Lower Body Lift

A lower body lift is a body contouring procedure to eliminate loose, excess skin at your lower half. A lower body lift includes the areas around the abdominal region, flanks, thighs and around the back to your buttock area. The procedure is ideal for treating sagging skin after pregnancy or massive weight loss.

About

Massive weight loss commonly results in circumferential tissue excess and laxity, most often noted in the abdomen, but also affecting the thighs, and buttock. This laxity is addressed with the lower body lift, 3 procedures combined into one: abdominoplasty, thigh lift and buttock lift. Skin and soft tissue excess, muscle laxity, and belly button malposition are all addressed in the abdominal region with an abdominoplasty. The texture changes and soft tissue laxity in the thighs is addressed with a lift. And the droop of the buttock is addressed with a lift. These circumferential changes are most completely addressed with surgery of the abdomen, thighs, and buttocks in a lower body lift. All these areas can be tightened by excising out the lax skin and soft tissue excess.

If there is notable volume loss and deflation in the buttock with loss of projection, instead of excising out the soft tissue leading to more tightening, flattening and loss of buttock projection, the local tissue can be rearranged to provide a more pleasing shape and volume enhancement of the buttock. This is an autoaugmentation of the buttock, using the excess lax tissue in the surrounding region, rearranging it to provide volume enhancement at the time of the lower body lift.

Benefits

Have you tried exercise and the muscles are still lax and the circumferential skin excess is not tightening anymore?  Do you have excess that goes to the back, beyond what will be addressed with a standard abdominoplasty? The flanks, thighs and buttock are not addressed with an abdominoplasty. Do you see texture changes in your thighs and buttocks that are improved by pulling the tissues up at your waist? You may have cellulite that is secondary to laxity of your soft tissues in this region that is best treated with an excisional and tightening procedure such as the lower body lift.

Because the abdominoplasty takes off less and less tissue as it proceeds towards the back, when an abdominplasty is performed in the face of circumferential excess, the ignored excess will manifest as a “dog ear” or fullness at the end of the abdominoplasty scar.

Because less and less tissue is removed with a tummy tuck as it proceeds towards the back, there is not the same tight pull that is transmitted to the thighs. When the procedure actually addresses the circumferential excess, taking out as much laxity as is present, it will translate into an indirect lift of the front of the thigh as well as a direct lift of the outer thigh, and transition into a lift of the buttock.

The best results are obtained when you are happy with your weight and you are at a safe weight for extensive body contouring.

Have you lost all your excess weight? Is your body mass index below 30? If so, you will be a safer candidate for this procedure. In addition, the aesthetic improvements you can expect, will be better. When the tissues are more deflated and weigh less, the tight pull of the lower body lift procedure is more effective, with the resulting tightening and flattening of the outer thighs and buttocks being transmitted further.

Bottom line, if you have a circumferential excess and laxity of your lower body affecting your abdomen, thighs, and buttocks, you will best be addressed with a lower body lift procedure that addresses all these areas. Anything short of this will leave you with some manifestation of soft tissue laxity and excess.

Lower Body Lift Addresses …

	Deformity	Intervention	Benefit
Abdomen	Skin Excess Stretch Marks Muscle Laxity	Skin Excision Skin Excision Muscle Plication	Skin Tightening  Remove Stretch Marks in Area Excised Muscle Tightening and Flattening
Thighs	Skin Excess Stretch Marks	Skin Excision Skin Excision	Skin Tightening & Lifting Remove Stretch Marks in Area Excised
Buttock	Skin Excess Stretch Marks Volume Excess Volume Deficiency	Skin Excision Skin Excision Tissue Excision Rearrange Tissue	Remove Stretch Marks in Area Excised Volume Reduction

Personal Consultation

Dr. Smith is a renowned body contouring specialist who has lectured locally, regionally, nationally, and internationally on post-bariatric body contouring surgery following massive weight loss. As the former Director of Body Contouring After Weight Loss at UC Davis, he has over 18 years of clinical experience treating this unique group of patients.

If you are interested in a lower body lift with Dr. Smith, he will be pleased to meet with you to discuss your pregnancy and weight history as well as seek to understand your goals and desires. He will want to know about your personal and family history of pregnancies, weight fluctuations, as well as any surgeries you have had on your abdomen, particularly any bariatric surgery. He will conduct a physical exam, focusing in on both your abdomen and entire lower body. He will then discuss your various options and recommend a treatment tailored to you and your goals and desires.

Preparation for Lower Body Lift

Doing all these will give you the best chance to have a great, uncomplicated surgical experience with the longest lasting best result possible for you.

Procedure

This procedure is done under general anesthesia. Before going to sleep, leg squeezers or sequential compression devices (SCDs) are placed on the calves to help decrease the chance of a blood clot or deep venous thrombosis (DVT).  Patients will also get a dose of antibiotics given in their IV to decrease the chance of a postoperative infection. Patients will also have a catheter placed into the bladder to monitor fluid balance and prevent bladder distension during the procedure.

The patient is then positioned prone or face down, protecting all pressure points, and the incisions are made across the lower back, just above the buttock. Skin and fat is removed, sculpting the underlying soft tissues of the buttock. Drains are placed to evacuate tissue fluid (serum) from the raw tissue surfaces. The skin is then pulled up and closed tightly over the preserved soft tissues, thus lifting the buttock. This results in a scar that runs just above the buttock from hip to hip.

