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Lower body lifts
- 1. LOWER BODY LIFT AND THIGH PLASTY DR ABDUL MALIK MUJAHID PGR/PS
- 2. 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
- 3. 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.
- 4. ANATOMY Zones of adherence restrict the descent or elevation with aging ,weight fluctuation or surgery
- 6. PATIENT SELECTION Massive weight loss 20-30 pounds over weight group (BMI 26- 28) Normal weight
- 8. CONTRAINDICATIONS Smoking Diabetes Malnutrition Wound healing issues Immunodeficiency Collagen vascular disease
- 9. CONTRAINDICATIONS Anticoagulant medications Lower extremity venous insufficiency Lymphedema History of VTE Other medical issues such as renal insufficiency, anemia, and pulmonary issue
- 10. DIAGNOSIS AND PATIENT PRESENTATION 3 Factors affect presentation BMI at presentation Fat deposition pattern Quality of skin /fat envelope
- 11. COMMON PRESENTATION Hanging penniculus Ptotic mons pubis Buttock ptosis Blunting of waist Ant and lat thigh ptosis
- 12. TYPES OF LOWER BODY LIFT Lower body lift type 2 (lockwood technique) Belt lipectomy /central body lift
- 16. BELT LIPECTOMY
- 17. LOWER BODY LIFT TYPE 2
- 18. 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
- 19. History of comorbid conditions History of nutritional status Previous abdominal scar Bariatic surgery
- 20. 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
- 21. 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.
- 24. PREOP EVALUATION Base line test Chest x Ray ECG Albumin /Prealbumin Total protein
- 26. MARKING
- 28. MARKING
- 29. MARKING
- 30. SURGICAL TECHNIQUE General anesthesia DVT prophylaxis Supine position with arm abducted (90) Marking reinforced and tattooed with methylene blue Folley catether
- 31. 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
- 32. 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
- 33. OPERATION TECHNIQUE Suction drains Closure of scarpa ,superficial layer and skin
- 39. SURGICAL TECHNIQUE Turn the patient to lat decubitus Waist flex Pressure points padded Reprep Back excision Liposuction of lat thigh
- 40. 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
- 41. OPERATION TECHNIQUE Drain placement Closure and dressing Turn to supine position
- 44. POST OP CARE
- 45. COMPLICATION Seroma Wound separation Dehiscence Infection Tissue necrosis
- 46. COMPLICATION DVT/PE Psychosocial difficulty Asymmerty
- 47. FINAL RESULT
- 48. FINAL RESULT
- 49. THIGHPLASTY Medial thigh lift techniques include prox inner thigh lift Vertical thigh lift
- 50. 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
- 51. PROXIMAL INNER THIGH Minor effect on distal medial thigh Increase incidence of superficial wound dehiscence due to moisture in inner thigh crease
- 52. 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.
- 53. 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
- 54. PATIENT SELECTION Discussion about the post operative problems and results should be done before surgery
- 55. INDICATIONS Isolated inner thigh laxity of proximal thigh inner thigh lift Circumferential thigh laxity vertical thigh lift
- 56. CONTRAINDICATIONS Same as lower body lift
- 57. 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.
- 58. OPERATIVE APPROACH Amount of soft tissue resection not more than 4-6 cm General anesthesia Supine position with frog leg Incision to dermis
- 59. 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
- 60. 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
- 61. OPERATIVE APPROACH 2-0 Vicryl for deep dermal clousure and 4- 0 vicryl for subcuticular closure
- 65. 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
- 66. OPERATION APPROACH Tumescent infiltration Additional infiltration if liposuction needed First perform lipo Readjust towel clip to identify excess skin
- 67. 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
- 68. 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
- 69. POST OP CARE Dressing change by needed Apply scar creams containing silicone ,steroid ,vit E
- 73. THANK YOU