Is the Belt Lipectomy Body Contouring Procedure an Option After WLS?July 13, 2018
THE SHORT ANSWER IS: YES!
How Fat Is Stored
It helps to understand the formation and storage of fat to understand the effects and benefits of a Belt Lipectomy. Fat cells, are also known as adipocytes, are specialized cells that can create and store fat. The fat stored in these cells comes partly from fats that are eaten and partly from carbohydrates that are then chemically turned into and stored as fats. The body uses fat storage as an energy depot. The relative number of fat cells in an adult remains stable over time. As we increase the amount of fat stored, the cells expand to accommodate the excess. When fat is used as energy and exceeds the amount being created, the cells shrink.
What Happens To Fat And Skin In An Obesity State
With obesity, the amount of the fat in cells increases. This also leads to a pro-inflammatory state that leads to more fat cells being converted to “white” or storage fat cells. The enlarging cells and triglyceride accumulation eventually expands to a point that puts pressure on the overlying skin. Our skin -- which is made of connective tissue that is adaptable -- begins to expand and eventually stretch. Stretched skin appears thinner and may also stretch rapidly enough to cause “stretch marks”.
Stretch marks are breaks in the dermis (collagen portion of the skin) that become scars. Since these scars are permanent, stretch marks are very difficult to treat.
Skin that has been severely stretched for long periods of time by large volumes of fat exerting pressure, tends to lose its elastic recoil. If the fat volume is reduced (weight loss, liposuction) the skin will tend to sag rather than tighten back up. For those that have undergone massive weight loss whether by surgery or diet and exercise, the leftover excess skin is not only a reminder of the past but also can be a nuisance for proper clothing fit and hygiene. Many turn to skin removal as part of body contouring procedures to regain their premorbid bodies.
Several Options - Incredible Solutions
One of the most sought after areas of body contouring is the abdomen, waist and lower back/buttocks. This tends to be the area of greatest sagging and interference with normal life and can cause a significant amount of insecurity after the pride of an extensive weight loss.
The anterior abdomen falls over the pubic region and is known as a “pannus”. The excess skin over the hips and flanks makes clothing difficult and unflattering. The lower back and buttocks tend to flatten and drop.
Depending upon the degree of weight loss and excess skin, the redundancy may be localized to the abdomen. In this case, a Panniculectomy, a standard Abdominoplasty (Tummy Tuck) or a Fleur-de-lis Abdominoplasty may be sufficient to reconstruct and restore. For most that fall into the massive weight loss category, the Abdominoplasty needs to be extended laterally toward the flanks. And in some cases, the excision is completely taken around the back known as a Circumferential Abdominoplasty, Body Lift or Belt Lipectomy.
A Belt Lipectomy is a powerful operation that changes the dynamics and shape of the torso. Anteriorly, the abdominal muscles are tightened to create a slimmer silhouette. As the skin excision is carried laterally to the flanks, the hips and love handles get reshaped and removed. Posteriorly, the excision in the back allows for buttock elevation and in some cases, the excess skin and fat can be used to augment the buttocks. I give special consideration to the mons in all body contouring procedures I perform. I believe that this area needs the excess to be removed and tightened to a more natural position both for cosmesis and function.
Incredible Solutions - But Some Challenges
The challenge for both the surgeon and the patient is the risk of complications. Massive weight loss could lead to some nutrient and protein deficiencies which are vital for the healing process. We are also trying to get skin that has been stretched and thinned to the point that it is pulled tighter for a better contour.
Philosophically, the inherent problem with the Circumferential body lift is that you are pulling the front tighter and the back tighter. This makes the healing positions very difficult. With a tummy tuck or abdominoplasty, the best position for healing is slightly hunched over or in bed which we call the beach chair position. This is with pillows propping up your back and your knees to reduce the tension on the incision.
For a back or buttock lift, the best position is standing straight up and lying flat in bed. It is very important to not sit within the first few weeks of healing. When the surgery is pulling in the front and in the back there isn’t a great position to heal in and there is also a higher probability of pulling the incisions apart. Using my own Schwartz Scar Secure™, I minimize the chance of pulling on the incisions. Even with this, I have found that I ask my patients to slightly flex at the waist around 20 degrees.
The highest probability of an area not healing is at the midpoint of the back since the incision is being lifted and held superiorly (against gravity).
There is also a “zone of adherence” running vertically in the midline of the back which means there is less movement and more tension on the incision. I try to mitigate healing problems in this area by having my patients bend at the waist during the markings as well as during the surgery.
Have A Doctor By Your Side
Complications are a reality with any surgical procedure and are higher in patients that have lost massive amounts of weight. The most important thing is to recognize complications early on and address them.
In the first few weeks after surgery, I see my patients very often and we also keep an open and constant dialogue as to how they are progressing and feeling. I use drains, compression garments as well as my scar methods to try to minimize the chance of complications.
During surgery, I am careful to recheck my surgical plan many times before committing to it. I will also use my Body LipoLift® techniques as well as special internal progressive tension sutures which have been shown to decrease the risk of complications.
When you research and select a surgeon, make sure you’ll receive the support you need. Making the decision to have plastic surgery is a big one. I encourage you to feel safe, feel understood, and confident about your surgeon, the procedures, and support.
ABOUT THE AUTHORJaime S. Schwartz MD, FACS, is a highly regarded expert & leader in the field of plastic surgery. Dr. Schwartz is known for his compassion & commitment to safety and advancing the field of plastic surgery through new techniques and procedures. From Dr. Schwartz’ values and relentless “patient-first” commitment, the Beverly Hills Breast And Body Institute is dedicated to both education and safety. Connect with Dr. Schwartz on Instagram.
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