Either with increasing age or significant weight loss there is often an excess of body skin and fatty tissue. In the area of the back and belly (the trunk), cases of mild excess may be treated appropriately by procedures such as a tummy tuck or liposuction. However, in more significant excess situations, especially where the excess is circumferential (circular) in nature involving the belly, hips, back, buttocks, and outer thighs, a more extensive procedure is required. This procedure is called "Belt Lipectomy", and is like a face-lift for the trunk.
Other names for this procedure include torsoplasty, circumferential torsoplasty, body lift, central body lift, lower body lift, circumferential panniculectomy, and circumferential lipectomy.
Notice: This section contains graphic medical images.
In all cases we obtain a general medical history prior to surgery. This is necessary to ensure that he or she can tolerate the anesthetic and surgical stress involved. A good history on weight and contour changes that the patient has experienced is taken. In some cases if the patient is capable of losing more weight, it is wise to delay the procedure till they have reached their maximal weight loss to insure the best results. In cases where the patient may have significant medical problems, consultation with other specialists is required in order that the patient's condition is optimized prior to surgery.
A complete physical examination is required with appropriate laboratory examinations. During the initial consultation the patient's photographs are taken and are later discussed by the surgeons. In most instances, the patient is seen at least three times prior to surgery. During the third and final preoperative visit the patient is marked for surgery. The markings are the road map, which guide the surgeons as to which tissues are to be removed, liposuctioned, and re-approximated (see Figure 24). Appropriate laboratory examinations are performed and the patient is evaluated by anesthesia.
Figure 24. This composite photo demonstrate typical markings that are made on the patient's body prior to surgery to help guide the surgeons as to how much tissue is to be removed. The tissues between the top line that encircles the trunk and the lower one are removed. The intermediate line is the proposed place where the scar will end up. The circular markings around the outer thighs are the areas of fat that are to be liposuctioned.
Because of our expertise in this type of surgery, we have many patients that come from areas that are not from the direct proximity of our institution. Many of our patients come from other states, as far away as either coast, as well as other countries. Obviously most patients would prefer not to spend more time than is essential in Iowa City, thus we alter our usual methodology of evaluation to accommodate those patients. We try to accomplish as much of the preoperative workup prior to the patient's arrival in Iowa City. We have the patient fill out a medical questionnaire and supply us with pictures, similar to the ones on this web page, by email or regular mail. We also ask the patient to have a psychiatric evaluation performed in their hometown. The patient is asked to arrive one to two days prior to surgery and they are physically evaluated here and the final preoperative workup is completed. We ask that patients spend 10 to 14 days in Iowa City in total, assuming that no complications occur. We require that we are put in touch with a local physician that will be willing to help take care of the patient, with our help, once they return home until the patient is completely back to normal.
The operating team consists of board certified plastic surgeon Dr. Cram. Although the surgical sequence varies depending on the needs of each patient, at Iowa City Plastic Surgery we will usually treat the belly first, by removing the excess skin from the belly button down to the pubic area. The belly button is cut out from the surrounding skin and left in place. The abdominal wall muscle, which is deep to the skin and fat of the belly, is then tightened. In most patients this layer is loose due to pregnancy and or excess weight that has been lost. The fat and skin above the belly button is then stretched down to the pubic area and sutured in place. A new opening is made to allow the belly button to be brought through, in its original position. The wound is then closed. The patient is then turned to the side and the excess skin and fat from the side to the mid back is removed. Most patients require liposuction of the outer thighs. This part of the operation reduces and lifts the outer thighs. As the skin and fat are removed from the back, the back rolls are reduced and the buttocks are lifted. Each of these maneuvers is done to a different degree depending on the needs of the patient. The same is performed on the other side of the body. A belt lipectomy will usually require between 3.5 to 7 hours to perform.
Postoperative Course and Care
All patients are required to stay in the hospital a minimum of two nights. Early in our experience with this operation patients seemed to experience a lot of discomfort in the early postoperative period. We have successfully alleviated this problem by adding epidural anesthesia to the general anesthetic, which is required for the surgery. The epidural is utilized after surgery to significantly reduce pain. All patients have a number of drains, (plastic tubes left under the skin and fat) to collect tissue fluid and blood, left in place for 1 to 2 weeks. The patients are expected to get up and walk the first night of surgery and their activity is slowly advanced over the next few days. They have to walk in a slightly bent position for a week, at which point they are allowed to start maneuvers to straighten up. Most patients are back to their daily activities in four to six weeks.
Because of good patient selection we have a very high rate of satisfaction at Iowa City Plastic Surgery. As you can see in the patient figures, there is a considerable improvement in patient truncal contour after belt lipectomy. The abdomen is flatter, the pubic area is elevated and reduced, the waist has better definition, the hips are less protuberant, the back rolls are greatly improved and the buttocks are smaller and better shaped.
Notice: This section contains graphic medical images.
As with any surgical procedure there are possible risks and complications. The complications that are associated with any surgical procedure include infection and bleeding. This procedure has specific risks, which include seroma formation, a fluid accumulation in the areas of the back mostly. This is usually treated by repeated needle aspirations. Wound separation is another possible risk and careful postoperative management of the patient best avoids it. Deep vein thrombosis, or blood clot formation in the legs after surgery, can lead to pulmonary embolus, which is a blood clot that travels to the lungs. This is a dangerous complication and every attempt is made to prevent its occurrence. This involves making sure the patient walks as soon as possible after surgery. (It is beyond the contents of this page to list all complications here). Most patients who present to us after massive weight loss have other areas that they would like addressed. Those areas include:
Breast - Both males and females may have excessive hanging tissues in this area.
Upper Arm Excess - Many patients will have hanging tissue of the upper arms, sometimes called "bat wings".
Thigh Excess - The outer thighs are usually addressed well by belt lipectomy but the remainder of the thighs are not. Procedures to treat these areas are covered elsewhere on this web site.
Belt lipectomy is not a simple operation and it is not offered in many places around the country. If it is offered, it is difficult to find surgeons with a significant experience in it. What we consider significant experience is at least 20 operations performed by the operating surgeons. It is an operation that requires all the skill of the surgeon and the cooperation of the patient. We at Iowa City Plastic Surgery feel that is an excellent operation for the well-chosen patient. We feel that it is not an operation that should be undertaken by the patient without a great deal of thought and willingness to withstand an arduous process.
Iowa City Plastic Surgery is committed to educating the public and other plastic surgeons about this procedure. To educate other plastic surgeons we have published a definitive paper on it in a major plastic surgery journal and we teach a course on Belt Lipectomy at the yearly meeting of American Society of Plastic Surgery. It is our hope that this web page is helpful to anyone interested in this type of surgery.
Contraindications (Patients Who Are Not Good Candidates)
If the patient is massively obese he or she is not a candidate for this procedure, because it will not improve contour and they may not heal their wounds. Patients who have medical problems that preclude a general anesthetic are also not considered. Smoking causes a significant decrease in blood supply to all tissues of the body, thus smokers are not candidates for belt lipectomy because of the increased risk of tissue loss associated with the surgical procedure. Patients who are deemed mentally unable to handle an extensive surgical procedure with its concomitant recovery period may not be good candidates and may require counseling and/or psychiatric drug therapy prior to being reconsidered for surgery.
Click here for more information on Belt Lipectomy (Body Lift).