Explore Plastic Surgery

With the tremendous increase in the number of bariatric surgeries performed in the past five years, to no surprise there has been a near equal increase in the number of post-bariatric body contouring procedures performed to deal with the resultant excessive hanging skin. These bariatric plastic surgery procedures include arm lifts, breast lifts, abdominoplasties, thigh lifts, buttock lifts, and the circumferential body lift.

The circumferential body lift, while an ‘old’ procedure per se, has been reborn in great numbers as a result of massive weight loss patients. The circumferential body lift, or a 360 degree tightening and lift, is really a combination of a frontal abdominoplasty and posterior hip and buttock lifts. In bariatric patients, many will have a frontal overhang of skin (with a sagging pubis) but with a buttock and thigh droop on the backside. The circumferential body lift works so well because it removes excessive overhanging abdominal skin (with a pubic lift) and lifts sagging buttocks, hips and thighs. In the properly selected patient, the resultant circumferential scar around the waistline is worth it. And, surprisingly, it is not a painful procedure to go through unlike what many would think.

If the patient has a midline vertical scar from an open gastric bypass procedure, then the body lift is combined with a ‘vertical wedge’ cut out along this midline scar. This helps produce some horizontal waistline tightening which, without it being done, would not happen as much. If the patient doesn’t have a vertical midline scar then I rarely do this as part of the body lift so as to not make more scar than the patient will already have.

One thing the body lift can not do is to increase the size of the buttocks. Most massive weight loss patients will develop a very flat buttock appearance. While there have been some variations of the body lift touted as taking the excess skin and fat from the back and using it as a ‘buttock implant’, this rarely produces enough bulk in the right place of the buttocks to make it worthwhile. And there are some risks in doing this as part of the body lift procedure. I tell my patients to think about buttock augmentation as a later procedure. It is likely that this concern will fall off the list for many patients over time.

The most significant complications that I have seen in body lift patients are fluid collections (seromas) and wound separations (in the front at the inverted T if a midline wedge is cut out and at the back just above the gluteal cleft). I tell every patient that the likelihood of these issues is very high and most patients will develop some variations of one or both of them. Fortunately, they are managed not by further surgery but by needle aspirations and dressing changes until they heal themselves. These issues always occur, not early, but between 2 to 4 weeks after surgery. If you reach a month after surgery without any of these common problems, then they are not likely to occur.

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

In the most recent issue of our prestuguous journal, Plastic and Reconstructive Surgery (April), I read an article on evaluating the effectiveness of mesotherapy on body contouring. This was a study out of Seoul, Korea on 20 women who had mesotherapy injections on their inner thighs on one side and not the other over a 12 week period. The results showed, not surprisingly, that no measureable improvement could be seen.
This study highlights several important points on aesthetic treatments that are frequently confused. Mesotherapy is the injection of a mixture of different compounds into the skin. (the study cited above used aminophylline, buflomedil, and lidocaine) This is different than LipoDissolve therapies where one specific compound, phosphatidylcholine, is injected into the underlying fat. Mesotherapy (meso = mesium or skin) and LipoDissolve are terms that are often used interchangeably but they really signify completely different types of treatments. Just because both come out of a small needle, like Botox and injectable fillers, doesn’t mean they all do the same thing. I have always questioned the effectiveness of mesotherapy approaches for fat removal or cellulite treatment. It is difficult to see how injecting chemicals into the skin can effect the underlying fat. Perhaps cellulite may have some improvement with mesotherapy since this problem has a skin component to it. But I have yet to see well-controlled studies that have provided convincing evidence to date. But the removal of fat requires agents that directly contact it such as what happens in LipoDissolve. While LipoDissolve requires more study and better analysis, given the large number of patients that are being treated (it is NOT an FDA-approved procedure), but I have first-hand experience with its outcomes and there clearly is some benefit to its use. The issue with LipoDissolve is not its effectiveness but in choosing the right patients for treatment and analyzing for each patient the cost-benefit analysis versus other treatment options, most typically that of liposuction.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

As a plastic surgeon, I get the ‘oportunity’ to see lots of fat-related concerns and, in the new world of bariatric plastic surgery, get to see patients who either still are or were obese prior to their bariatric bypass surgery. Looking at fat excesses, and I have to assume that the average U.S. citizen is fatter today than 10 or 20 years ago (that is what every report I have read on the subject says), it appear overly simplistic to assume that the problem is one as basic as too much in, too little out…..or to put it another way….someone’s weight problem is merely a function of greed and sloth. This is fairly well recognized today as much greater credence is given presently to the concept that I grew up with known as a ‘glandular’ problem. Today we refer to it as a genetic predisposition or a familial tendency towards weight gain. But even accepting that premise (which I believe has a lot of truth) still does not seem to explain the great diversity of body types one sees and how they respond to their lifestyle. I see lots of hospital employees , for example. who carry a gallon of water with them every day and purportedly eat very little but never loose a lot of weight. And then there are others who pretty much eat what they want and yet remain fairly trim.
In reading Michael Hanlon’s book, ‘10 Quyestions Science Can’t Answer (Yet)’, he reports a fascinating study as a spin-off to the movie Supersize Me in which the journalist Morgan Spurlock ate nothing but from a McDonald’s menu for several weeks. His weight gain and other ailments are well chronicled including the onset of incipient liver disease. In 2006, that ‘experiment’ was repeated in sweden under more controlled circumstances using 18 volunteers. While all subjects gained weight, they did in surprising variable amounts and some gained very little. Some subjects cholesterol levels actually dropped! And none developed the elevated liver enzymes until much later in the study. (one month in duration) What does this prove? At the least it suggests that increased fatness, if you will, is more than just calories. It a complex interaction of diet, genetics, intestinal absorption capacity, and probably something in the fat cells themselves that has yet to be described.
As I look at the tremendous variability in body types that I see everyday, and listen to the complaints of patients who have valiantly tried to reduce body areas they do not like (contrary to popular belief, we really don’t see a lot of tremendously overweight people for body contouring surgery), I have come to realize that for many of them their ‘problem’ is really a surgical one. Nothing short of sucking out or cutting off of the excess can really make a difference for them. Diet and exercise certainly helps but is not the final solution for many.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medcal Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
‘Indianapolis