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Posts Tagged ‘body lift’

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

Options in Buttock Lift Surgery in Extreme Weight Loss

Sunday, December 28th, 2008

Like the rest of the body after a lot of weight loss, the buttock area is not spared. While this is usually not at the top of the list of desired body changes, it can become the focus after other more higher priority areas such as the abdomen, arms, and breasts are addressed.

 Under the normal aging process, the buttocks do sag over time, more in some people than others. After extreme weight loss, this sagging is greatly exaggerated.  The deflation of the buttocks creates folds of loose hanging skin that either fold over the lower buttock crease or cause the buttocks to shift lower as a whole unit. In women, this sagging effect is usually much greater than in men as they generally have  more buttock skin and fat to begin with.

Lifting of the buttocks can be done with several different methods, approaching the problem from either above or below depending upon  the buttock problem and what other simultaneous procedures are being done. One of the most effective methods is the superior or upper buttock lift which is the back half of a circumferential body lift. Skin and fat is cut out around the waistline above the buttock area as part of the 360 degree excision of a body lift. While not as much skin can be removed in the lower back as the front part of the abdomen, the buttocks can be lifted a significant amount. Think of this procedure as ‘pulling up your pant’s’ so to speak. This buttocks lift can also be done alone, without the front half of a body lift, but it would be unusual to have a significantly sagging buttocks after weight loss without an abdominal overhang as well.

While the body lift or superior buttocks lift raises up sagging skin, it will not cause the buttocks to ‘re-inflate’ or solve its loss of volume from the weight loss. In essence, the buttock sag will be improved but it will still be fairly flat. Some plastic surgeons do an ‘auto-augmentation’ at the same time using some skin and fat that would normally be discarded with the cutout. Essentially using your tissue to serve as an implant. While this is a clever use of tissue flaps, it rarely adds significant volume and often does not  put it where the volume is really needed. (lower not higher) I remain not overly enthusiastic about this approach even though it is your own tissue.  If someone ultimately wants a buttocks that is bigger, I will usually do buttock implants at a later time.

Another type of buttock lift is from below or a lower buttock lift. This is an ‘old’ approach  that removes skin from the lower half of the buttocks that overhangs the buttocks crease. This is not usually helpful in cases of extreme weight loss as it pulls the buttock down further in cutting off skin. This  is pulling in the wrong direction for most patients. In cases of mild buttock sagging without a significant loss of volume, this type of buttock lift may be acceptable.

Dr. Barry Eppley

Indianapolis, Indiana

The Upper Body Lift in Bariatric Plastic Surgery

Wednesday, November 12th, 2008

The excess skin and fat from extreme weight loss often creates a circumferential hanging effect at many levels of the body. While many think of the body lift as only one contouring procedure, they are only thinking of the lower body lift or circumferential body lift procedure. There is another body lift procedure for the upper body, not surprisingly called the upper body lift.

Like the lower body lift, the upper body lift is a combination of three body contouring procedures. A frontal breast lift procedure (for both women and men), a side chest wall lift, and an upper back lift. In some cases, the cut out of loose skin may extend into the arms as well. This combined operation leaves long scars around the upper body but are usually a worthwhile trade-off for the dramatic improvement in the shape of the upper body. The resultant scars across the back and on the side of the chest are horizontal, much like the lower body lift. The change is in what occurs across the chest/breast area. Usually I like to keep it in the lower chest/breast crease and make it horizontal also. It can certainly be combined with a breast lift or a gynecomastia reduction if needed. But the one thing you don’t want to do is cross the midline/lower sternal area with a scar if you can avoid it. The risk of scar widening is very likely in this area, not to mention being very noticeable particularly in women. Therefore an upper body lift is not always completely circumferential as a lower body lift would be.

Upper body lifts are not as common as lower body lifts because it takes a very extreme amount of weight loss to create enough skin to justify the operation. Usually the patients must have lost 150 to 200 lbs after their bariatric surgery. The upper body lift has its greatest effect in the problematic area of the side of the chest wall and upper back. As a result, it would not be uncommon to just do a partial upper body lift stopping short of the chest/breast area and not crossing the exact middle of the back. Upper body lifts have the same riska and postoperative issues as lower body lifts including poor scarring, small areas of wound separation, and fluid build-up after the drains are removed.

Dr. Barry Eppley

Indianapolis, Indiana

The Circumferential Body Lift Procedure For the Surgery Patient

Tuesday, November 11th, 2008

In some weight loss patients, enough loose skin results that it feels like a suit is hanging off your body. The excess skin exists in a 360 degree fashion from the chest down to the knees. You could call this the ‘sharpee’ syndrome or one that looks like ‘wax melting off a candle’ but , either way, it is uncomfortable living in your skin suit. With this much skin excess, drastic and non-traditional methods of plastic surgery are required.

 To achieve a balanced body look, no one plastic surgery operation is enough. It requires a combination of procedures at the core of the body to make a dramatic difference. Such a procedure is the body lift. It goes by many different names including the old term belt lipectomy, circumferential body lift or a lower body. Essentially, a body lift reshapes the entire midsection of the body in a circumferential manner. It combines three operations into one, a frontal tummy tuck, a side thigh lift, and a backside buttock lift. Such an approach produces a complete recontouring of the waistline in a 360 degree manner. The effect can only be described as dramatic for every body lift patient. The waistline is narrower, the abdomen is flatter, and the loose skin of the buttock and thighs is lifted. Some of the rolls, wrinkles and cellulite of the legs and buttocks is also improved. While a final scar goes all the way around, that is but a small price to pay for such dramatic improvement.

The body lift is, by far, the most difficult body contouring operation for patient and plastic surgeon alike. Body lifts take a lot of time to perform (4 to 6 hours) and require the patient to be repositioned multiple times throughout the surgery. It takes a lot of cutting and sewing to perform a body lift which is taxing for the plastic surgeon. Patients surprising do not have a lot of pain but they must endure the use of three or four drains after surgery for a few weeks. Patients will feel like they have had their ‘pants lifted’ (sometimes like having a wedgie) and it will feel tight for awhile. Because of the magnitude of a body lift, It is the only body contouring operation I will do in one setting and prefer most patients to spent their first night after surgery in the facility for monitoring, IV fluids, and pain control. One should allow a good three, and preferably four weeks after surgery for recovery before returning to work. I have not yet had a need to do a blood transfusion but it is always a remote possibility.

Because of the length of the scar and the amount of sutures used, every patient will end up with some temporary wound separation problems. This, surprisingly, does not occur until about three weeks after surgery. It is not a question of if it will happen…just when and how much. Most wound separations are allowed to heal on their own with the use of dressings.

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


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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