Maximizing Aesthetics and Safety in Circumferential-Incision Lower Body Lift with Selective Undermining and Suction Lipectomy
Adam R. Kolker, MD, Joshua Lampert, MD.
Mount Sinai School of Medicine, New York, NY, USA.
Background: Circumferential dermolipectomy has been an effective means of reducing excess skin and fat after massive weight loss (MWL), however regions of residual mid-abdominal and epigastric fat frequently confer a suboptimal contour, and often a mediocre cosmetic result. Suction assisted lipectomy (SAL) in association with lower body lift surgery has been regarded with caution, for fear of ischemia or necrosis of the undermined flaps and peri-incisional skin loss as potential dire consequences. In this study, a theoretical and technical approach that improves safety and aesthetics in circumferential dermolipectomy after MWL with contouring using SAL is described and evaluated.
Methods: Twenty patients were treated with follow up ranging from 7 to 34 months (mean follow up 15 months). All patients were treated with the resection of circumferential skin and fat maintaining a low-lying transverse suture line with a prone-to-supine approach. Dorsally, liberal SAL is performed after the instillation of lidocaine-free wetting solution above and below the resection lines. Ventrally, the upper flap is elevated widely to the umbilical horizontal. The umbilicus is circumcised, and the dissection then progresses in a narrow column above the rectus sheaths to the xiphoid. Judicious subcostal undermining is performed, maintaining an intact bilateral subcostal “perforator zone” of 4 to 6 cm. Diastasis repair and anterior sheath plication are performed, and the umbilicus is anchored to the fascia. Wetting solution is instilled, and SAL of the entire flap, particularly in the midline and in the region of the neo-umbilicus, is performed, removing excess fat and providing discontinuous lateral flap “undermining”. Data were reviewed retrospectively.
Results: Of the 20 circumferential procedures performed, 9 achieved MWL by non-surgical means only, and 11 underwent bariatric surgery (bypass or band). Of these, 8 were performed laparascopically, and three were open incisional procedures. There were 14 females and 6 males. There was one hematoma (5%) requiring re-exploration and three seromas (15%) treated with percutaneous aspiration. There was no infection, skin loss, or wound dehiscence.
Conclusions: Unlike standard dermolipectomy procedures with wide undermining, the maintenance of a broad subcostal blood supply with selective direct undermining allows for liberal flap contouring with suction and the establishment of lower suture-line position (Figures 1-3). With this technique, liposuction can be safely used with lower body lift to maximize aesthetic outcomes.