Body Lift

body lift surgery - Dr Mark Magnusson

 

What is a body lift?

A body lift, lower body lift or belt lipectomy is in operation on the abdomen, flanks and back designed to address laxity that develops all the way around the body below the waist with ageing, weight fluctuations and especially after massive weight loss.

These changes can be loosely related to problems of the skin (looseness or stretch marks), problems of fat and fat distribution (uneven fat distribution, loose apron, contour changes in the silhouette, volume loss in the buttocks) and changes to the muscle (muscle separation primarily associated with pregnancy and called rectus divarication). While and abdominoplasty addresses problems are usually most severe centrally in the abdomen, a body lift is for people who have problems that are more widespread involving the buttocks, outer thighs, waist and hips in addition to the abdomen.

With the increasing application of bariatric surgery for obese patients and consequently a large group of patients with massive weight loss this procedure has become increasingly common. The operation addresses these changes very well and many patients have this procedure successfully every year.

The problem also affects men in the setting of significant weight loss, frequently referred to as massive weight loss (MWL). This group of patients often has more substantial concerns although the abdomen is usually still the most affected area.

Other patients will have this surgery without undergoing the massive weight loss journey and this especially applies to women as pregnancy affects every woman differently and is often associated with weight gain and weight loss with circumferential change to the body.

What problems does an body lift address?

As with an abdominoplasty, a body lift addresses changes to the skin, maldistribution or excessive fat and separation of the abdominal wall muscles of the abdomen that leads to flattening and an improved contour. Loose and redundant skin folds are removed. Irregular contours and fullness above the umbilicus/bellybutton are evened out. The skin which is removed is also the skin which is frequently most affected by stretch marks and consequently the skin that remains is of higher quality and a better appearance. Tension in the skin also makes residual stretch marks and irregularities less visible in a similar way that lines on a bed sheet are less noticeable when the sheet is tight across the bed even though they are still present.

In addition, a body lift performs a similar function in the flank, outer thigh, lower back and buttocks where contours are improved and skin is tightened.

The substantial functional improvements following abdominoplasty are also achieved with a body lift as the front part of a body lift is an abdominoplasty. Dr Magnusson has recently contributed 77 patients to a prospective multi-centre study of 214 patients investigating these functional improvements.

Functional improvement after repair of separated abdominal muscles during abdominoplasty and body lift.

The physical symptoms associated with these changes can be quite substantial. It is very common for women to develop back pain during pregnancy and for many women this is ongoing. Associated with this is a frequent struggle with the loss of “core strength” when people find it difficult to stand on one leg or to get up from lying on their back. It is also frequent to have symptoms of urinary incontinence following pregnancy.

In Dr Magnusson’s patients there was a roughly 75% improvement in back pain at six weeks and almost 90% at six months following repair of the rectus separation. Urinary incontinence also improved by 80% at six months.

The decrease in functional capacity following pregnancies due to a reduction in stability. There is a synergistic action of all of the trunk muscles that carry load and function through to the lumbar region. As a consequence these patients also can suffer from repetitive musculoskeletal injuries stemming from pelvic instability. During these procedures the anterior rectus distance is closed and function increases. The closure of the diastases restores fashionable tension throughout the abdomen and in particular in the transversus abominis and internal oblique complex responsible for “core strength”. The muscle repair also works to increase intra-abdominal pressure which acts as a further stabiliser for the lumbar spine.

The method by which urinary function improves relate to increased strength of the anterior abdominal wall leading to more complete bladder emptying and improved tensioning of the lumbodorsal fascia, stabilising the lumbar spine and improving pelvic stability as the lordosis of the spine is the most important parameter controlling the distribution of the forces between fascia and muscles. With abdominoplasty the plication improves posture, repositions the pelvis with a compensatory advancement of the head and shoulders. The lordosis of the lumbar spine is restored to the pre-pregnancy condition along with stability. Retensioning of the pubis acts to lengthen the urethra and improve continence.

