Genetics and lifestyle choices combine to create our body shapes. Over time some people develop significant laxity of the tissues of their abdomen, sides, lower backs, and thighs. This may happen to someone who lost a lot of weight, either through diet and exercise or as the result of weight-loss surgery. It also may happen to someone who has always been near her ideal weight but whose tissues are just naturally loose. At times this results in medical problems like rashes and infection. When loose, hanging tissue becomes undesirable it may be possible to have that tissue removed surgically.
Circumferential Body Contouring
Tummy tuck surgery addresses the front, and to a lesser degree the sides, of the abdomen. When loose tissue of the outer thighs, lower back, and buttocks are a concern, tummy tuck surgery may not be enough. In these situations, a more circumferential approach may be best. Lower body lift, belt lipectomy , and corset body lift are different operations that may be done to address the particular areas of concern a patient may have when loose tissue goes all the way around the central part of the body (the "trunk").
Lower Body Lift and Belt Lipectomy Surgery
Lower body lift surgery and belt lipectomy surgery are similar procedures. They both address loose tissue all the way around the lower abdomen, sides, and back. The front of the abdomen is addressed in much the same way as an abdominoplasty ("tummy tuck"). An incision is made beginning within the pubic hairline and extending transversely across the lower abdomen. The dissection continues deeply along the muscle layer in an upward direction, elevating all of the loose tissue off of the muscle. One the rib cage is reached, all of the loose skin and fatty tissue have been mobilized and can now be pulled down toward the thighs. This allows a substantial amount of skin and fat to be removed. The rectus muscles of the abdomen (the "six pack" muscles) are often pulled together in the midline with sutures, creating something like an 'internal girdle'. Once the extra skin and fat have been removed and the muscles addressed, the tissues are sutured together. This completes the abdominoplasty part of the procedure. With a lower body lift or a belt lipectomy, however, the patient is now turned on her side or stomach, and the incisions are extended all the way around to the midline of the back just above the buttock crease. Loose areas of skin of the outer thighs and buttocks are removed, lifting the outer thighs and the buttocks. The biggest difference between a lower body lift and a belt lipectomy is where these incisions are made. In lower body lift surgery, the incisions along the side and back are typically made in a lower position than in belt lipectomy surgery. Lower body lift incisions work best for the woman or man who has bulges of loose skin and fat over the hips and upper thighs. Lower body lift surgery creates more substantial changes in the upper outer thigh than belt lipectomy surgery. Belt lipectomy incisions are made a bit higher on the sides and the back. Belt lipectomy operations work best for the person whose tissues are loose but there are not distinct bags of tissue on the hips. Making the incision higher on the side and back may help create a more tailored, sculpted waist than a lower body lift. Dr. Kunkel takes the time to go over all of this with the patient during the initial consultation, helping identify the areas of most concern to the patient.
Corset Body Lift
Corset body lift is different than lower body lift and belt lipectomy operations. A corset body lift addresses tissues that are loose all the way around the central trunk, but all of this is done through incisions on the front; there are no incisions on the back. In this procedure when the patient is lying flat on her (or his) back, the loose abdominal skin is pulled tightly together in the midline from between the breasts down to the pubic hairline. Pulling the tissue strongly together in the middle allows tissues that are on the back to be pulled forward too. The extra tissue is removed, creating tightness centrally in the front. Extra skin and fat are then removed from beneath the breasts on the upper abdomen extending to the side. Finally, extra tissue is also removed from the lower abdomen extending far to the side as well. This results in a "corset" look to the central trunk. The scar pattern is like a 'sideways H', with scars running along the breast creases, down the center of the abdomen, and transversely across the lower abdomen. A corset body lift provides dramatic changes in the look of the abdomen and trunk, all accomplished through incisions on the front.
Customized Treatment for Optimal Results
An consultation in the office to learn about body contouring operations usually takes about 2 hours. The Vectra 3-dimensional photography system is used as part of the consultation. Photographs are taken of the person's abdomen and back. The Vectra software reconstructs those photographs into three-dimensional images, allowing the person to see herself/himself from angles that are next to impossible to see in a mirror. This 3-d system is a very powerful educational tool and helps ensure that the patient and Dr. Kunkel are seeing and talking about the areas of the body that are most important to the patient. The patient is involved in every step of the process. After listening to the patient, learning what she hopes to achieve, Dr. Kunkel then customizes a treatment plan. The consultation is not a quick "in-and-out" visit with the doctor. The patient has substantial interaction directly with Dr. Kunkel. Using this approach Dr. Kunkel believes that patients understand their own physical findings and the options available better than with just a quick 5 or 10 minute visit. The patient is also given a booklet to take home, written by Dr. Kunkel, containing essential information to know about how to prepare in the days leading up to surgery, what to expect after the procedure, and photographs of actual patients.
Recovery after Lower Body Lift, Belt Lipectomy, and Corset Body Lift Surgery
Dr. Kunkel's circumferential body contour patients typically spend one night in the surgical facility; an occasional patient may spend two nights. Why spend the night? Primarily as a safety issue. One of the most important things a person should do after body lift surgery is get out of bed and move around. By staying in the facility overnight the patient may receive intravenous medication to help relieve any discomfort and nausea they may have as a result of the body lift surgery. This makes them more likely to actually want to get up and get moving. The nursing staff helps the patient walk in the hallway. The first day or two can be a little intimidating, and the nursing staff helps the patient and family members understand how to move around and how to take care of the dressings. One of the risks of body lift and belt lipectomy surgery is blood clots in the legs. To help minimize this risk, massaging devices (called sequential compression devices) are placed on a patient's legs and left in place until the next morning. Dr. Kunkel also has patients use low doses of blood thinning medication for several days after surgery as another way to help minimize the risk of blood clots.
Rather than having a lot of pain, Dr. Kunkel's patients more commonly talk about feeling tired and "drained" for about five days after body lift and belt lipectomy surgery. Their tissues are usually pulled so tight that they actually walk in a "bent-over" position during those first several days. Beginning about 5 days after surgery some energy returns and they begin to walk more upright. Most patients take two to three weeks off from work after belt lipectomy or body lift surgery. Women with young children will need to make arrangements for someone else to be driving their kids to school and other activities for at least the first week after surgery. Compression garments are worn, often for two months or more. Strenuous activities like running, bicycling, working out, and swimming should be avoided for about six weeks after lower body lift, belt lipectomy, and corset body lift surgery. All of this is discussed during the visit with Dr. Kunkel, and the booklet you receive makes it easy to remember.
Risks of a Lower Body Lift, Belt Lipectomy, and Corset Body Lift Surgery
Every surgical procedure includes some risks. All operations, from hernia repairs to cesarean sections to heart surgery to body contour procedures, include risks of infection, bleeding, blood clots, and poor healing. Issues that are more unique to body lift and belt lipectomy surgery include the possibility that the belly button could end up slightly higher, lower, or a little off to the side than it had been before surgery and it may have a different shape, the scar on one side of the abdomen or back could be higher than the scar on the other side of the abdomen or back, and it is possible to have long-term numbness in the lower abdomen or even the upper thigh. With the corset body lift there is a risk of some distortion of the breast.