Bariatric Times - December 2008 - (Page 21)

Bariatric Times • December 2008 Body Contouring Perspective 21 and request abdominoplasty. Many of these patients neglect to consider what is often observed at presentation—a skin excess that extends circumferentially around the lateral thighs to the buttock region. One option to be considered when presented with this scenario is the circumferential lower body lift. Based on the patient’s priorities, a surgical plan can then be designed with attention to the likelihood that abdominoplasty alone, a “front only” procedure, may not address the lateral and posterior defects.1, 4 Another option is to perform the anterior procedure at one stage and then perform the posterior procedure at a later stage. The two-stage approach also has the obvious disadvantage of putting the patient through two separate procedures when one would suffice. Often, the patient desires the lower body lift but cannot afford to pay for the procedure. In these cases, the patient may elect to proceed with one part, such as the abdominoplasty first, then come back at a later date and undergo the buttock lift with adequate results.6 Patient selection must be done carefully in order to reduce the risk of complications. The lower body lift is a combination of procedures and therefore a longer and more extensive procedure. A thorough medical history, including smoking status, should be obtained.4 Other factors to consider when evaluating the patient are the past surgical history and the location of existing abdominal surgical scars. It is also important to differentiate a laparoscopic gastric bypass versus a gastric banding, as the port placement in the gastric banding can often affect the surgical markings and technique of the lower body lift. A port placed in the midline can inhibit plication performed during the abdominoplasty portion and the patient must be informed that this may limit the results. Also, body mass index (BMI) is an important factor in calculating risk of morbidity in these patients and should be taken into account when planning for the lower body lift. Lower body lift should be performed with caution in patients with a BMI>32 as this places the patient at a higher risk for complications including deep vein thrombosis (DVT) and seroma.8,15-17 Aesthetic results are also inversely proportional to the BMI at the time of surgery. Patients with lower BMIs (23–27kg/m2 range) often predict a more pleasing aesthetic result.1,9 OPERATIVE DETAILS AND POSTOPERATIVE MANAGEMENT The lower body lift technique varies from surgeon to surgeon. The plastic surgeon relies on his or her preoperative markings to guide him or her through the most precise skin excision.5,10 The markings are performed in the standing position. Defining the final incision line is paramount in achieving an excellent result as well as obtaining high patient satisfaction. The final scar can be determined and adjusted based on the preoperative markings. The locations of these markings differ with each surgeon but also depend on the trends in fashion as many patients are requesting that the scars be lower on the hips due to the popularity of low-cut jeans and pants. The final incision can be determined by using the standard pinch method—pinching the loose skin in between the thumb and fingers to http://www.ironintern.com http://www.ironintern.com

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Bariatric Times - December 2008 Table of Contents Patient Management Perspective Diabetes Perspective Interview: ASMBS’s Georgeann Mallory Editorial Message Editorial Board Body Contouring Perspective Meeting Perspective Journal Watch Advertiser Index News & Trends

Bariatric Times - December 2008

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