In this study, almost one in five of Dr Magnusson’s patients also had an abdominal hernia which was corrected at the time of surgery.

There are of course other physical symptoms associated with chronic skin irritations beneath overhanging loose skin folds. This condition, intertrigo, can be debilitating speeding to skin infections, chronic malodorous discharge and in fact if the apron is large enough can interfere with basic hygiene.

A number of Dr Magnusson’s patients undertake abdominoplasty surgery purely to address physical symptoms or hernias regardless of the aesthetic improvements.

What happens at a lower body lift operation?

A lower body lift is performed under general anaesthetic and most patients will stay at least one night in hospital, usually two and occasionally more.

In most occasions patients have a style of lower body lift that leaves a scar within the underwear line. Other types of lower body lift including one that has a higher scar running through the waist on the side of the body that has a more dramatic impact on shaping the waist but less control over the outer thigh.

At operation local anaesthetic with adrenaline is infiltrated into the area to be treated. This means that less pain during the operation allows for a lighter anaesthetic and there is also less pain immediately after the operation as well as a reduction in bleeding during surgery and bruising afterwards.

The operation starts with you lying on you stomach and the back and outer thighs are addressed first.

Liposuction is performed to remove fat directly under the skin that is removed so that the normal lymphatics and nerves can be preserved as much as possible to reduce the recovery time and likelihood of some complications such as seroma. The distribution of liposuction varies from one patient to the next according to the individualised operative plan and the specific patient goals. the liposuction can be just under the skin that is removed in the lower back, flank and outer thigh. It may incorporate the removal of fat all through the entire back to more completely sculpt the whole body.

Following liposuction, the posterior body lift is performed contouring the lower back, buttocks, outer thigh and waist.

When complete you are rolled onto your back and an abdominoplasty is performed.

Again liposuction is performed under the lower abdominal skin and can be extended into the upper abdomen if that is the plan.

An incision is initially made around the umbilicus and for a full abdominoplasty, the umbilicus stays where it is and everything else moves around it. The remaining skin and fat is lifted up off the abdominal muscles from the incision in the bikini line up towards the ribs in the centre exposing the muscles that have been separated. In the recent study the average separation of the muscles that was repaired at surgery was 5.2 cm. These muscles are repaired with permanent stitches so that the separation does not develop again. This is the most important functional step of the procedure and is performed regardless of which type of abdominoplasty is undertaken.

Following the repair of the muscle separation the bed is placed into a semi seated position and the skin is pulled down over the thighs and the excess is removed.

The skin is secured back on the muscles by progressive tension sutures which obliterates the space underneath the skin reducing the risk of problems in the recovery.

A small incision is made above the umbilicus and it is returned to the surface of the skin in it’s usual position.

A drain is usually required. The skin around the umbilicus and along the wound in the bikini line are repaired with stitches that are placed under the skin and dissolve without requiring removal.

Dressings that are waterproof are placed over the incisions and a compression garment is fitted in the operating room that will be worn night and day for six weeks apart from shower time. Normal showering is resumed once the drain is removed which may be the next day but is commonly three or four days.

Surgical options and additional procedures.

Circumferential trunk liposuction is performed frequently with abdominoplasty surgery in about half of the Dr Magnusson’s patients In this procedure all of the fat beneath the skin to be removed is taken away with liposuction preserving the lymphatics and superficial nerves. Additional liposuction is then performed above the umbilicus to reduce the thickness of the fat layer under the skin in this area so that it matches better the thickness of the skin and fat in the groin. Further liposuction is also performed with the patients on their side in the love handles, into the lumbar region of the back and also the lower chest in the bra roll. This allows for the removal of significant quantities of fat which can be returned into the buttocks as fat grafting commonly referred to as a Brazilian Butt Lift (BBL), or it can be discarded.

A body lift is a long operation taking close to 4 hours. It is only appropriate to add additional procedures in ideal circumstances when the bodyweight is in or close to the normal weight range, there are no additional significant medical problems in a patient who is fit and healthy.

