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Background: Large amounts of weight loss create tissue redundancies throughout the body. To improve waistline shape the standard approach is either a frontal tummy tuck/panniculectomy or an extended circumferential body lift. (belt lipectomy) This horizontal tissue excision can remove a lot of loose tissues around the waistline. For most patients this would produce a satisfactory improvement.

For a more significant waistline reduction additional options need to be considered. In the weight loss patient the primary focus would be further loose skin tissue excision. To do so a different direction of tissue excision would be needed and this would be in the vertical direction. Known as vertical body lifts, the maximal apex of the excision is at the horizontal waistline location. This is a form of an extended modified elliptical excision.

To maximize the vertical body lift effect at the waistline level, select rib removals can be done. This removes the last anatomic barrier for inward waistline movement.

Case Study:  This young female had lost a lot of weight (150lbs) and had previously been through a belt lipectomy procedure. She was interested in maximal waistline reduction through a combined vertical body lift and rib removals. Normally an elliptical excision would be marked out with its maximal width at the level of the horizontal waistline. But to avoid any lateral displacement of the breasts, the excision outline went further towards the back as it went superiorly before stopping at the axilla. (the cross-hatched area is the excision area to avoid)

Under general anesthesia and in the prone position, the posterior incision was opened along its length and an anteriorly-based fasciocutaneous flap was raised. This exposed  the entire lateral ribcage.

To maximize the waistline narrowing effect, subtotal excision of ribs #9, 10 and 11 were done from the lateral border of the latissimus dorsi muscle to their anterior cartilaginous attachments.

The combination tissue excisions of skin, fat and bone through these two procedures produces a unique waistline reshaping effort. The vertically-oriented tissue excisions produce unique wide exposure to rib removals and permits as high as rib #9 to be removed.

Case Highlights:

1) Maximal waistline reduction in the weight loss patient can be achieved through a combined vertical body lift and rib removals.

2) The vertical body lift provides a rare form of soft tissue removal at the umbilical level.

3) The excision from the vertical body lift provide unparalleled access to rib removals 9 through 12 if desired.

Dr. Barry Eppley

Indianapolis, Indiana

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