In some cases, excess skin or sagging tissue is not only in the abdominal area, but it is also extended around the lower torso. It can be caused by weight loss, aging skin, body type or a combination of several factors, creating saggy skin, tissue and a heaviness around the lower mid-section.

Following excessive weight loss, many men and women are faced with a by-product of their success, which is loose skin and tissue. One common area for sagging excess skin after weight loss is the torso, including the abdomen, upper hips and lower back. A “belt” of sagging skin and tissue can hang from the lower torso, impacting the shape and comfort of the patient. A belt lipectomy is an effective option to remove excess skin and lift the tissue to create a smooth, firm abdomen, hip and lower back area.

When To Consider Belt Lipectomy

• If you have had dramatic weight loss due to bariatric surgery or dieting.
• If you have relatively thin layers of fat below the skin in the hip, thigh, abdomen and buttock areas.
• If overhanging skin in your lower body restricts your mobility and/or causes painful chafing, rashes or infection.
• If you are distressed by sagging skin in your lower body.
• If your self-confidence would improve from such a procedure.

Considerations

• PROS
  • Loose skin will be removed and your contour sculpted, so you can see the results of your weight loss.
  • You will experience the improved self-esteem that comes from looking better.
  • You will get rid of overhanging skin that may cause painful chafing, rashes and infections.
• CONS
  • This is a surgical procedure with a lengthy recovery.
  • You will probably need one to three days of hospitalization or skilled nursing care at home.
  • You will have a scar, running around the torso, that is usually difficult to hide in the bikini line.

These are the top three pros and cons to weigh when considering a lower body lift. If you want to focus on those specifically unique to you, please consult with your aesthetic plastic surgeon.

Ideal Candidates

After you’ve achieved a healthy weight or have undergone bariatric surgery, you may still feel frustrated by your appearance if you have excess skin along the lower abdomen, relaxed abdominal wall muscles and loose and wrinkled skin along the thighs and buttocks. A belt lipectomy, which leaves a circumferential scar hidden in the bikini line, can dramatically improve areas of sagging skin and/or cellulite below the waistline. The following are some common reasons why you may want to consider a lower body lift:

• You have undergone bariatric surgery or significant weight loss through dieting.
• Pregnancy and/or aging have left you with loose skin and cellulite below the waistline.
• You have loose skin on your hips, the sides and fronts of your thighs.
• You have significant skin laxity, excess skin, ptosis (sagginess) of the buttocks and abdominal wall laxity.
• You are willing to accept a circumferential scar around your waist.
• You do not smoke. Smoking slows down the healing process and increases the risk of serious complications during and after surgery. If you smoke, you must quit at least six weeks before surgery.
• Your weight has been stable for at least a year, with no further weight loss expected. For optimal results, body contouring should not be done for about two years after the start of any massive-weight-loss program. This time allows your skin to shrink as much as possible and your nutrition to be stabilized and optimized, factors that will aid in your recovery.
• You are in overall good health without chronic medical conditions such as diabetes or heart disease. People in poor health are not good candidates for body contouring procedures. You must obtain clearance for plastic surgery from your primary care physician or from doctors treating you for medical conditions.
• You have a healthy diet. Problems such as protein deficiencies can interfere with healing.
• You have mental stamina. Surgical contouring procedures require patience and endurance.

If you are in good general health and have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

Detailed Procedural Info

How is a lower body lift procedure performed?

A belt lipectomy, has the advantage of treating the buttocks, abdomen, waist, hips and thighs in one procedure and is sometimes a part of a mommy makeover. Basically, the lower body lift extends the tummy tuck incision completely around the lower torso, which allows your surgeon to lift or resuspend the thighs and tighten the buttocks as well as to execute the traditional tummy tuck. The length and the pattern of incisions depend on how much extra skin is removed and where that skin is located. Your plastic surgeon will do his or her best to take your incision preferences into consideration. Here is a typical scenario for performing a belt lipectomy procedure, although your surgeon may use a variation:

• Your surgeon will create a circumferential incision extending around your torso, through which he or she will remove an apron of excess skin and fat below the incision and reposition and tighten your tissues.
• The remaining skin in your buttocks and thighs will be pulled upward and your skin and underlying tissues will be suspended and tightened. You will be positioned on your tummy or side during this part of the procedure.
• Once your back and sides have been addressed, you will be positioned on your back so the surgeon can treat your front side.
• Your incisions will be closed in multiple layers over drains to control stretching and swelling. Deep support sutures within the underlying tissues help to form the newly shaped contours. Sutures, skin adhesives or tapes are used to close the skin incisions.

What Will My Scars Look Like?

The incision used for lower body lift produces a permanent, noticeable scar around the entire lower trunk. The scar is placed low on the stomach, just above the pubic hair area, and extends toward the hip bones. At the hip bone the scar gently curves toward the top of the buttock crease to meet the incision from the other side. Your scar placement is determined by how you wear your clothing and your scar should be hidden by clothing.

What Can I Expect On The Day Of My Surgery?

