmHg.
Pre-aponeurotic dissection from the pubis to the xiphoid and the costal margins, with lateral dissection limited to 3-5 cm on each side and preservation of the fibro-connective septa.
Plication: a single continuous barbed monofilament suture (0 or 1) from the xiphoid to the pubis, completing the lower part through the service incision.
Mesh optional, according to the presence and size of the hernia: medium-weight polypropylene or large-pore monofilament polyester, introduced through the 11 mm trocar, with a 3-4 cm lateral overlap on the plication, fixed with sutures or surgical glue, in the onlay position.
The umbilical stalk is re-anchored to the musculo-aponeurotic plane with simple sutures; the 2026 update proposes preserving the umbilical ligament when no umbilical hernia is present.
As stated above, the simple plication described in the original publication can be replaced by any minimally invasive technique.
Third stage: energy-based devices (helium plasma radiofrequency, bipolar radiofrequency, 980 nm diode laser) applied through the same incisions, with power reduced by 30-40% over the dissected central area and continuous monitoring of skin perfusion. One or two suction drains in the subcutaneous space. The CO₂ used in the second stage does not alter the effectiveness or the safety of the devices.
References: Claus CMP et al., Rev Col Bras Cir 2024;51:e20243692 (DOI 10.1590/0100-6991e-20243692); Corrêa MA, Plast Reconstr Surg 1995;96(2):446-53; Malcher F et al., Surg Endosc 2021;35(10):5414-21; Ferrara F, Fiori F, Hernia 2024 (DOI 10.1007/s10029-024-03144-3).

The TESAR technique in detail

Frequently asked questions about MILA

Does MILA replace abdominoplasty?: No. MILA is designed for patients who do not have a real excess of skin, or who do not want the transverse scar of an abdominoplasty. When the excess of skin is real, resection remains necessary: no retraction technology replaces it. MILA may take the place of many current indications for mini-abdominoplasty, not of full abdominoplasty.
Can MILA be performed with the TESAR technique?: Yes. The devices used for tissue retraction can be employed alongside every surgical technique: the simple plication described in the original publication can be replaced by any minimally invasive repair, including TESAR with a retromuscular mesh. In substance MILA is the combination of three steps: liposuction, minimally invasive repair of the musculo-fascial wall defect and treatment of the soft tissues with thermal remodeling devices.
Is mesh always used in MILA?: No. The use of mesh depends on the presence and the size of the associated hernia. In the original description, when it is used, it is a large-pore mesh placed onlay, that is, in front of the fascia, overlapping the plication by 3-4 cm on each side. If the repair is performed with TESAR, the mesh is retromuscular instead.

Last updated: 2026-08-20 · Content by Dr. Federico Fiori