How to Achieve the Best Results with Safety in a Lower Body Lift After WLS

March 4, 2019

I recently presented a free paper session in the ISAPS 2018 congress in Miami for a future publication. This article is about the perfect combination of which I called A MARRIAGE that cannot be dissolved! Great Surgical Result and Safety.

Safety and Results for a Lower Body Lift After WLS

Based on my recent extensive research regarding the most updated information worldwide, SAFETY has turned out to be one of the most important goals for any type of plastic surgery including after weight loss surgery. No matter how much weight a patient has lost, how he/she lost it, her/his age, it is undeniable that this group of patients are categorized as Reconstructive Surgery patients and are seeking a change of life after their long weight loss journey.

Aside from the aesthetic improvement as their final goal, we cannot forget that SAFETY is always the priority to achieve an excellent outcome. We all agree (patients and doctors) that NO ONE would ever want to end up with serious complications.

These patients suffer from hanging skin, dermatitis, skin infections, odor, urinary tract issues, impossibility to wear normal clothing, and the negative effect on their sexual life.

It is well known that body contouring surgery improves the quality of life amongst these patients due to great improvement in both their attractiveness and overall health. Results are dramatic and life changing, improving self-esteem and creating a renewed self-confidence.

Top 5 Ways to Achieve a Safe Procedure & Wonderful Results

1. Achieve a Healthy BMI: You must understand that after massive weight loss you may require major reconstructive surgery and your body must be in the most perfect health condition. To prevent complications and one of the most important will be to achieve a healthy BMI, no matter how much weight you have lost we know the higher the BMI at the time of the plastic surgery, the higher the risk of complications. It is your responsibility to fulfill this requirement and at the same time acquire the healthiest habits to reach your goal weight.
2. Eat Healthy and Exercise: Great eating habits and exercise will be key to prepare your body for the great challenge of surgery and recovery. Patients who have undergone bariatric surgery are more prone to develop anemia and other nutritional issues which may prevent from having reconstructive surgery done in the first place, and secondly will disrupt the normal healing process in time and quality.
3. Be Proactive: Proactive positive thoughts because we are what we think, but it is not that simple. You may think very positive, but by doing nothing to improve your preoperative condition (diet, exercise, quit smoking or drinking alcohol), it may end up resulting in complications just by not being proactive. This is about concurrent thinking: what I must do to make my surgery journey safer easier, less painful and with normal healing.
4. Follow Instructions: Following instructions, because patients may listen better to their friends, family members, Dr.  Google or any person who may give wrong advice instead of listening to your doctor who is the expert that performed your surgery and who knows better about what you are able to do and not to do. The best you can do for yourself is to listen to your doctor and her/his staff’s recommendations. Any questions you may have, let them answer, be patient and wait for their response Follow diligently all instructions and my saying “TRUST MORE AND WORRY LESS”. Patients who do not observe their doctors’ recommendations always have more complications! Instructions are resting for two full weeks minimum, take medication for the length of time recommended, being very careful with hygiene/cleaning (hands, incisions, garments, clothing, bedding, chairs, showers), and continue having healthy meals to really nourish the convalescing body.
5. Be Patient: We, as humans, have the tendency to be impatient, and we expect to see final results the day after surgery, or a week after, or a month after surgery. Post-weight loss procedures are more extensive, invasive and longer procedures. In comparison with a Tummy Tuck or BBL, it is expected you'll have more swelling, pain or discomfort due to the extent of the procedures. Also expected is that recovery may be a little longer for the same reasons. Patients are excited and begin to see results in the first week, however amongst these procedures, we expect no less than three months to see close to the final results. Each patient is different and has their own custom surgery plan based on their individual needs and desires so times may differ. Due to the elasticity of the skin, it is often that we observe the need for revisions for scars, extra skin, irregularities, etc.

My Top 5 to Achieve Great Results With Safety

1. Selection Criteria: Very strict selection criteria of patients to prevent complications: BMI below 30, hemoglobin above 12.5-13 gr, perfect health condition.
2. Oxygen Monitoring: Tight muscle repair, monitoring the oxygen level throughout surgery in order to be sure the patient’s lung capacity will not be negatively impacted and at the same time create a flatter abdomen and slimmer waist.
3. Liposuction and Fat Grafting: Combination of Liposuction and fat grafting with the Lower Body Lift to help to contour the lower back and waist for female patients and love handles for male patients and at the same time use that fat to transfer to buttocks and hips to create a better more feminine shape. Liposuction must be limited (1000-2000cc max) when combined with the Lower Body Lift in order to prevent greater blood loss, which could lead to symptomatic anemia or blood transfusions.
4. Prevention: Quilting internal stitching to help several prevention issues: reduce the seroma formation which is the most common minor complication (20-30%), equal distribution of the abdominal flap tension reducing the risk of skin necrosis and dehiscence (10-40% in literature), and will help to remove more length of the skin.
5. Pubic Area and Buttocks: In 100% of the patients who undergo Lower Body Lift (men and women) the improvement of these two areas are crucial: the pubic area and buttocks. The saggy pubic area is related to many functional and aesthetic issues amongst the after weight loss patients and the lifting and/or reduction will help to improve their quality of life. The buttocks are another area which will improve the overall shape in male and female patients. Some patients will just want lifting and many others will desire some enhancement as is the mild augmentation through gluteal flaps or fat grafting or the combination of both. Female patients will also be benefited from hip enhancement when needed or requested.

As you can see, safety and great results are a realistic expectation, and the responsibility will belong to both: Patient and Surgeon!

Patient homework is a must. Extensive research to be sure your surgeon is a Board Certified Aesthetic, Plastic and Reconstructive Surgeon in her/his own country. Please, check the Board to verify. Remember, after weight loss procedures require only reconstructive surgeons that specialize in AWL with extensive patient experience.

Be encouraged!

ABOUT THE AUTHOR Dr. Carmina Cardenas is a Board Certified Aesthetic, Plastic and Reconstructive Surgeon. She completed her residency and graduated with honors from the Mexican Institute of Social Security, at the Hospital of Specialties in Plastic and Reconstructive Surgery. She is owner of Beauty Enhance Plastic Surgery. Read more articles from Dr. Cardenas!

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