Hey body lift can be combined with breast surgery and these circumstances and this is commonly referred to as a mummy-makeover. The nature of the breast surgery is quite diverse and clan include any form of breast surgery but most frequently breast implants/augmentation, breast lift/mastopexy, breast reduction or an augmentation mastopexy which is a combination of implants and a breast lift.

Who is a good candidate for a lower body lift surgery?

A lower body lift surgery delivers a substantial outcome but is also is a significant operation with an early recovery period associated with reduced activities, a reduced ability to perform normal household chores and no driving.

The ideal candidate for body lift surgery:

  • Has good general health with a positive attitude and realistic goals.
  • Is close to or in the normal body weight range and has achieved their goal weight if weight loss is required and has remained stable at this weight for some time.
  • If the patient is a woman, she has completed her family and waited at least 12 months firstly to be sure and secondly because there are significant changes to the body that occur during this period of time.
  • The chemicals in cigarettes reduce the blood flow in the skin and have the ability to impact wound healing. While many of the associated goals of this surgery are for an improved appearance wound healing problems would be a substantial concern. This surgery is not performed by Dr Magnusson on current smokers. Every patient who smokes would be required to stop smoking for at least six weeks prior to surgery and remain off cigarettes for at least 4 weeks following surgery.
  • The best outcomes from any procedure involve three aspects:
    • selection of the correct proceedure to reach the goal,
    • a technically well performed and safe procedure,
    • the patient diligently following the post-operative management plan.
  • Deviation from this path at any step may alter the outcome and importantly that also includes not following the post-operative instructions.

The Consultation

When you attend for your consultation with Dr Magnusson you will initially be seen by a nurse who will check your medical history, your current medications, any allergies you may have and clinical photographs for your record will be taken. These images are a private and confidential part of your medical record and are not shared in any way without your consent and prior approval. Clinical photographs greatly assist the consultation process as we can look at photographs of the body from angles that you would not normally see to help explain relevant points of the examination and treatment decisions that may be considered.

Information that is important includes past surgical procedures, medications, allergies and adverse reactions to medications.

You will be seen in a comprehensive consultation with Dr Magnusson. He will want to determine your goals, expectations and motivating factors.

Your body mass index will be assessed as there is a differential rate of risk and different outcomes associated with different levels of body weight and different body shapes. Dr Magnusson will have a frank discussion about your weight and your goals in this regard.

This surgery has many forms and in some patients additional procedures are indicated.

An examination will be performed that will include:

  • The assessment of skin elasticity and the distribution of stretch marks if any are present
  • The location and distribution of skin laxity all the way around the body.
  • Fat distribution and volume all the way around the body
  • Buttock fat content and shape
  • The separation of muscles in your abdomen and whether or not there are any hernias present.
  • The presence of any additional problems such as and apron which may be troubled by skin irritations.
  • Dr Magnusson will then spend time educating you about the various elements of the surgery and what they are designed to do and how this could relate to you specifically.

Commonly there is more than one option to consider. The natural tendency is to choose the smaller and simpler option. A most important aspect in choosing a procedure is to have a clear goal and by understanding how the various elements of the procedure interact to lead to outcomes it will become clear which procedure or combination is going to get you closest to that goal. Commonly this will involve considering the added benefit of a lower body lift compared with an abdominoplasty on its own.

Choosing an alternative procedure which won’t logically take you to your goal may be performed well, you may recover flawlessly and yet not be completely satisfied. If your goal and the surgical procedure do not align it is time to pause and realign your decision-making to avoid this.

Dr Magnusson will expertly guide you along this path.

Realistic Expectations

There are many factors that impact surgical outcomes and while good outcomes can be achieved in many different body shapes and sizes, it is important for the patient to appreciate which category they fit into and therefore what type of outcome they will individually achieve.

Patients present with different body shapes. There are curvy figures, apples, pears, those with central visceral fat depositions as well as different shapes according to body weight. In patients of each different type a procedure can be performed well with a good recovery and yet the results will still all differ.

