Background <p>Abdominoplasty, especially when combined with circumferential liposuction, is a widely performed body contouring procedure with well-established aesthetic and functional benefits. However, postoperative cutaneous sensory loss in the abdominal wall remains a frequent and underexplored complication. This study aimed to prospectively map sensory changes following lipoabdominoplasty and evaluate the influence of Scarpa’s fascia preservation on recovery trajectories and quality of life.</p> Methods <p>A prospective single-center study was conducted on 60 patients (mean age 42.7 years; 93.3% female) undergoing 360-degree liposuction and lipoabdominoplasty. Patients were stratified into two groups: Scarpa-preserved (<i>n</i> = 32) and standard dissection with Scarpa removal (<i>n</i> = 28). Sensory testing included Semmes–Weinstein monofilaments, thermal discrimination, and two-point discrimination across 12 abdominal dermatomal zones (T6–L1), assessed preoperatively and at 1, 3, 6, and 12 months. Patient-reported outcomes were measured using standardized questionnaires (SF-36, VAS, and POSAS). Statistical comparisons and multivariate regression were performed to identify predictors of long-term sensory deficits.</p> Results <p>At 1 month, 93.3% of patients exhibited sensory impairment, most pronounced in the infraumbilical medial (Zone 8), suprapubic (Zone 11), and supraumbilical midline (Zone 5) regions. Recovery progressed steadily: residual deficits persisted in 72.5% at 3 months, 55.0% at 6 months, and 21.7% at 12 months. Tactile, thermal, and spatial discrimination showed parallel patterns of recovery, with near-complete restitution in most cases. Preservation of Scarpa’s fascia significantly improved sensory outcomes, with better tactile thresholds (Zones 5 and 8 at 6 months, <i>p</i> &lt; 0.05), faster thermal recovery (Zone 11 at 3 months, <i>p</i> = 0.041), and fewer impaired dermatomes at late follow-up (<i>p</i> &lt; 0.05). Multivariate analysis identified higher BMI, standard dissection (Scarpa removal), and greater resection weight (&gt;1000&#xa0;g) as independent predictors of persistent hypoesthesia. Patient-reported maps correlated strongly with objective findings (<i>r</i> = 0.81, <i>p</i> &lt; 0.001). Quality-of-life scores and scar satisfaction were significantly higher in the Scarpa-preserved group at 12 months.</p> Conclusions <p>Cutaneous sensory loss is an almost universal early sequela of lipoabdominoplasty but typically resolves within 12 months. Preservation of Scarpa’s fascia confers measurable neuroprotective effects, reducing long-term deficits and enhancing patient satisfaction. Incorporating comprehensive sensory evaluation into surgical planning and patient counseling may improve functional and aesthetic outcomes.</p> Level of Evidence II <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>