Obesity is a global disease with epidemic proportions. Bariatric surgery or modified lifestyles go a long way in mitigating the vast weight gain. Patients following these interventions usually undergo massive weight loss. This results in sagging tissues in various parts of the body. Loose skin causes increased morbidity including skin problems and psychological trauma. This demands various body contouring procedures that are usually excisional. Liposuction may be included at surgery, but as a sole modality of treatment, it often fails. These procedures are complex and part of a painstaking process that needs a committed patient and an industrious plastic surgeon.
A belt lipectomy undertakes circumferential removal of the loose and sagging skin-fat envelope from lower abdomen, waist and lower back. Skin and fat from knee level up must be lifted, thus the soft tissues of the thighs circumferentially must be loosened from the underlying muscles. To accomplish this, the thighs are suctioned and the zones of adherence at the junction of the outer thigh and the hip fat deposits are intentionally broken, after a tummytuck. Then, the waist and lower back tissues are removed. After removal of the excess tissue circumferentially, most patients require a minimum of 4 weeks to return to work on a limited basis and resume normal physical activity in 6 to 8 weeks.
Massive weight loss patients who have normal thigh contour and only a minor anterior thigh descent can be treated by belt lipectomy alone. Liposuction alone usually does not work in these patients. In many patients, upper and inner thigh laxity is caused by a descent of relaxed lower abdominal tissues after massive weight loss. Usually, the trunk along with the lateral thigh is addressed initially by the belt lipectomy, which may reduce the amount of subsequent thigh surgery. This is then followed by the thigh lift that leaves a scar from top to bottom of the thigh on the inner aspect. For some patients who still have inflated thighs, it is preferable to deflate the thighs by circumferential liposuction and then undertake an excisional procedure 3-6 months later.
The process of massive weight loss often significantly alters the upper body subunit. This may cause drooping breas-ts, and outer breas-t and back rolls. Frequently, this patient, after satisfactory correction of lower trunk contour deformity, will seek improvement in the upper body as well. A variety of surgical options are available, ranging from total upper body lift for more extensive deformities to brachioplasty and/or breas-t surgery as individual procedures for more limited problems. The excess is horizontal as well as vertical. With women, a discussion of the desired breas-t size and shape after correction is essential to guide the surgeon in selecting the appropriate surgical approach. It is often helpful to show photographs of other patients who have had similar procedures to ensure that the patient has a realistic expectation of what can be accomplished. The key factor in determining whether an upper body lift is to be used in its entirety is the position of the outer breas-t crease. If it is properly positioned, isolated procedures such as a brachioplasty and breas-t reshaping surgeries can be performed. If the outer crease position is lower than it should be, an upper body lift is appropriate. For the upper body lift, three areas need to be addressed. First, the upper arm excess is eliminated using a brachioplasty. Next, the outer breas-t-upper back roll removal eliminates vertical excess and upper back redundancy while lifting the outer breas-t crease. Third, the breas-t crease elevation provides an accurate base for planning breas-t contouring procedures that are dependent on the patient’s sex and wishes. For men, a breas-t reduction is required, while females may require breas-t reduction, breas-t augmentation, mastopexy, or augmentation mastopexy.