• Your surgery will be performed in an accredited hospital, under general anesthesia. Your surgeon will give you an estimate of how long your surgery will last based on the details of your procedure.
• You will receive medications to keep you comfortable during the surgical procedure. An anesthesiologist will be present to administer general anesthesia and assist in monitoring you during surgery. After you are asleep, a breathing tube will be placed in your mouth to ensure that your airway is secure during position changes involved in the body lift procedure.
• For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
• Your plastic surgeon will follow the surgical plan discussed with you before surgery. Once the operation has begun, he or she may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.

WHEN YOU WAKE UP, YOU WILL FIND THE FOLLOWING:

• Surgical drains have been placed to remove fluid that accumulates under the skin.
• You are wearing a compression garment, which controls swelling, supports the suspended tissues and smoothens and flattens the skin. This garment may be placed at the time of surgery or later.
• After your procedure is completed, you will be taken into a recovery area where you will continue to be closely monitored.
• You will spend two or three days in an aftercare center with a nurse or in the hospital.
• Before leaving for home, you (or someone looking after you) should feel comfortable emptying and resetting your drains.

Aftercare & Recovery

Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your post-surgery care, including information about:

• Drains, if they have been placed
• Normal symptoms you will experience
• Any potential signs of complications

IMMEDIATELY AFTER YOUR PROCEDURE:

Generally, you can expect to be bandaged and wearing compression garments, and you will have some surgical drains. You will spend at least three days in the hospital. During this time you will learn how to take care of your drains and feel comfortable walking and moving. Once you are comfortable with oral pain medications, you will be discharged.

• When the anesthesia wears off, you may have some pain. If the pain is extreme or long-lasting, contact your physician. You will also have some redness and swelling after the surgery. In some cases, the swelling will remain for weeks or even months. Contact your physician to determine whether your pain, redness and swelling is normal or a sign of a problem.
• Make sure you continue to have lots of help at home—this cannot be stressed enough. You’ll be tempted to try to help around the house quickly, but you won’t feel like yourself for at least two weeks, and you still shouldn’t do anything strenuous, including lifting, for four to six weeks. If you have small children, you must put someone else totally in charge of their care for at least two weeks.
• Ask your surgeon how to sleep, including the use of pillows, to minimize the tension on your incisions, reduce pain and facilitate a thinner scar.
• Swelling, which is commonly seen after body lift surgery, is controlled by compression garments, which reduce swelling, support the suspended tissues and smooth and flatten the skin.
• Drains, which also control swelling, are placed to remove fluid that accumulates underneath the skin. Your doctor will ask you to measure the amount of fluid in your drains daily. Once the output falls low enough, your drains will be removed in your doctor’s office. Drains typically remain in place two to three weeks, but may be left longer.
• You will be encouraged to walk the day after surgery.

RECOVERY TIME FRAME AFTER BELT LIPECTOMY

Follow all postsurgical instructions, including guidelines about bandages, drains, taking an antibiotic, if prescribed and the level of activity that is safe.

• Weekly follow-up visits aid in your recovery by allowing for adjustments based on your progress.
• Your activity will be determined by the progress of your incision healing. Once the drains are removed, movement is easier.
• Discomfort will dissipate over a week or two after the surgery. Your doctor will prescribe pain medication for you to take after you return home. You will need to wear the compression garment for a few weeks after the surgery and your plastic surgeon may recommend that you follow a special diet.
• Sutures are typically removed about two weeks after surgery and this too is done in your plastic surgeon’s office.
• Full healing of the circumferential incisions may take four weeks or even longer.
• Wound separations may occur, delaying wound healing (but rarely requiring further surgery).
• You will need to take at least two to three weeks off from work and restrict normal activities for four to six weeks. You will have some discomfort. This is expected and typically is easily controlled with pain medications.
• You will have to wait approximately six to eight weeks before you can resume exercise.
• The bruising will begin to disappear in a few weeks, and the swelling should subside within a few months. Although the scars will be permanent, they will fade in about twelve months and can be hidden by clothing.

How Long Will The Results Last?

The lift effect from lower-body-lift surgery is permanent, for the most part. The contouring achieved by removal of excess skin and fat is permanent. The undermining, advancement, and tightening of the skin of the thighs and buttocks is also permanent. Naturally, there will be some relaxation of the skin early after surgery and the skin and connective tissues will loosen and sag gradually as you age.

MAINTAIN A RELATIONSHIP WITH YOUR PLASTIC SURGEON

For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes in your lower body lift. Do not hesitate to contact your surgeon when you have any questions or concerns.

What Will This Surgery Cost?

The cost of a lower body lift varies from doctor to doctor, from one geographic area to another, and with the technique that is performed. Generally speaking, medical aids will not pay for a lower body lift. Medical aids will only pay for procedures they (not your doctors) have determined are “medically necessary” and usually have strict criteria for each procedure to be covered. For example, they may pay for a panniculectomy (removal of the overhanging “apron” of abdominal tissue) if they feel that your pannus is interfering with your functioning.

Dr Efraim will give you a detailed quotation of all the costs involved, based on your surgery plan.

Limitations & Risks

Fortunately, significant complications from lower body lifts are infrequent. Your specific risks for lower-body-lift surgery will be discussed during your consultation.

All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your lower-body-lift surgery.