LOWER BODY LIFT AND THIGH PLASTY

DR ABDUL MALIK MUJAHID

PGR/PS

INTRODUCTION

Body contour deformities of the lower trunk can range from “ anterior only” to “circumferential” deformities

If deformity involves circumferential skin and subcutaneous laxity body lift/ belt lipectomy required

ANATOMY

The subcutaneous abdominal fat is divided into superficial and deep layers by the superficial fascial system the scarpa , fascia

In thin patients the two layers are fairly close to each other in thickness.

Patients with high BMI the superficial layer is thicker than the deep layer.

ANATOMY

Zones of adherence restrict the descent or elevation with aging ,weight fluctuation or surgery

ZONE OF ADHERENCE

PATIENT SELECTION

Massive weight loss

20-30 pounds over weight group (BMI 26-28)

Normal weight

PATIENT SELECTION

CONTRAINDICATIONS

Smoking

Diabetes

Malnutrition

Wound healing issues

Immunodeficiency

Collagen vascular disease

CONTRAINDICATIONS

Anticoagulant medications

Lower extremity venous insufficiency

Lymphedema

History of VTE

Other medical issues such as renal insufficiency, anemia, and pulmonary issue

DIAGNOSIS AND PATIENT PRESENTATION

3 Factors affect presentation

BMI at presentation

Fat deposition pattern

Quality of skin /fat envelope

COMMON PRESENTATION

Hanging penniculus

Ptotic mons pubis

Buttock ptosis

Blunting of waist

Ant and lat thigh ptosis

TYPES OF LOWER BODY LIFT

Lower body lift type 2 (lockwood technique)

Belt lipectomy /central body lift

BELT LIPECTOMY

LOWER BODY LIFT TYPE 2

PREOP HISTORY AND EVALUATION

What was their greatest weight?

How did they lose weight?

What was their lowest weight?

How long have they been at their present weight?

Do they think they are going to lose more weight?

Are they prone to “heroic methods” of weight loss

History of comorbid conditions

History of nutritional status

Previous abdominal scar

Bariatic surgery

EXAMINATION

The degree of skin laxity

The amount of subcutaneous fat

The translation of pull

The presence of scars

Waist definition

The presence of abdominal or back rolls

EXAMINATION

Degree of rectus diastasis and/or the presence of hernias

Amount of intra-abdominal content

“Diver’s test” is not effective

Degree of buttocks projection and ptosis

Degree of anterior and lateral thigh lipodystrophy and ptosis.

PREOP EVALUATION

Base line test

Chest x Ray

ECG

Albumin /Prealbumin

Total protein

SURGICAL TECHNIQUE

MARKING

MARKING

MARKING

SURGICAL TECHNIQUE

General anesthesia

DVT prophylaxis

Supine position with arm abducted (90)

Marking reinforced and tattooed with methylene blue

Folley catether

SURGICAL TECHNIQUE

Compression boot

Traction suture at 6 and 12

Incised the umbilicus

Inf lower abdominal mark incised down to scarpa fascia

Preservation of scarpa fascia

Dissection up to umbilicus

OPERATION TECHNIQUE

Supra umbilical dissection uptill xiphoid and costal margins

Abdominal wall vertical plication in 2 layer

Horizontal plication

Advance the flap inferiorly

Resect the excess flap and mons pubis

Make a new umbilicus

OPERATION TECHNIQUE

Suction drains

Closure of scarpa ,superficial layer and skin

THREE POINTS FIXATION

SURGICAL TECHNIQUE

Turn the patient to lat decubitus

Waist flex

Pressure points padded

Reprep

Back excision

Liposuction of lat thigh

OPERATION TECHNIQUE

Sup mark incision

Level of dissection depend on buttock projection

Undermining of lat thigh adherence zone

Pull the inf flap up and resect

OPERATION TECHNIQUE

Drain placement

Closure and dressing

Turn to supine position

POST OP CARE

COMPLICATION

Seroma

Wound separation

Dehiscence

Infection

Tissue necrosis

COMPLICATION

DVT/PE

Psychosocial difficulty

Asymmerty

FINAL RESULT

FINAL RESULT

THIGHPLASTY

Medial thigh lift techniques include

prox inner thigh lift

Vertical thigh lift

PROXIMAL INNER THIGH LIFT

Laxity of the proximal medial thigh

In normal weight individual with mild to moderate inner thigh laxity

Incision in the pubic-thigh crease.

Limited impact on the shape and contour of lower half of thigh

PROXIMAL INNER THIGH

Minor effect on distal medial thigh

Increase incidence of superficial wound dehiscence due to moisture in inner thigh crease

VERTICAL THIGH LIFT

massive weight loss patients with significant medial and circumferential thigh laxity.

Performed by itself or in combination with thigh liposuction.

Resection of tissue results in a vertical scar from the inner pubic area and ending at the medial aspect of the knee.

VERTICAL THIGH LIFT

Final results less ideal when combine with liposuction

Procedure can be continued below knee if laxity is present

Break the linear scar when extend below knee to prevent scar contracture

More useful and powerful in tightening and shaping the thigh

PATIENT SELECTION

Discussion about the post operative problems and results should be done before surgery

INDICATIONS

Isolated inner thigh laxity of proximal thigh inner thigh lift

Circumferential thigh laxity vertical thigh lift

CONTRAINDICATIONS

Same as lower body lift

OPERATION APPROACH FOR INNER THIGH LIFT

Mark the inguinal crease

Posteriorly, the markings end before they become visible in posterior view.

Anteriorly, the markings extend approximately to the level of the pubic tubercle.

OPERATIVE APPROACH

Amount of soft tissue resection not more than 4-6 cm

General anesthesia

Supine position with frog leg

Incision to dermis

OPERATIVE APPROACH

Incise the skin and subcutaneous tissue

Dissection above the mascular fascia

Inf dissection up to marking or skin laxity

Tissue to be removed reevaluated mark and resect

OPERATIVE APPROACH

Closure begin posteriorly anchoring the thigh superficial fascial system

Anchoring done without vulvar distorted

Anchored from the SFS of the thigh flap to the periosteum of the ischio-pubic rami, pubic tubercle, and Cooper•s ligament.

Tissue adjustment is performed as needed to minimize the formation of a dog-ear

OPERATIVE APPROACH

2-0 Vicryl for deep dermal clousure and 4-0 vicryl for subcuticular closure

OPERATION APPROACH FOR VERTICAL THIGH LIFT

Marking start at insertion of gracilis muscle in pubic area

By manual palpation for laxity and proposed resection from groin to knee

General anesthesia

Use of towel clip to gather the excess skin

OPERATION APPROACH

Tumescent infiltration

Additional infiltration if liposuction needed

First perform lipo

Readjust towel clip to identify excess skin

OPERATIVE APPROACH

Incision and dissection from prox to distal

Skin removal by evulsion

Preserving venous and lymphatic network

Hemostasis

Wound closure

Drains used when lipo and vertical lift combine

POST OP CARE

4 inch wraps used from foot to knee and 6 inch wrap from knee to groin

Sequential compression devises maintained through first post op evening

Avoid standing or sitting

Ambulate for short period

POST OP CARE

Dressing change by needed

Apply scar creams containing silicone ,steroid ,vit E

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