Get to Know Lower Body Lifts After Massive Weight LossJune 15, 2018
Lower Body Lifts are one of the most common procedures that I do for my patients that have been successful with a massive weight loss. Without stepping foot in an operating room with me, today you can be informed as to the detailed process of how this procedure is done. When patients understand the process, it will better prepare them for what will happen and what can generally be expected.
Lower Body Lifts After Massive Weight Loss
Performing Lower Body Lifts are very technical so I’m providing what you need to know in a two-part article series. Let’s start off with how the procedure is done and the issues that I consider for each patient.
Patient Preparation The Day of the Procedure
I have my patients bring in and wear their smallest underwear. This allows me to make sure the markings before surgery are placed in such a way that they will be covered by their underwear. The patients stand up so I can tentatively mark the amount of tissue that will be removed which is still adjusted at surgery.
Sequential pneumatic mechanical compression stockings are placed to prevent a pulmonary embolus or blood clot from forming in the legs during the surgery. Intravenous antibiotics are administered by the anesthesiologist. Sometimes, if the patient will be spending the night in the hospital, a tube or Foley catheter is inserted into the bladder to monitor the patient's fluids during the surgery so the patient does not have to worry about getting up to urinate while in the hospital.
How A Body Lift Is Done
A local anesthetic is injected in the area to be removed, either by itself or combined with saline (tumescent solution). This has a vasoconstrictive effect due to the epinephrine to minimize the blood loss as well as gives some pain relief after surgery. Also, lidocaine local anesthetic has been shown to be antibacterial.
Then, after this is allowed to work, liposuction may be performed on the tissue being removed or it is just cut out taking care to remove enough that it will be a tight closure, and not loose or not so tight that it may come apart after the surgery. Each plastic surgeon has their own preference as to how the tissue and skin are approximated or brought together. Usually, sutures that dissolve in variable periods of time are placed below the skin surface and the skin layer is closed with either staples, sutures, or both followed by Steri-Strips or glue and then cotton gauze and tape.
Sometimes a drain(s) may be placed depending on the amount of bleeding, though most of the bleeding is stopped with a cautery device which seals the blood vessels.
Liposuction is performed wherever necessary. Other variations that can be done are enlargement of the buttock by inverting the tissue to be removed, placement of a buttock implant or even transferring of fat from other areas to the buttock (Brazilian Buttock Lift-BBL).
The incisions are usually connected at the back and can either be straight across the back or reverse curve and meeting in the buttock crease. These cuts are taken to the sides and then the patient is turned over and the front portion or abdominoplasty (tummy tuck) portion of the lower body lift is performed.
The Tummy Tuck Incision
The tummy tuck incision is directly above the pubic area and follows the crease of the abdomen and connects with the back scar on both sides. Further infiltration of local anesthetic or tumescent solution is then injected and the cut is then opened and carried through the skin and fatty tissue, down to the fascia or gristle overlying the rectus abdominis muscle.
I recommend repair of the separation of the rectus abdominis muscle which flattens the lower abdomen. This is much better for the patient because not only does it further flatten the lower abdomen as well as the upper abdomen but also brings more stability to the back.
Pregnancy results in a separation of these muscles, as does weight gain. The fat that we accumulate on the outer surface of the body also accumulates between the intestines within the abdominal cavity which causes a spreading of the rectus abdominis muscle. Fatty tissue there is lost resulting in the diastases or separation of the rectus abdominis muscle.
The tissue is then elevated off the abdomen. A cut is made around the umbilicus which retracts and the separation is continued all the way to and a little over the rib margin on both sides. Then, re-approximation of the diastases recti is performed with many sutures and as tightly as possible.
This is then followed by the liposuction, as necessary, of the flank areas in order to further decrease the excess fat. The operating table is flexed to allow as much skin to be removed from the abdomen as possible. The tissue is then removed, and in a usual massive weight loss patient, all of the skin and tissue between the umbilicus and even above this to the pubic hair area is removed. The pubic area is elevated.
Applying Drains To Decrease The Chances Of Seroma
Either a drain(s) is placed to collect any fluid after the surgery and to decrease the chances of seroma formation. Usually, I place one drain out through the cut on the side.
I have now been using TissuGlu instead of a drain to seal the tissue down to the fascia overlying the muscle. In the past, I was reluctant to use an adhesive in the abdomen because it was made from human tissue and was afraid of transmitting disease. Now, TissuGlu is purely synthetic and does absorb over a period of several months. It makes the postoperative course much easier for the patient allowing them to shower much sooner, even as early as several days.
After all bleeding is controlled, the cuts are sutured closed with many sutures of an absorbable material. Staples are once again used for the skin as well as Steri-Strips. The new position of the umbilicus is ascertained and it is exteriorized and sewn in place.
Finally, dressings are placed over the wounds, as well as cotton and an abdominal elastic binder, which gives the patient support in the back and in the front. The patient is transferred to a recovery bed in a moderately flexed position. The sequential mechanical stockings are continued in the recovery room until the patient leaves the facility or the hospital.
If the patient’s surgery is done in an outpatient facility, they are discharged home or to a recovery facility. They need to be in a mildly flexed position. This is achieved by placing a pillow underneath their knees. This is one of the difficulties of a lower body lift, for too much flexion may cause a lot of tension and pull on the back cut while too much straightening may cause opening up of the abdominal cut.
Medications After Surgery
My patients are administered antibiotics intravenously in surgery. A narcotic for postoperative pain is also given, something for sleep, as well as for nausea. I recommend a stool softener like Colace. Infrequently, I'll use a pain pump, which supplies a numbing anesthetic within the cavity and the cuts to minimize pain. The patient needs to be active but not too active for fear of opening up of the incisions. We provide the abdominal binders and girdles at no cost to the patient.
The patient gets put on a soft diet for the first night and then they may return to their regular full diet. My preference is for patients to refrain from taking any herbal medicine or vitamins for probably one week before surgery and one week after. They may contain some medicines that cause bleeding. The patient returns to my office the following day after the surgery when the removal of all dressings is done with the examination of the wounds. In most cases, there is drainage on the abdominal binder.
The abdominal binder is changed, or if the patient has elected to use TissuGlu, they may be put into a garment, both of which give support in the healing phase.
If TissuGlu has been used, the patient may remove their girdle at approximately the fourth day after the procedure and take a shower. The patient will return to the office and the staples are removed and Steri-Strips replaced. If the drain is in place, I'll wait for the drainage to decrease to proximally 20 cc in a 24-hour period, which occurs anywhere from 7-14 days on average from the surgery.
At the time the drain is removed and a day later the patient is able to take their binder off and take a shower. The patient usually can return to full activity within 3 weeks after their surgery. Many patients like to continue to wear either Spanx or their girdle after this time but it is unnecessary. I have all of my patients use my ScaRxtape after the Steri-Strips have been removed for about 2-3 months after the surgery to minimize the scars. These are easy to apply and are provided at no cost to my patients.
ABOUT THE AUTHORDr. Edward J. Domanskis is certified by the American Board of Plastic Surgery. He's a member of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, President & Founder of the American Society of Bariatric Plastic Surgeons. His primary office of Body Contouring International is in Newport Beach, CA with satellite offices in San Francisco, Miami, EU, Anguilla.
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