This procedure is often called (albeit incorrectly) a Belt Lipectomy or Circumferential Abdominoplasty, a Lower Body Lift (lbl) is the work horse procedure for post bariatric plastic surgeons.
An LBL consists of five major elements:
- Abdominoplasty ( also called a Tummy Tuck ), always with muscle tightening.
- Mons Lift and reduction ( either by direct excision of excess fat or liposuction ).
- A very strong lateral thigh lift.
- Buttock lift.
- Auto-augmentation of the buttocks and hips as needed (90%)
A belt lipectomy is similar to a LBL in that the incision goes all the way around the trunk and lifts the buttocks. It is dissimilar in that the final incision is much higher on the trunk of the leg. It elongates the buttocks and narrows the hips even more than a standard LBL. To combat this elongation, Dr. Fisher performs a concept he developed known as a hip auto-augmentation.
A circumferential abdominoplasty results in incisions that are the same as a LBL but typically does not call for a buttock or hip augmentation or a lateral thigh lift. It is therefore an extremely extended abdominoplasty (commonly known as a tummy tuck ).
Lower body lifts are commonly performed following massive weight loss. It is however frequently done together with an arm lift and or breast lift. This operation is far more complex than any other that we do and a lot of experience is needed to do it correctly. No two patients are the same and therefore experience in marking these patients, which is the quintessential part of the procedure, is imperative.
Dr. Fisher will freehand mark without using anatomical landmarks so that he will visually define the final outcome including incision placement in hundreds of different body types. Not only is this important to the final outcome, but it is extremely important to reduce the risks of complications.
All procedures are done in a hospital under a general anesthetic. Minor complications can be taken care of in the office with the use of local anesthetics.
It is essential to stop all kinds of female hormones at least two weeks prior to any surgery. These include BCP’s and any other estrogen and progesterone combination pre and post menopausal. Other medications to stop include all non-steroidal anti-inflammatory meds and vitamin E.
Dr. Fisher places patients on a liquid diet two days prior to surgery. The patient is seen for a pre-operative visit, either two or three days prior to surgery. At this time all final questions are answered. Photographs are taken and markings placed on the patient. Prescriptions are given including twelve Arnica tablets. The patient is given an appropriate girdle and encouraged to obtain a second one as well. There are no issues with patients continuing taking different kinds of nutritional supplements.
In the holding area sequential compression devices (SCD’s) are started.
The patient is brought to the operating room and following induction of general anesthesia a foley catheter is placed. Very carefully they are then placed face down onto the operating table and appropriately padded. The buttock lift and any auto-augmentation that is needed as well as liposuction is then performed. The patient is then placed face up onto the operating table and again appropriately padded. The tummy tuck and mons lift and contouring as well as any liposuction is then performed. If the arms and or breasts are also being done, they are taken care of next. Appropriate dressing girdle and binder are then placed.
The patient is awakened and taken to the recovery room where a PCA (intravenous analgesics ) is started. The patients are using this less and less with the use of a new long acting local anesthetic ( Experel ) that we inject at the time of surgery. Dr. Fisher only gives Lovanox in select patients based on bleeding risks.
When stable, the patient is transferred to the hospital floor. They are kept on ice chips until there are bowel sounds. Liquids are then started. The patient is mobilized as soon as possible. Oral analgesics are started when the patient can take liquids. The foley catheter is discontinued when patient is comfortable getting out of bed. The patient is discharged when able to void and taking liquids to adequately hydrate themselves.
The patient may shower 24 hours after surgery. Soap and warm water is used directly over the incisions which are then padded dry and redressed afterwards. The patient it taught to empty strip and record the drainage from their drains. No lifting more than one pound for two weeks. The patient is seen back in the office when the drains are putting out less than 30cc in a 24 hour period.
Dr. Fisher’s office stays in touch frequently and we advise patients to call us with even the smallest concern. Dr. Fisher is available 24 hours a day.
Walking is encouraged in the first two weeks without overdoing it. We encourage patients to obtain a walker to be used for the first two weeks. Most patients will require four to six weeks recovery before returning back to work and start exercising. Occasionally patients are able to return to work earlier and sometimes later.
To learn more, please contact our office today.
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