Body lift

Definition and principles

The frequency of enormous weight loss further to gastroplasties ( 5500 in France in 2003) led to plastic surgeons incorporating a further operation into their speciality: body lift.

The operation consists of removing excess skin around the waist, coupled or not with excess fat residue. The operation therefore acts on the stomach, the outer thighs and buttocks, leaving a scar where the upper g-string line would sit. The stomach is tightened downwards using the same techniques as abdominal plastic surgery, whilst the outer thighs and buttocks are lifted. The lower back is also improved. Thus, a veritable lift of the middle body is achieved.

The operation is suitable further to weight loss leaving a clear excess of skin. It is the most in-depth of current aesthetic surgery operations. The technique was first initiated by R Baroudi ( Brazil) in 1992 and enhanced by T Lockwood (USA) in 1993. The third stage of development was French in 2002. This technique is most commonly used:

• after massive weight loss (50kg or more) once a digestive surgeon has performed a gastroplasty to treat near-fatal obesity (a ring is placed around the stomach to reduce its capacity.)
• when there is a very significant slackening of skin due to age and when the patient is in excellent health
• to repair certain liposuctions

Very few surgeons in the world perform this operation, principally due to its duration, which entails considerable risks for the patient, fatigue for the surgeon and little profitability for clinics. The other obstacle is the extent of scarring which makes many patients hesitate before taking the decision to undergo this type of surgery. Experience has shown that due to the fact that the scar is hidden by a g-string, most patients will later not mind the fact that there are scars, especially due to the aesthetic body shape and social benefits. The vast majority of patients are satisfied with the results since they are spectacular in terms of the large quantity of skin (and possibly fat) removed.

Operation technique

The body lift is a long operation (4 to 6 hours) that entails specific problems. The duration of the operation could be reduced if performed in two parts, but this is impossible, since when the back section of the body is operated on, the lateral cut is very wide ( 15 cm on average) which means that the front of the body needs to be dealt with at the same time to avoid “Mickey mouse ears” on the side.

The operation is divided into two; firstly the back section is operated on (the patient lies on their stomach) and then the patient is rolled over and the front is operated on.

The scar is positioned where the upper G string sits.
The scar runs along the panty line of a G string, more anatomic than today’s low waistbands. From the front it looks almost like the handle bars of a low bicycle near the pubis and runs upwards in the inguinal creases towards the hips. From behind, the scar runs along the upper circumference of the buttocks and design a V in the inter-buttock fold. When performing a bodylift, the phase of preoperative mark is crucial to save time during the operation (no re-cuts) and therefore to reduce the risks: time saved = less blood loss.

The posterior face is operated on using the high lateral tension body lift technique including the Le Louarn and Pascal flap.
This flap enables to reshape the buttocks that have sagged with weight loss (when previous techniques were preformed the vertical tension on the back used to make buttocks even flatter). Fixations are used in the saddlebags area (high lateral tension) to tighten the skin upwards, on the side and to make the operation viable.

The surgeon firstly performs, where necessary, liposuction on the back and the thighs.

Then, the surgical posterior resection is performed along the lines drawn prior to the operation with the patient standing up.

Then, the muscular-fat flap is “glided” into the buttocks.

Then the surgeon raises the sides of the thighs (saddlebag region), fixing them to close up the sides.

Finally, he closes the back up.

The patient is then rolled over to enable the surgeon to operate on the front.

Two principles are respected:

• the large lymphatic trunks are respected to avoid secondary lymphatic effusions (seroma)
• all dead spaces are closed using padding to limit haematomas and tension on scars which can lead to postoperative skin suffering and slackening.

The frontal face is operated on using the technique of High Superior Tension abdominoplasty.

This technique works has 4 aims: to avoid the risk of lymphatic effusions, to minimise the risk of haematomas, to reduce the risks of superior residual bulges and to limit the risk of necroses.

