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Archive for the ‘body lift’ Category

Circumferential Body Lift – Safety and Effectiveness Evaluation

Monday, June 12th, 2017

 

The large amount of obesity isn America has created the need for bariatric surgery over the past two decades. With large amounts of weight loss has come the resultant excess skin issues which poses their own set of medical and personal hygiene and self-image issues. A number of bariatric plastic surgery procedures have been developed and modified over the years to manage the loose and sagging skin over the trunk and extremities.

What is fundamentally unique about many of the these bariatric plastic surgery procedures is the large body surface areas that they cover and the length and extent of surgery to treat them. This is on top of any underlying medical issues that a weight loss patients may have. Together this has created a known high rate of complications after this type of body contouring surgery. The circumferential body lift is the most extensive of these types of procedures and any series that reports their experience its noteworthy to define the effectiveness and risk of the circumferential body lift.

In the June 2017 issue of the journal Plastic and Reconstructive Surgery an article was published entitled ‘Safety of Outpatient Circumferential Body Lift: Evidence from 42 Consecutive Cases’. In this paper the authors review their experience in this type of body contouring surgery over a six year period looking at complications and the occurrence of revisions. Of note on their technique and protocol; the posterior lift was performed first in the prone position, a urinary catheter was not used, the anterior portion was performed with liposuction of the epigastric area and a diastasis repair, and drains were used in both the back and front. No drug prophylaxis for DVT was given but sequential compression devices were used during surgery with compression stockings after surgery. The vast majority of the patients were female (41 out of 42) with an average weight loss off over 120lbs. A few patients (12%) had the fleur-de-lis modification to the front tummy tuck part of the body lift. Total average operative time was just over 2 1/2 hours.

The overall complication rate was 36% with the vast majority related to what would be expected in a large body surface area operation with a long incision…wound separation (24%) and seromas. (5%) The wound separations occurred usually over the sacrum which is both common and expected. The revision rates were 26% and were usually done for scar revisions. There were no adverse medical events including deaths, DVTs, hematomas or the need for hospitalization for any reason.

This paper supports that circumferential body lift surgery is both safe and effective and can be done in an outpatient facility. Overnight observation is useful particularly in patients that do not live close to the site of surgery. High satisfaction rates are typical for this type of operation, even with complications, given the dramatic changes that result and the lack of any other alternatives to solving the large amount of loose and sagging skin.

Dr. Barry Eppley

Indianapolis, Indiana

The Body Lift or Extended Tummy Tuck

Thursday, February 11th, 2016

 

A tummy tuck is a well recognized body contouring operation because it has been around for many years. It is generally perceived as a hip to hip excisional and tightening abdominal operation as it only affects the front side of the torso. The term ‘body lift’ however is less well defined in the eye of the patient and can be open to interpretation.

It is recognized that a body lift is more than just a tummy tuck but how much more can be debated. It is an operation that is closely associated with managing the abundant loose and hanging tissues in the extreme weight loss patient, whether the weight loss was surgically induced or not. In this context, a body lift is a circumferential or 360 degree operation removing tissues completely around the waistline.

Body Lift Dr Barry Eppley IndianapolisBut a modification of the body lift can be used in non-weight loss patients. Rather than going completely around the waistline or 360 degrees, the excision extends about halfway between the spine and the side of the waist. (270 or 300 degrees) This captures more loose skin that might otherwise not be adequately addressed by liposuction. This extended skin excision is best done in patients with poor quality skin with little contractile ability around into the back, when a large skin rolls extends into the back and/or when sagging skin exists over the outer thighs.

