LOWER BODY LIFT

After a successful weight loss people often find they are left with excess folds of skin that will not conform to their new body shape. Not only is loose hanging skin unsightly but it can cause functional problems. Large amount of excess skin can cover the pubis and groin. Skin irritation can occur in this area due to sweating. Patients feel that despite losing weight they cannot fully benefit from it as this excess skin restricts them and is also a cause of social embarrassment.

The lower body lift, or belt lipectomy, consists of an abdominoplasty that extends to remove the skin around the hips and back. The procedure also lifts the pubic area, outer thighs, and buttocks, getting rid of excess skin in the abdomen and back. This can leave you with tighter skin and muscle, reducing hygiene issues and resulting in a more toned appearance. Lower body lift therefore offers improved contouring, core strength, cosmetic appearance, and confidence in clothes.

Lower Body Lift – FACTS

Length of surgery	4- hours
Anaesthesia	General anaesthetic
Hospital stay	1-2 nights
Risks/complications of surgery	Frequent: Bruising, swelling, temporary numbness, discomfort on movement/coughing Infrequent: Infection, bleeding, delayed wound healing, fat necrosis, asymmetry, poor scarring, seroma, skin/tummy button necrosis
Recovery	7-10 days until socialising with close friends and family 3-4 weeks until return to work and normal social engagements 3-12 months until swelling disappears 6 weeks wearing specialized pressure garment and no children lifting 4 weeks travel abroad 12 weeks until return to gym and other strenuous activities 6-12 months until final result
Driving	3-4 weeks
Sleeping position	Sleep on your back with pillow under your knees
Follow up	1 week, 6 weeks, 3 months, 6 months
Duration of results	Permanent unless followed by pregnancy or weight gain

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Lower Body Lift

Any plastic surgery procedure is a very personal choice and understandably there are a few questions that arise. This information sheet is a general guide for patients considering lower body lift under the care of Dr Mackenzie. It should provide the answers to some questions that you may have. There are many factors that can affect your individual operation, your recovery, and the long-term result. Some of these factors include your overall health, previous surgery, any bleeding tendencies that you have and your healing capabilities, some of which will be affected by smoking, alcohol, and various medications. Such issues that are specific to you need to be discussed with Dr Mackenzie and are not covered here. Please feel free to ask her any further questions before you sign the consent form.

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Introduction

Many factors can contribute to the appearance of excessive, loose, and saggy skin along your lower body. The most common reason is massive weight loss, but a lower body lift can also address the aftermath of aging, sun damage, pregnancy, significant fluctuations in weight and genetic factors.

Skin is often not able to recover and retract to fit new contours, and you may be struggling with loose skin that drapes and hangs.

Body lift procedures are surgical procedures, and they require extensive incisions. Incision length and pattern depend on the amount and location of excess skin to be removed, as well as surgical judgment.

Advanced techniques usually allow incisions to be placed in strategic locations where they can be hidden by most types of clothing and swimsuits.

A lower body lift can:

Narrow the waistline and decrease bulging
Tighten and smooth the sides and back
Remove excess fat and tighten loose skin on the lateral area of the thighs
Lift buttocks
Improve the fit of clothes
Increase mobility
Improve the health of the skin
Improve hygiene

What is lower body lift?

Also called belt lifts or belt lipectomies, a lower body lift surgery is several different surgical procedures that help recontour the lower portions of the body. A lower body lift uses a series of strategic incisions, the most important being the one that encircles the torso as a belt would. This allows access to the thighs, buttocks, and midsection. The resulting scars are usually hidden by most clothing. Excess skin is removed, and to lift the remaining skin on the waist, hips and buttocks, surgeons use a technique called undermining. This separates the skin from the connective tissue and allows it to be stretched upwards to eliminate any bulging. Because a lower body lift addresses multiple areas of the body, this procedure may require more than one surgical session.

Who is a good candidate for lower body lift?

In general, body lift candidates include:

Individuals with significant soft tissue looseness in one or multiple body areas
Healthy individuals without medical conditions that impair healing or increase risk of surgery
Individuals with a positive outlook and realistic goals for what body lift surgery can accomplish
Non-smokers

Are there any reasons for a patient to not have lower body lift?

