Bariatric Times - December 2008 - (Page 23)

Bariatric Times • December 2008 Body Contouring Perspective 23 areas. The lateral thigh skin is loosened by the action of the thigh liposuction which also aids in skin closure. If there are significant fat deposits in these areas, the outer thigh lift can actually worsen the saddlebag appearance unless this area is sculpted with liposuction.2 The abdominoplasty portion of the procedure is then performed in the supine position. The abdominal flap is elevated and plication is performed to refine and tighten the abdominal wall. The umbilicus is repositioned and then the incision closed. Drains are left in place and some advocate the use of body garments for postoperative management. Some of the most common complications that arise after a lower body lift include seromas and wound healing problems such as infection or dehiscence. Flap necrosis, hematomas, and thrombotic events can occur but are not as common.15 Thromboembolic events have been shown to be higher in those circumferential lower body lift patients that have a BMI>30, or are on oral contraceptive pills or hormone replacement therapy. In these patients, the use of enoxaprin has been associated with a lower incidence of venous thromboembolism complications. There is a slightly increased risk for bleeding with its use, so the benefits and risks must be evaluated on an individual basis.17 Hospitalization after the lower body lift is recommended for adequate pain control and monitoring of any immediate complications. In healthy, lowrisk patients, the lower body lift may be performed in an outpatient setting as long as careful follow-up is provided. 4. 5. 6. 7. 8. 9. 10. Coleman J. Simplifying circumferential body contouring: the central body lift evolution. Plast Reconstr Surg. 2006;118(2):525–535; discussion 536–538. Aly AS, Cram AE, Heddens C. Truncal body contouring surgery in the massive weight loss patient. Clin Plast Surg. 2004;31(4):611–624, vii. Hurwitz, D.J., Single-staged total body lift after massive weight loss. Ann Plast Surg. 2004;52(5):435–441; discussion 441. Borud LJ. Combined Procedures and Staging. In: Rubin JP, Matarasso A. Aesthetic Surgery after Massive Weight Loss. 2006: Philadelphia; Saunders, 159–1657. Baroudi R. Body contour surgery. Clin Plast Surg. 1989;16(2):263–277. Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric bypass patient presenting for body contour surgery. Clin Plast Surg. 2004;31(4):601–610. Capella JF. Body lift. Clin Plast Surg. 2008;35(1):27–51; discussion 93. Pascal JF, Le Louarn C. Remodeling body lift with high 11. 12. 13. 14. 15. 16. lateral tension. Aesthetic Plast Surg. 2002;26(3):223–230. Colwell AS, Borud LJ. Autologous gluteal augmentation after massive weight loss: aesthetic analysis and role of the superior gluteal artery perforator flap. Plast Reconstr Surg. 2007;119(1):345–356. Centeno RF. Autologous gluteal augmentation with circumferential body lift in the massive weight loss and aesthetic patient. Clin Plast Surg. 2006;33(3):479–496. Richter DF, Stoff A, Velasco-Laguardia FJ, Reichenberger MA. Circumferential lower truncal dermatolipectomy. Clin Plast Surg. 2008;35(1):53–71; discussion 93. Saldanha OR. Lipoabdominoplasty. Saint Louis: Quality Medical Publishing; 2006. Shermak MA, Chang DC, Heller J. Factors impacting thromboembolism after bariatric body contouring surgery. Plast Reconstr Surg. 2007;119(5):1590–1596; discussion 1597–1598. Shermak MA, Rotellini-Coltvet LA, Chang D. Seroma development following body contouring surgery for 17. massive weight loss: patient risk factors and treatment strategies. Plast Reconstr Surg. 2008;122(1):280–288. Hatef DA, Kenkel JM, Nguyen MQ, et al. Thromboembolic risk assessment and the efficacy of enoxaparin prophylaxis in excisional body contouring surgery. Plast Reconstr Surg. 2008;122(1):269–279. AUTHOR CORRESPONDENCE Martin I. Newman, MD, FACS, Department of Plastic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331. Phone: 954-659-5212; Fax: 954-659-5210; E-mail: newmanm@ccf.org. CONCLUSION The lower body lift is a widely performed procedure that corrects circumferential skin excess in the MWL patient. Body contouring surgery is rapidly growing and techniques are evolving because of the high demand from the bariatric surgery. With proper patient selection and newer modifications of the lower body lift, the MWL patient should be able to achieve an excellent aesthetic result. REFERENCES 1. 2. 3. Borud LJ, Warren AG. Body contouring in the postbariatric surgery patient. J Am Coll Surg. 2006;203(1):82–93. Aly AS, Cram AE, Chao M, Pang J. Belt lipectomy for circumferential truncal excess: the University of Iowa experience. Plast Reconstr Surg. 2003;111(1):398–413. Rohrich RJ, Gosman AA, Conrad MH, http://www.obesityeducation.com/ICSSG

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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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