There are also patients who actively engage their abdominal core muscles and stand straight and tall. There are others who don’t engage these muscles nearly as actively. Although the muscles are repaired in all patients this does not mean those muscles will be activated. With two patients of identical body shape size and BMI, a patient who engages their muscles will always have a flatter stomach following surgery although both have the ability to hold their stomach flat and this is not under the control of a surgeon.

Additional elements such as massive weight loss, lead to other concerns such as horizontal laxity around the body in addition to vertical laxity in the front of the body. There are also frequently concerns in other areas such as the breast, arms, thighs and even the face. These additional areas may need to be addressed at the same time or at subsequent procedures.

Preparation for surgery and the hospital

Body lift surgery is performed by Dr Magnusson at fully accredited hospitals under a full general anaesthetic with fully qualified and experienced anaesthetists.

The vast majority of patients remain two and occasionally three nights in hospital.

You will be contacted by the hospital prior to admission who will go through your medical history to ensure there are no additional requirements in preparation for your anaesthetic.

You will be admitted to the hospital a couple of hours prior to your surgery and these details will be checked again to ensure that the right person has the right operation.

Dr Magnusson will see you before the anaesthetic and lines will be drawn onto your skin while you are awake in a combination of standing and lying positions to plan the operative procedure. You will have an opportunity to ask questions at this point however it is not a good time for complex questions because at this point most patients are more focused on the immediacy of the surgery rather than the answers to these questions.

You will be well cared for

  • After you are asleep, a catheter is inserted into your bladder, the skin is prepared and the procedure is undertaken as outlined above.
  • You will wake up in the recovery room, the bed will be bent into a semi-sitting position and you will have your compression garment on.
  • After about 60 minutes you’ll be taken to the ward and attending family will be able to see you there.
  • At the end of the day’s operating Dr Magnusson will see you before he leaves the hospital and you will be seen on each day you remain at the hospital. After a long anaesthetic many patients don’t recall this visit however you will be seen again the next morning.
  • Most patients with a body lift have a drain and this may not be ready for removal before you leave hospital. You will be taught how to read this and remaining contact with the clinic so that you are aware when it requires removal. For local patients on the Gold Coast or in Toowoomba it will be conveniently removed in clinic. For patients from a more remote or distant location these can frequently be removed with guidance by a GP or nurse. We will assist with instructions in this regard if required on an individual basis.
  • You will be commenced on a medication called clexane and taught how to administer it at home. Clexane thins your blood and is administered by injection once a day. Abdominoplasty and body lift surgery increases the intra-abdominal pressure and reduces blood flow from the legs. This theoretically increases your chance of clots. This medication helps reduce the risk of clots during the initial early stage of your recovery during which your mobility is most affected and therefore this risk is Increased. This is a very effective precaution and is continued for a total of 10 days for most patients unless there is additional risk.
  • This is a significant operation and consequently there is always a volume of blood lost at surgery. Patients will have their blood count checked the following day and most patients will leave hospital on iron replacement. It is rare for patients to require a blood transfusion.
  • Dr Magnusson will need to see you on a number of occasions over the next 12 months. Your post-operative visits will be two weeks, two months, six months and 12 months following surgery. If there are concerns or problems arising along the way you will be seen as required at other times.

Preparing for the return home

When you return home from hospital you will have a reduced ability to perform your normal activities and especially your normal household duties.

For those with children arrangements will be necessary to ensure that they are adequately cared for during this time.

Meals: prepare with simple meals that are easy to reheat and healthy snacks with lots of available water.

Accessibility: think of those things that you will need to wake toiletries, medications, tissues/wet wipes, phone/charges/computer/TV remotes. These items should be readily available at hip height so that they don’t require bending or reaching.

Written instructions: keep information about your medications, their timing and your post-operative recovery instructions handy for regular reference as required. Consider a medication organiser so that regular medications can be taken at the right time of the day.

Recovery

There are various stages of the recovery from surgery and especially from a significant procedure such as an abdominoplasty.

