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One of the many evolutions in plastic surgery has been the tremendous expansion of excisional body contouring procedures. Spurned on by the prevalence of extreme weight loss patients, particularly those from bariatric surgery in which large segments of loose body skin develops, the need for innovative and expanded uses of body contouring have been developed. Many of these bariatric plastic surgery procedures are more like reconstructive surgeries than cosmetic surgery per se. As naturally happens in plastic surgery, what was once a reconstructive procedure soon finds some more cosmetic applications.

One of these areas is that of the back and the development of back rolls. Even in women of more normal weight, back rolls can develop from aging. They occur above or below the bra line. Women detest them and they are evident in clothes as visible rolls. Wearing a bra accentuates them and can make their rolled appearance even more evident. Unfortunately they can not be exercised off nor lost by any amount of weight loss.

A modified bariatric plastic surgery technique, known as a backlift, can be very effective at getting rid of these back rolls. This is not a liposuction method that removes fat as this is not the major tissue component of most backrolls. It is the excision of loose back skin with some underlying fat that is oriented along the bra line. In an excisional pattern that looks similar to the infinity symbol, horizontal elliptical skin segments are removed from both sides of the midline spine. The vertical level of the ellipses is so oriented that skin is equally removed above and below so that their closure will place the final scar inside the cover of the braline. It is important to mark the outlines of the bra that the patient typically wears before marking the pattern of the skin excisions.

With skin closure after the excisions, a formal backlift is achieved effacing the rolls caused by the loose skin. This produces a dramatic tightening of the back at the price of a horizontal scar line. It is important that the excisional patterns do not cross the skin overlying the spine as this tissue is much tighter than that on the sides and will produce significant scar widening and hypertrophy. Usually drains are not used for backlifts due to the tightness of the closure and the fact that the patient provides natural compression of the surgical site by laying on it.

Like all excisional skin procedures, the scar tradeoff for a backlift must be carefully considered. While in a bariatric surgery patient, these scar concerns are often well worth it given the amount of loose skin and body dysmorphia that exists. But in more weight appropriate patients, which aesthetic concern is more relevant (backroll vs scar) will differ for each patient and that decision is never clear (or relevant)to an outside observer.

The recovery from a backlift is fairly rapid and one can return to work in just a few weeks. It will be sore for sure and will take up to a month until one can return pain-free to all physical activities. The back scar will be red for a while and can take up to six months for the redness to fade to a white scar line.

Dr. Barry Eppley

Indianapolis, Indiana

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