Cosmetic Surgery and Beauty Magazine #65

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ody in patients whose BMI is higher than 30. Body Mass Index is calculated by dividing your weight in kilograms by your height in metres squared: Normal: 20 – 25 Overweight: 25 – 30 Obese: 30 – 35 Morbidly Obese: >35 Patients who intend to lose more weight are advised to wait until they reach their target weight before treatment. Smoking is a contra-indication to MWL body contouring. ABDOMINOPLASTY Whilst the abdominoplasty procedure is most commonly performed on women following pregnancy, it is also often performed in the massive weight loss setting, both as an independent procedure and as the front half of a circumferential lower body lift. This is due in part to any previous pregnancies and in part to stretching of the abdominal wall by the large volume of fat deposited around the abdominal organs in the obese individual. Not infrequently, the weight loss (‘bariatric’) surgery requires an open rather than a keyhole procedure, which involves splitting the vertical tummy muscles (‘rectus muscles’). Due to these patients’ very large size, the repair of the separated muscles may come apart post-operatively, resulting in a ‘ventral’ (incisional) hernia in which some of the abdominal contents bulge out through the muscle gap. If the lower trunk skin/fat excess is confined mainly to the front, then an abdominoplasty suffices and a circumferential procedure is not required. The procedure A transverse wedge of skin and fat extending just above the umbilicus is excised, followed by suture repair of the rectus muscles with or without reinforcement with synthetic mesh or ‘artificial dermal matrix’ (ADM). Sometimes a vertical wedge is also removed, producing an inverted T-scar pattern. This is called a ‘trefoil’ or ‘fleur-de-lys’ pattern abdominoplasty. Once the muscles have been repaired, the remaining abdominal skin is pulled down and sutured to the lower incision. Lastly, the umbilicus (‘belly button’) is brought back out to the surface through a new incision. Drains are not routinely used. A compression garment is typically worn for four to six weeks. The patient is usually discharged on the second to fourth post-operative day and walking is encouraged. Heavy lifting and gym work can be resumed after about eight weeks. Driving may be resumed after 10 days, and three to four weeks off work are usually required. LOWER BODY LIFT The introduction of the circumferential ‘lower body lift’ (also known as a belt lipectomy) in the early 1990s revolutionised the surgical treatment of the massive weight loss patient. The Lower Body Lift is a circumferential procedure consisting of an abdominoplasty in the front, and lifting of the buttocks and the outer and back part of the thighs. Liposuction is often performed in conjunction. The buttocks in particular can be dramatically improved. The buttocks in these patients tend to be very flat in addition to drooping, and fat liposuctioned from other areas can be transferred (grafted) to the buttocks to produce a more rounded and pleasing shape. Not infrequently an additional vertical wedge of skin/ fat is removed from the middle of the abdomen to deal with the laxity in the horizontal direction (fleur-de-lys abdominoplasty). The Lower Body Lift can be combined with other contouring procedures. The procedure A Lower Body Lift takes around four to six hours on a thinner patient and longer on a larger patient where liposuction has to be performed before the excess skin can be excised. All the wound closures are performed with buried dissolvable sutures. Drains are not routinely used which makes the post-operative recovery much easier. At the end of the procedure a compression garment is worn. Patients are encouraged to sit out of bed and walk a little on the first post-operative morning. A blood transfusion may be required to optimise recovery, especially where the body lift has been combined with another contouring procedure. Discharge from hospital is around the fifth postoperative day. UPPER BODY LIFT This term includes breast rejuvenation surgery (reduction/ lift/enlargement/gynaecomastia treatment in males) and tightening of the sides of the chest and back if required. Some practitioners include arm reduction surgery (brachioplasty) in this grouping. BRACHIOPLASTY Arm reduction surgery is an excellent procedure for individuals who are self-conscious about the appearance of excess tissue below their arms (so-called ‘tuck-shop arms’). The brachioplasty procedure restores more youthful, toned contours to the arms and gives patients greater selfconfidence in their appearance. Interestingly, many massive weight loss patients, in spite of the fact that they have extensive rolls of loose skin and fat around the lower trunk, which one would think would be the top priority for treatment, request brachioplasty as the initial procedure. This is because they desire to wear short-sleeved tops which expose their arms and find it very hard to find clothes that fit, whereas the lower body/thighs can be easily hidden by clothes and so can be dealt with at a later date. 64 www.cosbeauty.com.au
ody 4 BEFORE AFTER body contouring by Dr Maxwell 5 BEFORE AFTER body contouring by Dr Maxwell 6 BEFORE AFTER body contouring by Dr Maxwell 7 BEFORE AFTER body contouring by Dr Maxwell www.cosbeauty.com.au 65
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