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Background:  The desire for a smaller waistline is an historic one for women that dates back for centuries by non-surgical tightening garments. Surgical approaches more recently have included the well known procedures of liposuction and various forms of tummy tucks. Most recently more internal procedures like rib removal offers improved waistline narrowing results in properly selected patients.

The desire for more significant waistline narrowing has become part of the goals of the very popular BBL (Brazilian Butt Lift) procedure. By removing fat from the abdomen and torso and relocating it to the buttocks creates a dual effect, a larger buttock and a more narrow waistline. It is a truly diametric procedure in its effects as each change makes the other look better. The larger the buttocks becomes the smaller the waistline looks and vice versa. 

But liposuction has its limits on its waistline narrowing effects and further efforts in that regard must look at other anatomic structures. Skin, muscle and ribs are the tissue options to be further manipulated. 

Case Study: This female had a prior history of 3 BBL procedures, on of which necessitates weight gain and weight loss afterwards. While she had a good BBL result she desired further waistline narrowing. She has a lot of loose skin on her back which she clearly demonstrated in snapshots from a video. I felt this made her a good candidate for the vertical backlight waistline narrowing procedure.

Under general anesthesia and in the prone position a vertical ellipse of skin was excised over and along the spine based in a preoperative pinch test. Large fasciocutaneouos flaps were then raised out onto the side of the torso. (edge of the latissimus dorsi muscle) With the back fully exposed oblique latissimus muscle wedges were removed and tightened.

The large fasciocutaneous flaps were brought to the midline, pilot cuts made in their middle and the maximum amount of skin and fat removed. A central midline closure was done over the spine using quilting sutures after the placement of a drain on each side.

When seen five days after surgery with both drains in place, her waistline narrowing effect was clearly seen. She removed her drains on the following day.

The vertical backlight procedure is not well known for waistline narrowing. But it can have a significant effect in the properly selected patient. This is the type of patient who has loose skin on the back that can be easily picked and rolled up as well as the acceptance of a long midline scar down along the spine.  

Case Highlights:

  1. The last anatomic barrier to a more narrow waist is skin tightening in the vertical direction.
  2. Excessive and loose skin can develop after weight loss or extensive liposuction surgeries.
  3. The vertical backlift tightens the waistline and torso by removing large segments of the skin through fasciocutaneous flaps, cinching in the waistline.

Dr. Barry Eppley

World Renowned Plastic Surgeon

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