Immediately after the surgery is common to feel a little dizzy, discomfort and a bit disorientated in association with the medications from your anaesthetic and for managing pain.

The various stages include managing discomfort and the activities of daily living, managing more general household responsibilities, returning to activities including driving and exercise and finally the full maturation of the outcome and scar. These aspects all occur at different speeds.

A body lift procedure is a large operation and the first two or three days particularly are significant. After this the recovery becomes quite similar to an abdominoplasty as it relates to the repair of the abdominal muscles which is performing both procedures.

You will remain in hospital until you are able to manage your discomfort and perform all the necessary routine activities of daily living with the level of support that you will have available at home. This is most commonly after two nights.

While in hospital you will be taught how to manage your drains and remain in contact with the clinic so that you will know when the drain is ready for removal.

In the short term when you get home there will be no driving, no significant exertion, you will feel a little bent over when you try to stand and your abdomen will feel tight. In bed most patients require some extra pillows under their knees to keep them in a slightly bent position for comfort. After about one week most people are standing and lying flat.

At about one week you are well in control. You can return to driving, you know what will bring on the pain and therefore you avoid it and the medications are becoming far less necessary to remain comfortable. A relatively moderate discomfort during the day can be ignored when you are busy or thinking of other things that may become more noticeable when you are trying to clear your mind for sleep. Consequently many patients will still take a stronger pain tablet at night.

Patients with a sedentary job and need to be back at work may be able to go back on light duties at one week if they are no longer requiring strong painkillers and especially if they are able to have shortened hours. Most patients will prefer to wait until two weeks if their circumstances permit. If the level of exertion at work can’t be controlled then six weeks off work will be required in uncommon circumstances.

By three weeks you are performing gentle exercise such as walking quietly without hand weights. You are in control of all aspects of your recovery and many patients have completely stopped painkillers. At this stage you will be performing most of your normal activities they will just be a little more slow and deliberate than usual because you will still be avoiding significant exertion and not moving quite as freely as usual to avoid exacerbating any discomfort.

At six weeks you are liberated! You can return to all activities even exertion at the gymnasium however it will take a while to build back up to normal speed. You will have both good days when you do a bit more and bad days when you feel the results of those activities. For those with significant back pain prior to surgery there will have been about a 75% improvement and about an 80% improvement in bladder function for those with symptoms of urinary stress incontinence.

At six weeks your scar will appear as a relatively fine pink line. From this point it will actually become pinker and reach its most obvious point for most patients between three and five months.

At about three months most patients feel that they are not reminded daily about the surgery. They are back to their normal activities and for those who are normally quite active and familiar with their own capabilities will comment that they are notably stronger and they were prior to surgery after the repair of the muscles. The post-operative swelling in the lower part of the abdomen and associated with areas of liposuction will have largely stabilised and resolved. There will be further improvements particularly in areas of liposuction over the next 12 months but these won’t be occurring at a appreciable rate from day-to-day.

At six months patients with back pain will have had an average 90% improvement and this tends to be maintained. The scar will have usually peaked in terms of its visibility and already be improving but the full improvement of the scar is slow and takes 18 to 24 months.

Is there any Medicare and health fund assistance with abdominoplasty surgery?

At the end of 2015 the federal government limited the accessibility of item numbers for abdominoplasty surgery to post-weight loss patients. Anew item number was added for a lower body lift.

This means individual patients may receive assistance with the costs of the hospital admission and medical expenses relating to the surgery if they meet the government requirements. These item numbers are subject to change without notice and are meant as a guide.

The item number for a lower body lift is 30179 and the requirements that need to be met are:

Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that is a direct consequence of significant weight loss, with or without a radical abdominoplasty (Pitanguy type or similar) if:

  • the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment
  • the circumferential excess of redundant skin and fat interferes with the activities of daily living
  • the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

Following your consultation you should understand and have answers to the following questions:

  • Are you a good candidate for this surgery?
  • What type of procedure are you going to need to achieve my goal?
Dr Magnusson

Dr Mark Magnusson

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