BACKGROUND: Patients that present for plastic surgery after massive weight loss (MWL) often complain of multiple areas of deformity. Patients that desire correction of buttock ptosis and the saddlebag region will benefit from a lower body lift. A simple excision of excess skin and subcutaneous tissue from the superior gluteal region and the lateral thighs (e.g. belt lipectomy) may result in a flattened appearance of the buttock. To improve buttock projection, we preserve the tissue that would normally be discarded in a belt lipectomy and rotate this tissue inferiorly into the gluteal region to autoaugment the deflated buttock.
METHODS: Over 500 patients who have undergone weight loss ≥ 50 have been entered into our IRB-approved prospective database. Of these patients, 104 have undergone lower bodylift. Patients that have significant buttock ptosis with poor projection are indicated for gluteal autoaugmentation. We first mark our superior incision line that serves as the anchor line due to the strong zone of adherence of the superficial fascial system (SFS) to the spine. Using a pinch test we then estimate the area of resection. The amount of tissue to be preserved as a gluteal rotational flap is then marked. The maximal point of buttock projection opposite the pubic symphysis is also identified. The gluteal flaps are deepithelialized and dissected to the gluteal fascia. A pocket is then dissected caudally to allow the dermo-adispose flap to be inferiorly rotated to the desired point of projection. The lower incision is then reapproximated over the flap to anchor line. A Lockwood underminer is used to release all attachments over the trochanter to allow for a strong lateral pull on the thighs to improve the saddlebag region.
RESULTS: The lower bodylift results in improved contour of the buttock region with good projection and correction of the saddlebag region. This procedure was performed in woman 90.4% of the time. This procedure was combined with an additional procedure 97% of the time: abdominal procedure (88.5%), mastopexy (28.9%) and thighlift (23.1%). The most common complications were: wound dehiscence (45.1%) which was most commonly treated with local wound care, seroma (22.5%) and wound infection (15.7%). Our revision rate was 7.7%.
CONCLUSIONS: The lower bodylift results in improved contour of the buttock region with good projection and correction of the saddlebag region. This procedure was performed in woman 90.4% of the time. This procedure was combined with an additional procedure 97% of the time: abdominal procedure (88.5%), mastopexy (28.9%) and thighlift (23.1%). The most common complications were: wound dehiscence (45.1%) which was most commonly treated with local wound care, seroma (22.5%) and wound infection (15.7%). Our revision rate was 7.7%.