Patients who are actively smoking or on blood thinning medication such as aspirin and warfarin are at a high risk of complications such as bleeding or wound infections and delayed wound healing. It is advisable to not consume nicotine in any form for six weeks before the procedure and a similar time after. Medication such as aspirin or warfarin may need to be stopped (if this is not for an essential or life-threatening condition) at the appropriate time before surgery. This should be discussed with Dr Mackenzie or GP.

What are the limitations of lower body lift?

If you are soon after pregnancy or plan to have more children in the future, are planning to lose weight or are overweight, it may not be the right time to have a body lift. You must remember, that a body lift is body contouring or reshaping surgery NOT weight loss surgery.

Body lifts are not intended strictly for the removal of excess fat. Liposuction alone can remove excess fat deposits where skin has good elasticity and is able to naturally conform to new body contours. In cases where skin elasticity is poor, body lift techniques along with liposuction may be recommended.

What to expect from lower body lift consultation?

You would normally meet Dr Mackenzie for at least two pre-operative consultations. The first of which is mainly about assessment and the formulation of an operative plan specific to your lower body. Dr Mackenzie usually summarises this consultation in a letter to you and if you decide to move forward towards surgery, a second consultation is scheduled to go over things once more and discuss the possible complications in more detail. It is usual for Dr Mackenzie to write to your GP but often patients do not want this, in which case no communication is made.

During your consultation Dr Mackenzie will discuss:

Your surgical goals
What outcome do you expect from the surgery? What is your chief motivation in undergoing a lower body lift?
Your complete medical and social history, drug allergies
Your previous abdominal surgery
Your current prescription medications, including vitamins, herbal supplements, alcohol, tobacco, and drug use. Make sure to tell your doctor about any herbal supplements you take, as some of them may cause bleeding problems

Dr Mackenzie will also:

Evaluate your general health status and any risk factors
Discuss your options
Ask you to look in a mirror and point out exactly what you would like to see improved
Examine your abdomen, lower body and quality of skin and any scars
Evaluate elasticity of the skin and position of tummy muscles
Evaluate any evidence of bulges or abdominal wall hernias
Take the photographs
Discuss your ideal weight, realistic weight and current weight and possibly suggest a weight loss program before surgery
Discuss your plans related to future pregnancies
Discuss your expectations with you. An honest discussion will help determine a satisfactory outcome
Recommend a course of treatment
Discuss likely outcomes of the tummy tuck surgery and any potential complications
Blood tests, a heart trace (ECG) and a chest X-ray may need to be organised

Preparation for surgery

It is important to avoid taking any aspirin or products containing aspirin for 2 weeks either side of the operation since aspirin has an adverse effect on bruising as it thins the blood. The same is true for non-steroidal anti-inflammatory drugs (such as Brufen, Nurofen and Voltaren) and vitamin E tablets. You may also be asked to stop taking naturopathic substances such as garlic, ginko, ginseng and St John’s Wort as they may affect clotting and anaesthesia. Always tell your surgeon EVERYTHING you are taking.

For procedures lasting longer than 1 hour it is normal practice to stop the contraceptive pill one cycle before the date of surgery. For smaller procedures may not be necessary and you should discuss this with Dr Mackenzie before surgery.

Some patients find homeopathic remedies such as arnica helpful to reduce bruising although it is very difficult to prove their efficacy scientifically. If you wish to use arnica you should begin 2-3 days before the operation and continue for a week afterward.

If you are a smoker, it is imperative that you to stop for 6 weeks before surgery and for 6 weeks afterwards so as not to restrict the circulation to the skin. This restriction applies to all forms of nicotine including patches, inhalers and nicotine chewing gum!

For the best results of a lower body lift, it is optimal if you have a body mass index (BMI) as close to normal (25) as possible.

Surgery requiring general anaesthesia is most safely conducted when patients are fit and healthy. General anaesthetic is unwise in patients who are unwell with viral illness or colds.