Firstly, liposuction is performed solely on the zone that will be preserved to alleviate the flap. This thinner flap is then pulled downwards better toward the pubis and therefore the correction will be improve and the scar can be lower (and positioned along the panty line of a string)

To protect the lymphatic vessels, the dissection is firstly carried out on the surface, then by the navel (where are only small lymphatic ramifications) it changes of plan and move in depth upwards towards the crease under the breast.

The creation of an internal muscular corset enables the risk of secondary superior bulges to be avoided. The majority of the tension is above the navel and the tension in the lower area is slight, thus limiting the risk of necroses.

Operation

Practical recommendations prior to the operation

Do not arrive too morally or physically tired to the operation. Let us know about any change in your state of physical or mental health and do not forget that there is never any urgency to carry out an aesthetic operation. The operation will be cancelled if you are ill, or for women, if you are pregnant on the day of the operation.

The main problem of this operation is the potential blood loss and thus the risk of a transfusion (resulting from the duration of the operation, the length of the incisions, the size of the surfaces operated on and the volume of the liposuction.) Thus, everything possible must be done to minimise blood loss. Furthermore, the ex obese tissues have the specificity of being much more prone to haemorrhages since the vessels developed with obesity and have not reduced in size in parallel to weight loss.

• Due to the risk of necrosis it is imperative that a patient stops smoking. Medicines that cause bleeding are prohibited during the days leading up to the operation: Aspirin, Anti-inflammatory medicines, Anticoagulants, Vitamin E….
• It is advisable to take blood from patients in most cases. Three samples are taken during the month prior to the operation (at one month, three weeks and two weeks pre-op.)
• A course of oral medicine to prevent anaemia will be given one month prior to the operation.

Also, no progestin treatments (contraceptive pill) should be taken during the month before and after the operation to limit the risk of embolisms.

It is imperative that you neither drink nor eat for the 6 hours prior to the operation. Smoking must be stopped due to the risk of necroses.

The operation will be cancelled if preoperative advices are not adhered to : assessment, fast, stopping smoking…

When preparing your belongings DO NOT FORGET YOUR MEDICAL FILE AND PRESCRIBED SUPPORT (anti-thrombosis tights.)

Where possible, do not bring any valuable jewellery with you (or put it in the safe at the clinic with your other valuables during the operation.) Bring with clothing that is not put on over the head and is not too tight around the waist. Men should use braces instead of a belt.

Have a shower or bath before coming to the clinic and make sure your hair is clean; women should obviously not wear nail varnish or make-up. Do not shave your pubic area before coming for the operation (risk of germs if there are micro-cuts, therefore a risk of infection during the operation.)

Prior to the anaesthetic contact lenses, dentures and hearing aids must imperatively be removed.

Anaesthetic and hospitalisation

Operation performed in a clinic with considerable technical supports and always under general anaesthetic. The operation lasts from 4 to 6 hours. Hospitalisation lasts 3 to 6 days.

Dr Le Louarn will make pre-op markings on you which are very important to determine the position of the future scar under your underwear as well as to reduce the duration of the operation.

After the operation you will have a bandage and your anti-thrombosis support will be put on. When you wake up, the bottom of your bed will be tilted upwards (your legs will be lifted) to limit the risk of embolisms. You will have drains to reduce the risk of haematomas.

From the day after the operation you will be asked to get out of bed to reduce the risk of embolisms. A physiotherapist will massage your calves during your hospitalisation to further reduce this risk.

Leaving hospital

Prepare clothing that is not too tight around the waist for when you leave hospital. Men can replace their belt with braces.

Next steps

For the first few days at home you must relax as much as possible and avoid all over exertion. However, you should walk a little several times a day to prevent the risk of embolisms and should eat enough to enable healing.

It is important that you do not smoke for 15 days in order to facilitate healing and reduce the risks of necroses.

Since the operation entails a huge shift in the body shape, you should not hesitate in enlisting the help of a psychiatrist or psychologist so that the operation is a psychological success.

