Background: Traditional procedures for making a better waistline or more shapely torso include liposuction and certain excisional procedures like a tummy tuck. These are removal and discard surgeries. A more recent and extremely popular torso reshaping option is BBL surgery or the Brazilian Butt Lift. This is a tissue recycling procedure in which fat is taken from the torso and transferred to the buttocks and/or hips. This diametric tissue redistribution is very effective by making the torso smaller and the buttocks/hips below it larger.
The torso reduction effect of BBL surgery, while reducing its circumference, can have an adverse effect of creating loose skin. Liposuction relies on skin shrinkage to create its effect, which while always occurs to some degree, may not occur as much as desired. This can be particularly pertinent if liposuction for BBL surgery is done more than once.
The presence of loose skin around the torso is has historically been refractory to any traditional body contouring procedure. A tummy tuck or even a circumferential body lift is not effective since the tissue removal is in the wrong direction, horizontal rather than vertical direction. To narrow the torso the sides have to be pulled in which means the tissue excision needs to be vertical orientation.
Case Study: This female had a prior BBL and rib removal surgeries, which while providing some good body enhancements, did give her the maximum torso narrowing effect that she desired. A vertical backlift was marked down the midline with the superior end at the level of the shoulder blades and the inferior end at the base of the spine. The highest part of the convex arc on each side should correspond to the horizontal line of the greatest desired inward torso pull or narrowing location.
Under general anesthesia and in the prone position the vertical ellipse of skin and fat was excised down to the muscle fascia leaving a large open area on the back.
The skin flaps were raised out to the edge of the latissimus dorsi muscle and brought together in the midline. A multilayer closure was down over a drain, quoting the midline down to the fascia to eliminate the midline dead space.
The vertical torso tuck brought her waistline down to 25 inches. Her rib removal scars, which were lateral, now appeared closer to the midline almost touching the midline incisional closure.
The vertical backlift is the final and definitive torso narrowing procedure. It removes the last anatomic barrier to body narrowing by removing soft tissue in the correct orientation. While very effective there are two prequalifiers for the procedure, the existence of sufficient loose back skin and the acceptance of a postoperative midline back scar.
Case Highlights:
1) The vertical backlift is the final torso contouring procedure for loose back and side skin as it has a corset-like effect.
2) A vertical backlift can be done as part of rib removal surgery or can be done afterwards if adequate skin retraction has not occurred.
3) The elliptical limits of the vertical excision in most patients runs superiorly at the base of the scapula and inferiorly at the horizontal level of the iliac crests.
Dr. Barry Eppley
World-Renowned Plastic Surgeon