In the February 2016 issue of the journal Plastic and Reconstructive Surgery, an article was printed entitled the ‘Cosmetic Body Lift’. In this paper the author reviewed 72 patients over a ten year period who had a body lift defined as a  270 degree extended lipoabdominoplasty. (tummy tuck) The amount of liposuction aspirate removed was just over 3,000cc. Complications included a near 3% incidence of seroma (drains were used),  a 4% infection occurrence, and skin necrosis in 4%.  No hematomas occurred. One patient developed a deep vein thrombosis. (DVT) Secondary revisions were done in 18%

Extended Tummy Tuck of Body Lift Indianapolis Dr Barry EppleyThis series demonstrates that the body lift procedure in non-weight loss patients can be done safely and with a similar low rate of complications as that of standard tummy tuck. The critical question for most patients who may benefit from having this ‘bigger’ tummy tuck is whether the extra scar length is perceived as a good trade-off.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Body Lift Surgery in the Extreme Weight Loss Patient

Tuesday, February 26th, 2013

Background: Extreme weight loss has a lot of positive medical benefits for the obese patient, from cardiovascular health to an overall lifestyle improvement. The one negative effect from a generalized ‘body deflation’ from the weight loss is the discovery of loose and hanging skin that is seemingly everywhere. While it can occur anywhere from the neck to the ankles, it is always seen in both men and women around the waistline.

While extreme weight loss definitely causes a dramatic change in one”s waistline, one will almost certainly not look like the picture that is often illustrated as seen here. Rather, the negative waistline effects from extreme weight loss can include an overhanging abdominal pannus and hip and buttock sagging. Like the effects of wax dripping off a candle, the skin slides off the upper trunk down over the waistline and into the thighs. Reversal of these effects requires a circumferential approach that removes excess tissue and lifts and tightens around it. This procedure is known as a body lift.

The body lift has become well known as a bariatric plastic surgery technique over the past decade. While it has become popular as a result of the influx of patients from surging numbers of people who have had bariatric surgery, it is actually a much older procedure that dates back decades and is known as a belt lipectomy. The trade-off of a circumferential scar is a small price to pay for the dramatic effects of the procedure.

Case Study: This 42 year-old female had lost 125 lbs after gastric bypass surgery one year previously. Her weight has been stable for the past four months and she had been on a regimented diet and regular exercise program. Her laboratory studies showed stable electrolytes and nutritional levels. She was bothered by an abdominal pannus, bulging hips and hanging buttocks.

Markings for a body lift procedure included the design for a frontal tummy tuck with arced excision patterns carried across the hips and across the midline of the back using a pinch technique to see what could be safely removed. Under general anesthesia, the tummy tuck portion was carried out in the supine position. Then switching to alternating right and left side positions, the hip and back excisions were performed and closed. A total of three drains were placed prior to the skin closures. Her long circumferential skin incisions were closed with barbed sutures. All incisions were taped and a circumferential binder was placed. She was sent home as an outpatient after recovering from anesthesia.

She had a surprising low level of pain after surgery. Her drains were removed two weeks after surgery. She returned to full activity, including exercise, but six weeks after the body lift surgery.

The circumferential body lift is a very effective procedure for the extreme weight loss patient. It often is the foundation of all the body contouring options and is always the first procedure done and may be the only one that is ever done for some patients. Whether the back portion of the body lift is needed depends on how much loose skin exists over the hips and buttocks and its scar trade-off must be carefully weighed compared to the sagging tissue problem. If it is not done, then the patient is having an extended tummy tuck and not a body lift.

Case Highlights:

1) Generalized sagging of the body commonly occurs after extreme weight loss, either from bariatric surgery or diet and exercise-induced..

2) A body lift treats the excess sagging tissues by a waistline circumferential excision.

3) A body lift is a combination tummy tuck, hip lift and upper buttock lift done in a 360 degree horizontal orientation.