The patient is then positioned supine or face up. Incisions are made across the lower abdomen and the skin and fat are removed from the lower abdomen, sparing the umbilical stalk. The upper abdominal skin is then elevated to the level of the lower portion of the sternum or breast bone. The muscles are now clearly visible and the diastasis or separation between the rectus muscles is repaired by plicating or pulling in the muscles toward the midline. This tightens and flattens the abdominal wall. A pain catheter is placed to deliver local anesthetic across the plicated muscles and drains are placed to evacuate tissue fluid (serum) from the raw tissue surfaces. The skin is then pulled down and closed to the lower incision and the umbilical stalk is matured through this redraped skin. This results in a scar around the umbilicus or naval as well as a scar that runs across the lower abdomen from hip to hip, joining the scar from the back. Thus, there is a circumferential scar like a belt that goes all the way around the lower body, completing the lower body lift or belt lipectomy.

Rapid Recovery

Once awoken from surgery, your will go to the Recovery Room for observation.  Once you have met all milestones to leave, you may go home or to a 23-hour observation area. If you go home, Dr. Smith likes to see you the next day to make sure all is well.

Pain Management

Narcotics: You will be prescribed oral narcotics for moderate to severe postoperative pain. You are also encouraged to take non-narcotic medications to help decrease the amount of narcotic consumed. Narcotics have more undesirable side effects that can be avoided with the use of non-narcotic pain medications.

Pain Pump: The pain pump will deliver a continuous flow of local anesthetic through a catheter placed through your abdominal wall at a prescribed rate determined by Dr. Smith. This is designed to take the edge off of your early post-surgical pain and decrease your need for narcotic pain medications. It will be removed at the 1-week postoperative visit when the bulb is empty. The tape is removed, sutures are cut and the catheter is pulled out. This is wiped down and then covered with a small dressing.

Nausea Prevention

Medicine for nausea will be provided. Take if you need it. The pain pump will hopefully decrease the amount of narcotic you need, and thus decreasing any nausea associated with your narcotic pain medication.  Take your medicines with a little food. This will also help decrease nausea associated with your medications.

Itching and Sleep

Some patients may experience itching associated with taking narcotics. If this is the case, Benadryl has been prescribed for you to help with this. If severe itching is noted, please contact Dr. Smith to evaluate you for a possible allergic reaction. Some patients will benefit from a gentle sleep aid in the early postoperative period. Benadryl can also be helpful to you in this regard.

DVT Prevention

While in bed, the SCDs should be worn. You are encouraged to be out of bed and walking at least once an hour. Both the SCDs and this ambulation will help decrease the chance of a blood clot or DVT. This can be a life-threatening complication. In some patients with enough risk factors for blood clots, some patients may get a blood thinner to minimize the chance of such a clot. This needs to be balanced with the risk of increased bleeding.

Antibiotics

As no implants are used, you will not receive any additional antibiotics unless there is evidence of a postoperative infection.

Nutrition

You are encouraged to advance to a normal diet, eating a good well-balanced diet, emphasizing your protein intake. Your nutritional requirements go up with the stress of surgery and you need the appropriate nutritional building blocks to heal. You are encouraged to consume 1.5 – 2.0 grams of protein for each kilo they weigh. For instance, if you weigh 60 kgs, then you should eat 90 – 120 g of protein each day. When patients are not appropriately healing their wounds, it is commonly traced to inadequate nutrition, specifically protein.

Drain Care

You will have four drains, two draining the back and two draining the front. The two outer drains, evacuate fluid from the back, while those in the middle drain the abdomen. You need to record your 24-hour drain output for each individual drain. The bulbs must be collapsed at all times to create the suction necessary to facilitate good flow of fluid out into the bulbs. To more easily calculate 24-hour drain outputs, it is best to empty the drains at least once at the same time everyday. The drain may be emptied more frequently to ensure the bulb is always collapse create sufficient suction. Once the drain output has slowed to less than 30 cc in a 24-hour period, the drain is removed. Drain sites typically take a day or two to seal up. Once both drains are removed and both drain sites have sealed, the patient may shower.

Showers

While you have drains in your abdomen, Dr. Smith prefers you sponge bathe. Once the drains are out and the sites have sealed, then you are allowed to shower, but no soaking in the tub for 4-6 weeks, assuming normal healing.

Compressive Garments

Abdomen: Once the final drain is removed, most patients will benefit from wearing a lightly compressive garment. This helps stabilize the tissues and decreases the chance of fluid accumulation in between the tissue layers. Some patients may wish to wear a compressive garment before the final drain is removed. This may help stabilize the soft tissues and result in earlier drain removal.

Incision Management

The incisions are closed in multiple layers of dissolvable sutures and/or staples. The incisions are sealed with a skin tape and glue combination. This typically stays in place for a month.  When showering, these should be patted dry. If the tape begins to lift, the lifted areas may be trimmed leaving the adherent tape in place.  If there is moisture that is accumulating underneath the tape, this portion of tape should be removed to prevent maceration or incision break down due to moisture. Any tape and glue that is still in place at the one-month postoperative visit will be removed by Dr. Smith. 

Lifting

You should not lift anything greater than 10 pounds for 4-6 weeks assuming normal healing. After all is sufficiently healed, Dr. Smith will allow you to gradually increase your activities to normal.

Activity

You should be ambulating at least once an hour, to minimize the chance of a blood clot. This also helps your bowl function return to normal more quickly. To get out of bed, you need to initiate all moves, only accepting gentle support from your care taker. You know the body position where the incision has the least tension throughout and should assume this position to prevent separation of your sutures. Light activity around the house is good, but remember, no lifting more than 10 pounds for the first 4-6 weeks, until preliminary healing has occurred. After all is sufficiently healed, Dr. Smith will allow you to gradually increase your activities to normal.