Note down the telephone number of the office, (01 45 53 27 17 from France or 33 1 45 53 27 17 for international call), and the number of the clinic near your home telephone and in your mobile phone. Do not hesitate to call us if you are worried. Call us if you have a temperature, experience weeping, pain or other symptoms that give you cause to worry.

Leave from work: 2 weeks to 1 month
Tights anti-thrombosis tights for 8 days
Corset 8 days
Stitches will be absorbable or removed 15 to 20 days after the operation
Bruises 15 to 20 days
Swelling at its height on 3 rd /4 th pre-op day then fades progressively
Scars 6 to 9 months before they whiten
Abdominal exercises have to be resumed 1 month after the operation and performed daily thereafter

Risks

In most cases, operations run smoothly and patients are happy with the result. However, before deciding to go ahead with an operation, you should be aware of the risks and possible complications.

General risks of all surgical operations: infections, haematomas, healing problems and risks from anaesthetics

Infections

General risk of infection is limited by antibiotics before and after the operation when it is performed under normal conditions and when pre and post-op care and advice are adhered to. You will notably be asked to initially wash every day to keep the scars clean and to respect the antiseptic and antibiotic prescriptions.

Sometimes a limited infection can occur due to a localised fatty necrosis following tractions or a haematoma. The treatment is the rapid removal once the abscess is collected.

Haematomas

Haematomas are rare enough complications, but need to be evacuated rapidly. They tend to occur in the hours following the operation. The risk of haematoma rises considerably when medicines that can cause bleeding are taken pre and post-op.

Healing problems

As in any plastic surgery operation, the quality of healing is not known in advance. Immediately after the operation a scar can inflame or weep, requiring specific local treatments that can often be long. Respect of advice concerning cleanliness, stopping smoking and attendance of monitoring sessions will be decisive. In the mid-term, a scar can sometimes develop poorly: thicken, expand, or form keloids. This principally depends on the type of skin (red or black skins experience more problems) and health behaviour (cigarettes and the contraceptive pill increase this risk.)

Risks from anaesthetics

Anaesthetic techniques and monitoring methods have improved immensely and safety is high when an operation is performed in non-emergency conditions on a person in good health, when the anaesthetist is competent and working in a recognised establishment. However, the effect of anaesthetics on the body can be difficult to predict and treat. Therefore there are still risks and hazards inherent to all anaesthetics before and after the operation. This is why it is imperative that you consult the anaesthetist prior to the operation and fully inform him of the state of your health. In function of your health and the planned operation, he will assess the risks related to anaesthetics and tell you of any potential precautions to take. If the anaesthetist objects to the operation, this decision is final.

(see in chapter ” Before surgery ” section “Check up and anaesthetic consultation“)

Risks during any aesthetic operation: asymmetry, a result judged as insufficient or excessive, need to touch up results, sensitivity issues

The way in which tissues react to an operation is always specific and, to a certain extent, unpredictable. It depends on the patient correctly following the doctor’s recommendations, but luck also plays a role. This is why all risks of asymmetry, unsatisfactory or excessive results and the need to touch up are evoked prior to any aesthetic operation.

Body lift – specific issues:

Asymmetry

The scar may be asymmetrical (this risk increases in cases where the vertebral column is deformed.)

Imperfections of the result

There is no real risk of an excessive result; however, the risk of an insufficient result does exist, since the skin tends to slacken again as of the day after the operation, especially for once-obese patients. This is why the surgeon will not hesitate in using strong tension based on the principle that for body lifts, it is better to touch up an expanded scar than to need to repeat the whole operation.

Need to touch up results

As we have just mentioned, skin has a particular specificity of slackening quite soon after the operation, which is why touching up or even repeat operations are not rare. Some once obese patients, although few, need to be operated on twice for every operation to achieve a satisfactory results (body lift, arm lift, inner thigh lift).

Sensitivity

During the procedure to insert the flap in the upper part of the buttock, a dissection is performed that detaches the buttock and this can, in 20% of cases, cause serious pain directly after the operation. Exceptional and definitive loss of feeling in the buttock region has been reported.

