Details for Lower Body Lifts After Massive Weight Loss
June 18, 2018Body lifts have increased 5000% over the past 15 years. This has paralleled the rise in bariatric procedures that have been performed. Obesity was classified as a disease by Medicare in 2002, prompting bariatric surgery to be a covered expense by most insurance carriers as a means of controlling and eliminating diabetes, high blood pressure, and heart disease. The American Medical Association followed the government’s lead in 2013.
A body lift can be either upper or lower depending on where the tissue is removed. A lower body lift is the most common location. Essentially, it is a combination of an Abdominoplasty and a Back Lipectomy performed in continuity.
Types of Lower Body Lifts
Several variations can be performed. Two variations are a Panniculectomy and a Fleur de Lys.
Panniculectomy is the removal of the excess tissue straight across with no opening up the space or movement of the umbilicus or repair of the rectus abdominis muscles. This usually is made at the level of the umbilicus. In my estimation, this is not very attractive and the patients gain much more by doing an approximation of the abdominal musculature as well as keeping the scar as low as possible.
Fleur de Lys is another variation which results in an additional scar between the umbilicus and the pubic area but would further tighten the excess skin in the midline. Torsoplasty can also be performed. This results in a cut under both breasts as well as one extending from the area between the breasts to the lower abdominal incision. This is the most extensive resection possible on the abdomen.
Details to Know About a Body Lift
When Should a Body Lift be Performed?
After bariatric surgery, I usually recommend that the patient’s weight loss is stable for a period of about six months. There can be fluctuations of plus/minus 10 pounds but not much over this.
The reason is that if the surgery is performed, and the patient loses a significant amount of weight after this, then the results of the lower body lift may not be as good since the excess skin may reoccur. However, I individualize, so for some patients, I may recommend it to be done sooner for hygiene issues or if there is minimal fat present in the abdomen or back.
We try to get a lower body lift covered by the patient’s insurance. Each private insurance carrier is different. We take photos or request the patient to send them if the patient lives out of our area. When the patient provides this information to their insurance, it helps if they include a letter explaining the medical issues involved such as rashes, hygiene, difficult walking, incontinence among others.
Unfortunately, the percentage of patients covered for post-bariatric plastic surgery is still less than 50%. The patient is advised to be prepared because it can take months for an approval and, if denied, the appeal process will take additional time.
Where is a Body Lift Surgery Performed?
A body lift can either be done as an outpatient or inpatient depending on several factors including the patient’s overall health, age, BMI, and personal preference. It is almost always done under a general anesthetic. The hospital stay can be as short as one day.
What are the Preparations for Body Lifts?
Fortunately, most patients that have lost a massive amount of weight are in good health and have been taking their vitamins, supplements, even exercising, and are self-motivated and need minimal preparations. I restrict the use of herbals, any aspirin-containing medicines for a variable time before and after surgery so they do not interfere with surgery. They may also start taking iron as well as a stool softener.
Please note that you should be perfectly honest with your plastic surgeon if you are taking any medicine, cannabis and smoking which may interfere with recovery and healing.
It is important for the surgeon to extensively go over the procedures planned as well as their limitations and complications.
How Much Pain Occurs with Surgery?
Unfortunately, of all the procedures that I do, the abdominoplasty causes the most pain. This is because of the tightening of the muscles but will normally become less within several days. Make sure to discuss pain management with your surgeon.
What Complications Can Occur?
Make sure that your surgeon thoroughly discusses the complications and limitations of the procedures in great detail. I stress the limitations of these procedures and that their results will never be perfect.
The complications that may occur are those that occur with any surgery. However, since lower body lifts are extensive procedures, and the patient’s less-than-ideal health and damaged tissues from extreme weight gain and loss, the complication rate is greater. This may be bad scars, that can be red, raised, and spread.
Infections can occur and either be localized or involve larger areas which can necessitate further antibiotic use and can be persistent. Excess bleeding may result in anemia which may cause weakness, headaches, dizziness, and shortness of breath. Every patient experiences numbness as well as swelling for a prolonged period. Seromas or fluid accumulation do occur in about 10-20% of the patients even with a drain or TissuGlu. There may also be unevenness of the scars, asymmetry, or differences from one side to the other, irregularities, and opening of different parts of the incisions.
Patients who have lost massive amounts of weight will invariably have some recurrence of the excess skin tissue even as early as several months after their surgery because their collagen and elasticity of their skin and tissues have been permanently damaged with the weight gain and subsequent weight loss.
Revisions on these areas with removal of more skin and tissue. I suggest that the patient wait until at least one year after their lower body lift.
The final and most dreaded complication is a pulmonary embolus, that is, the formation of a blood clot in the legs which then travels to the lungs and causes chest pain, shortness of breath and rarely death. In patients who have a history of this or other factors that may increase its incidence. I discuss the use of a blood thinner administered after the procedure and possibly for several days. Unfortunately, this does sometimes cause other problems like excess bleeding.
What is the Cost of a Lower Body Lift?
Any procedure that I do depends on several factors, primarily the extensiveness of the excess tissue to be removed and how long the procedure will take. The range for a lower body lift is between $14,000 and $18,000.
Th cost may vary depending on the condition if other procedures are done. This does not include the price of TissuGlu, pain pump, or excess liposuction. The surgery takes approximately four hours and the cost of the anesthesia is about $1,200, the cost of the operating room is approximately $2,200. Finally, if the patient wishes an overnight stay, this may vary but is about $1,200.
If insurance does not cover the procedure or part of it, we offer the patient different financing options like Care Credit, Alphaeon, and even in-house financing for those that may not qualify. Another possibility to ask about is possible discounts. We receive requests from media for patients willing to talk about their surgeries and offer these patients a discount.
Can a Lower Body Lift be Combined With Other Procedures?
Yes, the body lift can be combined with other procedures. I usually set a time limit of approximately 5-6 hours and if I can do other procedures in that time frame these can be combined. My main concern is the safety of the patient. To this end, I sometimes recommend the patient donate a unit of their own blood (autologous blood) which I give them back after surgery.
Equally important to me is the result that the patient achieves. Check on the availability and mode of contact to your plastic surgeon. I provide my cell phone number to all my patients and am available to them and visit those that are out of town at their hotel as needed.
The lower body lift is a very satisfying procedure for the patient as well as to myself. It goes a long way to complete the patient's journey which they started with their bariatric surgery. This procedure, or just the abdominoplasty, is probably the most common procedure that I do on a post-bariatric plastic surgery patient. It is exciting to see the patient not have the tremendous overhanging tissue. If you are going to travel for an experienced plastic surgeon to perform your procedures, check to see if they are available via Skype/FACETIME for consultations.
You can Get to Know Lower Body Lifts After Massive Weight Loss which is the first article of my two-part series on Body Lifts.
 | ABOUT THE AUTHOR Dr. 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.Read more articles by Dr. Domanskis! |