Dr. Barry Eppley

Indianapolis, Indiana

The Top Ten Instructions After Your Body Lift Surgery

Tuesday, August 19th, 2008

Body lifts are almost exclusively done in the bariatric surgery patient who has undergone massive weight loss. (> 100 lbs) A body lift is a combined frontal tummy tuck and a posterior buttock lift with a resultant 360 degree (circumferential) scar. While good care after a body lift is not hard, the need for management of several drains can be challenging.
1. Body lifts usually have only a moderate amount of postoperative discomfort as
only skin and fat have been removed and no muscle work has been done. In addition
to taking your pain medication, keeping yourself in a partially flexed position (knees
slightly bent toward your chest) when resting in either a chair or bed is very helpful
during the first week after surgery.
2. You will have as many as four (4) drains coming out of the pubic and back area after
surgery. They will be removed when the drainage is sufficiently low. As most drains
don’t come out before 10 to 14 days after surgery, it is not important to start
recording their output until after the tenth (10th) postoperative day.
3. Get up and walk periodically even in the first few days after surgery. This will help
you breathe deeper and ultimately feel better. Judge your activity level on how you
are feeling. You will tire more easily than expected, even up to one month after
surgery.
4. You may shower on the 2ndd day after surgery. Do not submerge your incision in a bath
tub or hot tub/jacuzzi until 1 month after surgery. By this time, your drains will have
been removed and the incision healed adequately to prevent internal contamination.
5. Tapes are usually placed across the abdominal and back incisions. They should be
left in place and do not require any care. They will be removed within the
first two weeks after surgery.
6. You are to continue wearing your circumferential binder for 2 weeks or more after surgery.
As these binders have a tendency to ride up, it is important to keep them repositioned
low over the hips so some pressure can be maintained over the incision site.
7. Numbness of the abdominal and back skin is to be expected and complete return of
feeling may take up to 6 months after surgery. During this period, exposure to heat
(e.g., hot tubs, heating pads) should be done with this consideration in mind to avoid
potential burn injuries.
8. Avoid exercise and heavy lifting for 6 weeks after surgery. Abdominal stress and
abdominal specific exercises can be resumed 8 weeks after surgery.
9. You may drive when you feel comfortable and can react normally and are off pain
medication. Driving is all about whether you are safe to yourself and others on the road.
10. It is not rare to have some small openings along your extensive incision line which
develops several weeks after surgery. This is either sutures which are coming to the surface
or small areas that have slightly separated due to tension and movement on the wound.
Simply keep them covered with antibiotic ointment and a dressing and they will go on to
heal on their own. It is ok to get them wet in the shower.
Dr. Barry Eppley

Indianapolis, Indiana

Circumferential Body Lift in the Bariatric Surgery Patient

Saturday, April 26th, 2008

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

Indianapolis, Indiana

Upper vs Lower Lifts For Buttock Reshaping

Tuesday, January 8th, 2008

Buttock Reshaping by Lifting Techniques

 

The shape of the buttocks can be altered by liposuction, implants, fat injections, and lifts. Buttock lifts are reserved for those cases in which the buttocks sag, with skin overhanging the lower buttock crease. This condition is most common today after significant weight loss after bariatric surgery. In the past, buttock lifts were synonymous with the term, ‘fanny tuck’, which implied the cut out of skin along the lower buttock crease.

Today, buttock lifts are of two types, upper and lower buttock lifting. An upper buttock lift is really part of a circumferential body lift, which is now commonly performed in bariatric surgery patients who have had a lot of weight loss. In severe weight loss, the buttocks sag considerably and a circumferential body lift is like pulling up one’s pants after cutting out a lot of skin along the lower back. The back cutout is only half of the 360 degree cutout which includes a frontal tummytuck as well. This leaves a scar along the lower back and does do a tremendous job of lifting severely sagging buttocks. It will not, however, provide any volume to the buttocks which will remain quite flat. In some cases, the skin and fat from the back is rotated on a vascular pedicle to add volume to the upper buttocks as the lower buttock skin is lifted over top of it.

The lower buttock lift is done along the lower buttock crease which is at the junction of the buttocks and back of the leg. An elliptical cutout of skin and fat along this crease does remove any skin overhang and ‘hides’ the scar in this crease area. It will not, however, add any volume or add any rounder shape to the buttocks.

While lower buttocks were the only option in the past, upper buttock lifts today are done as often, if not more so, than lower buttock lifts. Either way, buttock reshaping is done more often by liposuction, fat injections, or implants than excision and lifting procedures. Buttock lifts are just one option of many in buttock sculpting options.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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