Introduction: Abdominoplasty in patients with mutilated abdomen is still a challenging procedure. These patients need anterior wall reconstruction with prosthetic mesh placed either superficial to the primary repair (on-lay), or deep to the musculo-aponeurotic layer (sub-lay). Both techniques have their advantages and disadvantages. Objective: To compare the on-lay and sub-lay prosthetic mesh application to propose the best   technique  as   standard  in   cases  of   mutilated  abdomen abdominoplasty. Patients and methods: 140 patients were subjected to this clinical controlled randomized study conducted in Plastic Surgery Unit in Suez Canal University Hospital, Ismailia, Egypt from March 2003 to March 2011. Each group was formed of70 patients. Results: Seroma,hematoma,wound complications,mesh removal, days before drain removal, days of post-operative pain, hospital stay, and time before return to work were significantly higher in the on-lay group than in sub-lay group. In addition, the higher rates of DVT, chest complications  and hernia recurrence observed in the on-lay group were not statistically significant.Similarly longer operative time in sub-lay group was without statistical significance. Conclusion: Sub-lay mesh herniorrhaphy with concomitant abdominoplasty offers significant better functional and cosmetic results. Significant reduction of post operative complications in sublay technique than in the onlay technique was proved