Thigh lift

The skin of the medial thigh is thin and inelastic, and laxity here is often the earliest sign of ageing in the thighs. The medial thigh skin is also one of the areas most affected following weight loss. The majority of skin laxity occurs at the junction of the anterior and medial thigh, where the skin tends to hang in a dependent, pleated fashion. This can interfere with walking, toileting, and various other day-to-day activities, resulting in irritation due to chaffing between the thighs. Body contouring techniques are routinely combined in stages to achieve a more harmonious result. Medial thigh lift is frequently combined with upper body lift or breast surgery, or both, whereas brachioplasty is usually combined with abdominoplasty/lower body lift. Opposing vectors of pull and excessive damage to local vascularity are thereby avoided. However, staging surgical procedures has the potential to reveal additional areas of dissatisfaction to the patient. Abdominoplasty patients often report increased dissatisfaction with the medial thighs as a consequence of this previously hidden deformity becoming visible to them postoperatively. In fact, massive weight-loss patients’ dissatisfaction with their thighs is almost as great as with the changes to their breasts in terms of their severely decreased self-esteem, sexuality, and quality of life.

Lower body lift and abdominal surgery after massive weight loss

Following the establishment of modern body lift procedures by Ted Lockwood, who sadly passed away in 2005, other innovative approaches are also now available. The main idea behind these operations, similar to modern face-lifting procedures, is to reconstruct the superficial and deep tissue layers (comparable to the superficial musculoaponeurotic system of the face) and the overlying skin. Large areas of tissue undermining and separation are, however, necessary to allow sufficient mobilization and tightening to achieve improvement in function and form. At the same time, it should not be forgotten that patients who have undergone major weight loss often have intrinsic medical problems such as diabetes mellitus, high blood pressure, nicotine abuse, and hormonal changes. These factors must be considered when planning the reconstruction. The problems and solutions derive from the authors’ experience over the last 15 years at the Department of Plastic Surgery at the Dreifaltigkeits-Hospital in Wesseling, Germany. These surgical procedures create great wound cavities but have associated risks that are manageable when planning and surgery are carried out meticulously.

Body Contouring of the Trunk

Body contouring is a term that encompasses both surgical and non-surgical (minimally invasive) procedures for improving the form of the body. There are a variety of reasons patients may seek out truncal body contouring, including massive weight loss and changes associated with childbirth and aging. Knowledge of the available treatment options and technologies is paramount to the ability to counsel patients accurately about suitability for surgery, expected outcomes, and recognition of complications. This review covers pre-operative patient assessment, techniques, and complications of surgical and non-surgical treatments for body contouring of the trunk (excluding abdominoplasty, which is covered in a separate chapter). This review contains 4 figures, 2 tables, and 27 references. Keywords: body contouring, trunk, liposuction, lower body lift, upper body lift, skin tightening, skin laxity, cryolipolysis, panniculectomy, focused ultrasound, radiofrequency.

Successful Back Contouring With Elimination of Back Rolls Using Ultrasound-Assisted Liposuction and Helium-Activated Radiofrequency

Background Patients are routinely consulted regarding dislike of their upper and middle back contour and associated back rolls that stick out of their bras. Although patients only associate this fullness with excess fat, on examination it becomes evident that back rolls are due to a combination of excess fat as well as skin redundancy. To date, treatment of both excess skin and fat in back rolls has required consideration of excisional surgery such as an upper body lift. Objectives We present 14 consecutive back contouring cases that were treated with an alternative protocol involving simultaneous ultrasound assisted liposuction and helium activated radiofrequency. Methods Patients underwent ultrasound assisted liposuction to remove superficial fat over the upper and middle back as well as helium activated radiofrequency to tighten the skin using subdermal coagulation. Results All 14 patients visually demonstrated elimination of back rolls and improvement in upper and middle back contour. All 14 patients also reported overall satisfaction in their postoperative follow-ups at 3, 6, and 12-months. Conclusion In summary, simultaneous ultrasound assisted liposuction and helium activated radiofrequency provide an effective treatment for patients desiring improvements in upper and middle back contour and elimination of back rolls while avoiding more invasive excisional surgeries. Level of Evidence: 4

Fibrin Sealant Artiss Compared to Progressive Tension Sutures With Stratafix in the Management of Wound Drainage Following Post-Bariatric Body-Contouring Surgery

Background: Post-bariatric body-contouring surgery is one of the most rapidly growing areas in plastic surgery. One of the most common complications following post-bariatric body-contouring surgery is seroma. There are a number of approaches to reducing wound drainage and seroma formation. A promising strategy to reduce these complications is to develop effective methods for reducing dead space between the tissue layers. Methods: We conducted a retrospective trial assessing the use of human fibrin sealant Artiss in comparison to progressive tension sutures (PTS) with Stratafix, a bidirectional barbed suture device in patients undergoing post-bariatric body-contouring surgery. Thirty-six patients for abdominoplasty or lower-body-lift were evaluated. Treatment patients underwent procedure with fibrin sealant applied to adapt the tissue layers. Control patients underwent an identical procedure but with PTS. Primary outcome measures included total wound drainage and time to drain removal. Results: The use of Artiss in abdominoplasty was associated with a mean drain volume that was significantly higher and more days that were needed to remove all drains compared to the PTS group. In body-lift, the mean drain volume and number of days needed to remove all drains tended to be higher when using Artiss compared to the PTS group. Conclusion: The use of Artiss in post-bariatric body-contouring surgery did not decrease the rate of seromas and the length of time required for post-surgical drains when compared to PTS.