On the night before surgery, we would ask that you eat well, and remain well hydrated. In most cases you will be asked to come to the hospital at 7:00am on the morning of surgery, having had nothing to eat from midnight. Clear water can be drunk up to 2 hours before surgery and tea without milk or coffee without milk can also be taken. Milk is considered a solid food and cannot be taken within 6 hours of the start of surgery.

On the morning of surgery, you will be admitted to the ward. You will meet the anaesthetist who will discuss the anaesthetic with you in detail and you will also see Dr Mackenzie who will mark the surgical site as required and complete the consent form for surgery with you.

While preparing, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days at home.

What is involved in the operation?

There are variations depending on your individual anatomy and goals. The standard surgery is done under general anaesthesia. A low incision is made along the pubic hairline from hip to hip, continuing around to the lower back just above your buttocks as well as around the belly button and the skin is lifted up. The underlying abdominal muscles are tightened by stitching them together creating a firmer tummy wall and a narrower waist, excess or overhanging skin is removed and your belly button re-sited. The skin is restitched in a tighter way with a smoother contour. Drains are used as required. Stitches are all absorbable.

Where will the incisions be?

Advanced techniques usually allow incisions to be placed in strategic locations where they can be hidden by most types of clothing and swimsuits. It may be possible to make slight variation in the placement of scars depending on the type of clothing you favour. However, please remember, the scar cannot follow fashion.

What can you expect after lower body lift?

It is vitally important that you follow all postoperative instructions provided by Dr Mackenzie. Dr Mackenzie will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

You may expect the following immediately after the procedure:

Immediately following a lower body lift, the skin of your abdomen and back will feel very tight. It may, in fact, be difficult to stand up straight for the first few days
Drainage tubes are usually removed after 24 to 48 hours and the dressings from the surgery are usually left in place until the first visit to the practice one week following your operation. You must keep them dry
Moderate discomfort is common and can usually be controlled by taking pain killing tablets such as Paracetamol as required. Stronger painkillers are also prescribed and given on discharge, but they are often necessary only before you go to sleep at night. Aspirin and certain anti-inflammatory medications must be avoided because it can promote bleeding
You will be wearing a wide elastic compression garment to reduce swelling and provide support to the skin as it tightens. You will wear this garment for 6 weeks
The first few days after surgery, you should rest quietly. Whilst lying in bed it is advisable to keep the knees bent with two pillows behind them as this reduces the tension and is more comfortable. Likewise, you will need to walk slightly bent forwards once you are up and about and will gradually straighten up over the first few days after surgery

Recovery from a lower body lift procedure occurs over a period of six months or more. In the first couple of days, managing pain and avoiding complications is your top priority. The first week will be the worst, and you will still feel like you are recovering for about two to three weeks. After a few weeks, regaining mobility and fitness becomes important. After several months, you can start evaluating the aesthetic outcome of your surgery. It is important to remember that the time it takes to recover varies greatly among individuals.

To prevent coughing and bleeding, do not smoke after your procedure. Do not drink alcohol for five days after surgery or while you are taking pain medication
Occasionally, fluid will continue to collect under the skin (a process called seroma formation). If this occurs the fluid may need to be drained with a needle
It is normal for the sensation to the skin over the lower abdomen to be reduced after a tummy tuck. This is as a result of the surgical lifting of the skin from the underlying muscles thereby reducing some of its nerve supply. You will need to be patient, though, as this process may take months, even years, to complete
You should expect to light to moderate bruising. This is quite normal and usually begins to settle in two to three weeks. It should be completely gone in about six weeks. Taking Arnica for a week before your surgery and two weeks afterwards can lessen bruising
You should be up and walking the day after surgery, although slowly. It is important to walk to discourage swelling and to prevent blood clots in the legs. However, avoid strenuous exercise for four to six weeks, because it can trigger unnecessary fluid retention in the treated areas
It is advisable to have help around the house and with young children for the first couple of weeks after surgery. At the end of two weeks most patients can drive, carry light shopping and prepare light meals. At the end of 6 weeks patients are expected to be able to return to normal lifestyle including gym, sport and aerobics unless they have had tightening of the abdominal muscles or repair of an abdominal hernia at the same time as the abdominoplasty
Most people are able to return to work which does not involve heavy lifting in approximately three to four weeks after surgery. It may take up to six weeks for some patients to return to normal work and leisure activities
Like all surgeries, a lower body lift carries some risk, however they are small and infrequent. To prevent blood clotting problems, you will wear anti-embolism (TED) stockings before, during and after your surgery for 6 weeks and will be encouraged to get up and move about as soon as possible
Scars from a lower body lift usually take many months, or even a year to settle. In the period immediately following your surgery, these scars may be firm, red, raised, lumpy and itchy due to a build-up of excess scar tissue. As your skin strength returns and the scars mature, they will become softer, flatter and more natural in colour and texture. This process usually takes about 18 months and can be helped by daily massage with moisturizing cream
Call your surgeon immediately if you notice an increase in swelling, pain, redness, drainage, or bleeding in the surgical area, or if you develop fever, dizziness, nausea, or vomiting. Other red flags include shortness of breath, chest pains, and an unusual heartbeat

