Plastic Surgery Forum

Brachioplasty. Mastopexy ? with or without implants. Abdominoplasty, lower body lift and medial thighplasty. For the thousands of bariatric surgery patients desiring body contouring, the list of surgical solutions to sagging skin can be staggering, as are the pain and healing time after multiple operations. Until 2002, corrective surgery encompassing various areas of the body was always multi-staged, meaning numerous operations and an additional year or more of surgery and recovery after weight loss surgery (WLS) for patients. Thanks to Dr. Hurwitz, that has changed.

Dennis J. Hurwitz, MD, FACS, is the creator of Total Body Lift (TBL) surgery. A plastic surgeon since 1977, Dr. Hurwitz began his career working with complex congenital deformity of the face. Prior to his training, Plastic Surgeons were taught to stage these multiple facial operations on children over many months. The breakthrough was the emergence of craniofacial surgery, whereby a team of specially trained surgeons completed multiple operations in a single session. His experience as director of craniofacial surgery at the University of Pittsburgh prepared Dr. Hurwitz for the challenges of body contouring after massive weight loss. At first he improved the individual operations in body contouring surgery. He then began to understand the interrelationships of the operations.

Dr. Hurwitz started encountering many patients who had experienced massive weight loss when he joined the University of Pittsburgh bariatric surgery team in 1998. Numerous operations were standardized, but Hurwitz slowly began to develop a method of bringing the many sessions required into a single session.

?As I gained skill and understanding of procedural interrelationships, a single stage Total Body Lift was conceived,? Dr. Hurwitz states. ?An abdominoplasty, lower body lift and thighplasty were to be immediately followed by the upper body lift, breast reshaping and brachioplasty.? Taking advantage of gravity during the surgical-prep stage, Hurwitz avoids cumbersome hanging skin by putting his patients through various reclining positions as he marks areas of skin to be removed. During the actual operation, the patient?s position changes only once, turning from prone to supine.

Without sacrificing quality of care, Dr. Hurwitz has worked to improve efficiency, safety and teamwork during the operations, using innovations and modifications to the procedures to create better-looking results. Placement of incisions is carefully planned to minimize scarring and create a more natural appearance.

Dividing the total body procedure into its separate parts, Hurwitz designed the program so that skilled surgeons may work simultaneously. Hurwitz has scheduled time to work in the operating rooms at Magee-Womens Hospital of University of Pittsburgh Medical Center three days a week, which allows him the advantage of the experienced nurses and technicians available to him at the facility.

Hurwitz doesn?t work alone. Assisting him are a physician assistant and Dr. Siamak Agha, a graduate of the University of Cambridge. With the assistance of the plastic surgery residents in the teaching hospital, as many as three operations may be underway at any given time.

Hurwitz is aware that some patients will not want to have multiple surgeons operating on them simultaneously: ?This team effort is not for every patient. For those who want me to execute every step, much less can be accomplished during a single operative session. Either the goals are limited or the TBL is multi-staged.?

Most patients he encounters, however, see the inherent value of completing the surgery quickly. ?As soon as weight loss patients learn of my comprehensive approach, they request as much treatment in one operative session as possible. They prefer not to interrupt their busy lives for a year or two of surgery and recovery. Some tell me that I get one good chance to do as much as possible, and that is it.?

After surgery, patients spend at least three days in the hospital for medical observation and pain management. Once they are deemed fit to be moved, patients are discharged home or to a specially equipped hotel. Single stage TBL patients generally experience more discomfort and, on average, need an extra week of recovery. Visits from the nearby office are planned to provide Endermologie® massage treatments and hygiene assistance, in order to speed recuperation as painlessly as possible.

While the idea of avoiding numerous operations is appealing, Total Body Lift surgery is not a feasible option for all people. Candidates for the TBL procedure cannot be overweight and should be under 50 years of age. ?The operation is too long and too traumatic for thick and heavy tissues,? Hurwitz explains. ?Older individuals may not respond as well to the stress of surgery as the young. Chronic diseases tend to complicate recovery.? It is also suggested that candidates be not only healthy, but also physically fit. ?The physically fit have the physiologic reserve for quicker recovery. My TBL patients should prepare as if competing for a marathon.?

The most important factor for Dr. Hurwitz, however, has nothing to do with his patients? physical aptitude. He believes that motivation is the deciding factor in the surgery?s success. ?Intense desire accepts higher risks and gets you through the tough post-operative period,? he states. ?Otherwise, multiple stages are better for you.? Careful to suggest the surgical approach most appropriate to each patient, Hurwitz firmly believes that no well-chosen TBL patient has regretted having the single stage surgery.

TBL surgery has been featured prominently by television media. Various patients have appeared on news shows such as NBC?s Today Show and Inside Edition, and Discovery Health Channel is airing six different patient stories, including an hour-long feature about a family with obesity problems.

Organized Plastic Surgery, however, has not embraced the TBL for other plastic surgeons. Even though Hurwitz?s results remain highly successful, many surgeons object to the length of the surgery, believing that a single eight-hour set of operations is riskier than two five-hour sessions. There is also concern that under-qualified or less-skilled surgeons would endanger patients by being inexperienced and failing to assemble the requisite organized team.

Despite the concerns and objections of some surgeons, Dr. Hurwitz? continued lectures and teaching courses remain over-subscribed and recorded for future viewing, and hundreds of surgeons travel from around the world to Pittsburgh in order to witness TBL surgery. His methods appear in over a dozen scientific articles and books, and his paper, ?Single Stage Total Body Lift,? was nominated by a committee of the American Association of Plastic Surgeons for the best scientific paper of 2005.

Dr. Hurwitz expects that some of the surgeons who are skeptically observing the procedure at present may someday perform the surgery themselves, as continued research and experience promote greater acceptance of the TBL within the plastic surgery community. Dr. Agha, who is setting up his own plastic surgery practice in addition to assisting Dr. Hurwitz, is one example of many former University of Pittsburgh residents are capable of performing single stage TBL surgery.

For now, Dr. Hurwitz will continue his fight to improve this surgery for those who need it and to demonstrate its safety and efficacy to his detractors: ?In either single or multiple stages, Total Body Lift surgery safely satisfies the needs of weight loss patients as they strive for improved appearance, self-esteem and quality of life. For many worldwide distressed by generalized sagging skin with loss of appealing contours, that means Total Body Lift surgery in Pittsburgh.?

For more information, read Dr. Hurwitz? ObesityHelp.com-recommended book Total Body Lift: Reshaping the Breasts, Chest, Arms, Thighs, Hips, Back, Waist, Abdomen & Knees after Weight Loss, Aging & Pregnancies.