Potential bodylift complications

Blood loss and risk of transfusions

The main problem of this operation is the potential blood loss and thus the need for a transfusion resulting from the duration of the operation, the length of the incisions, the size of the surfaces operated on and the volume of the liposuction. Furthermore, the former obese tissues have the specificity of being much more prone to haemorrhages since the vessels developed with obesity and have not reduced in size in parallel to weight loss. Thus, everything possible must be done to minimise blood loss. And respect of anaesthesiologist recommendations is essential.

Thrombo-embolic problems

Thrombo-embolic troubles are the most dreaded complications, even if they remain extremely rare. The phlebitis can sometimes lead to pulmonary embolisms which can be fatal ( 1 in 10 000). This risk increases with long haul flights too soon after the operation, by certain pathologies and, as already mentioned, by all operations on the lower basin (case of the body lift). This is why an anaesthetic consultation and the respect of preventative measures will be decisive: anti-thrombosis tights, respect of potential anticoagulant prescriptions, tilted bed, halt of all progestin and hormonal treatment. Furthermore, if the anaesthetist feels that the patient should be rejected due his decision is final. If in doubt, in post-operative period, a blood test can be performed to measure the D-Dimere in order to search impending trombo-embolic problem.

Risks of long operations

The body lift is an intense operation lasting from 4 to 6 hours. When it takes longer than five hours, the body may become cold, leading to serious complications. Of course, specific heater keeps the body warm. But it is essential to limit the duration of the operation as much as possible, notably thanks to markings made prior to the operation.

Lymphatic effusions

Effusions may require draining. Usually they dry with no further consequences, but if they persist for several months, a further operation may be required to remove the residual envelop after the halt of seroma. The technique used has been developed especially to avoid these problems. Two principles are respected on the front and back sides of the body:

• the large lymphatic stems are respected to avoid secondary lymphatic effusions
• all dead spaces are closed using padding to limit haematomas and tension on scars which can lead to skin suffering and slackening.

Necroses

Spread necroses are very unlikely, but it should be pointed out that the risk increases due to two factors: cigarettes: cigarettes and traction on skin. The second factor being much better controlled with the high tension lateral body lift technique, this risk is therefore reduced using this technique.

Marginal necroses are, however, less common. They usually lead to a localised slackening of stitches due to the post-op tension on poor quality skin (notably further to huge weight loss.)

The result

Two to three months after the operation, an initial evaluation of the result can be made. However, scars and tissues can experience an inflammatory peak at that moment, which is why it is often necessary to wait for nine to twelve months to see a final result.

Usually an appreciable aesthetic result is achieved with real psychological benefits and the comfort of the patient is also greatly improved.

The final appearance of the scar depends on the reaction of each patient and the cessation of smoking will be a decisive factor in this.

The longevity of the result of body lifts depends essentially on health behaviour. The effect will be long-lasting depending on 2 conditions: daily abdominal exercise and the limitation of significant weight changes. Pregnancies are possible but can affect the abdominal result.

By way of conclusion, we remind you that precise and detailed information, an in-depth analysis of the reasons for the operation, teamwork between the patient and the surgeon during the preparatory phase, the search for surgical excellence coupled with a good analysis of benefits and risks, the respect of pre-op and post-op advice and regular monitoring of the patient are all key elements for aesthetic surgery to be a success.

References:

Body contouring techniques all use for the anterior part of the procedure the abdominoplasty (tummy-tuck) surgery techniques. Regarding the abdominal part of body lift surgery performed by Dr Le Louarn, please refer to the chapter “abdominoplasty” on this web site.