How long does the effect of lower body lift last?

Although the results of a lower body lift are technically permanent, the positive outcome can be greatly diminished by significant fluctuations in your weight. For this reason, individuals who are planning substantial weight loss or women who may be considering future pregnancies may be advised to postpone a tummy tuck.

Lower body lift will not prevent the effects of normal aging. Once the skin is tightened, it will get a little looser as you age.

What are the complications of lower body lift?

In general, a lower body lift is safe and the results are entirely predictable, with an associated high degree of patient satisfaction. Nevertheless, no surgery is without risk.

All general anaesthetics carry risks such as deep vein thrombosis and chest infection but with modern anaesthetic techniques, these are minimised.

Early complications

Bleeding which can lead to a collection of blood (a haematoma) that needs to be drained in theatre. This is likely to be a concern in the first few days after surgery
Infection- you are given a dose of antibiotics at the beginning of the operation. Further antibiotics are not routinely given, because this leads to antibiotic resistance. The signs of infection are increased redness, discharge from the wound, fevers or feeling unwell. If your wound gets infected, more antibiotics will be required, and sometimes admission to hospital or an operation may be needed to resolve it.
Pain- usually not severe and you can manage it with oral pain relief
Seroma (fluid collection within the wound after the drains have been removed)- it may need to be drained using a little needle
Fat necrosis (small deposits of fatty tissue that turn hard)
Clots in the legs or lungs- to prevent this, you will wear special stockings and have an injection of a blood thinner medication into your tummy each night. You will have a little machine to massage your legs for the first few days. For women, it is best to stop oral contraceptive pills for 6 weeks before surgery and use alternative forms of contraception
Loss of belly button- It is treated with dressings and rarely may require another operation to re-create a belly button
Damage to internal abdominal organs

Late complications

Numbness- tummy will feel numb following the operation and this tends to be permanent
Suture spitting-sometimes the deep sutures do not dissolve. Dr Mackenzie can remove any sutures that are spitting out of the wound in the clinic
Contour irregularities and asymmetry. Sometimes certain asymmetries that were present, but less noticeable pre-operatively are revealed after abdominoplasty surgery
Encysted seroma (fluid collection that feels firm)
Poor scarring-occasionally scar revision is required
Delayed wound healing problems
Occasionally, there is a need to undertake adjustment or revision surgery at a later date to correct an uneven result or an uneven scar. If needed, this can usually be performed under local anaesthetic as an outpatient procedure

Some patients will feel their abdomen is not exactly as they were hoping it would be. This may be due to residual fullness in the upper abdomen, for example, or excess tissue around the flanks. The limitations of lower body lift mean that it may occasionally be necessary to undergo further procedures to improve the surgical result – these further operations will incur a further cost in most situations. It is crucial that you know what you can (and cannot) expect from a lower body lift prior to undergoing surgery.

Complications requiring reoperation are uncommon, however revisional surgery for unexpected surgical outcomes may be necessary on rare occasions. In this unusual circumstance emergency or after hours care may only be available in the public hospital system, for which there is no additional charge. Unplanned reoperation in the private hospital system would incur additional costs that the patient is responsible for however in some circumstances ACC may assist with partial or full funding.