lower body lifts
TRANSCRIPT
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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