You will find general information in English about the abdominoplasty on the page « Abdominoplastia » of the ISAPS’website (International Society of Aesthetic plastic Surgery) – chapter: « Info for patients ».
www.isaps.org

You will also find general information about abdominoplasty in French, on the page « Chirurgie de la paroie abdominale » on the SOFCPRE’s website
www.plasticiens.org

Body lift surgery itself did became a recognized procedure thanks to Ted LOCKWOOD and his tremendous work in the field:

LOCKWOOD T. : The role of excisional lifting in body countour surgery
Clinics in Plastic Surgery Vol 23 N°4 Oct 1996 – Edited by Frederick M. Grazer – Saunders – ISSN 0094-1298

LOCKWOOD T.:  Lower body lift with superficial fascial system suspension
Plast. Reconstr. Surg. – 1993 Nov ; 92(6):1112-22
http://www.ncbi.nlm.nih.gov/pubmed/8234509

LOCKWOOD T.: Transverse flank-thigh-buttock lift with superficial fascial suspension
Plast Reconstr Surg. 1991 Jun ; 87(6):1019-27
http://www.ncbi.nlm.nih.gov/pubmed/2034722

Specific informations appearing on this website are based on Doctor Le Louarn’s practice and on his scientific works :

1 – LE LOUARN C., PASCAL J.F.: Autologous gluteal augmentation after massive weight loss
Plast Reconstr Surg. 2008 Apr ; 121(4):1515-6
http://www.ncbi.nlm.nih.gov/pubmed/18349690

2 – PASCAL J.F., LE LOUARN C.: Complications des bodylifts – Bodylift complications
Ann Chir Plast Esthet. 2004 Dec;49(6):605-9.
http://www.ncbi.nlm.nih.gov/pubmed/15582217
http://dx.doi.org/10.1016/j.anplas.2004.10.009

3 – PASCAL J.F., LE LOUARN C.: Remodeling Bodylift with High Lateral Tension
Aesthetic Plast Surg. 2002 May-Jun;26(3):223-30.
http://www.ncbi.nlm.nih.gov/pubmed/12140705

Regarding body lift surgery, the following publications and works can also be listed (this list is obviously not exhaustive and may be amended) :

1 – ROHRICH R., GOSMAN A.A., CONRAD M.H., COLEMAN J. : Simplifying circumferential body contouring: the central body lift evolution
Plast Reconstr Surg. 2006 Aug;118(2):525-35

2 – GONZALES R. : Etiology, definition and classification of gluteal ptosis
Aesthetic Plast Surg. 2006 May-Jun;30(3):320-6
http://www.ncbi.nlm.nih.gov/pubmed/16733776

3 – LOCKWOOD T. E. : Maximizing aesthetics in lateral-tension abdominoplasty and body lifts
Clin Plast Surg. 2004 Oct ;31(4):523-3
http://www.ncbi.nlm.nih.gov/pubmed/15363907

4 – HURWITZ D.J., RUBIN J.P., RISIN M., SAJJADIAN A., SEREIKA S. : Correcting the saddlebag deformity in the massive weight loss patient
Plast. Reconstr. Surg. – 2004 Oct ;114(5):1313-25.
http://www.ncbi.nlm.nih.gov/pubmed/15457056

5 – HURWITZ D.J. : Discussion of “Autoprosthesis Buttock Augmentation During Lower Body Lift” by Sozer et al.
Aesthetic Plast Surg. 2005 May-Jun;29(3): discussion 138-40.
http://www.springerlink.com/content/wk27k175505243u2

6 – SOZER S.O., AGULLO F.J., WOLF C. : Autoprosthesis buttock augmentation during lower body lift.
Aesthetic Plast Surg. 2005 May-Jun ; 29 (3):133-7
http://www.ncbi.nlm.nih.gov/pubmed/15948016

7 – LOCKWOOD T. : The role of excisional lifting in body countour surgery
Clinics in Plastic Surgery Vol 23 N°4 Oct1996
Edited by Frederick M. Grazer – Saunders – ISSN 0094-1298

8 – ASTON S.J.: Buttocks and thighs – Chapter 37 Volume II in Aesthetic Plastic Surgery
Edited by Thomas D. REES –  Saunders 1980 : ISBN 0-7216-7521-2