Toronto, Canada — Plastic surgeons who perform a total body lift operation, which combines several individual operations, must have the skill and confidence in performing the individual operations before embarking on combined surgery, says one plastic surgeon.

Speaking at the 7th annual Toronto Breast Surgery Symposium in early May, Dennis J. Hurwitz, M.D., F.A.C.S., a clinical professor of surgery at the University of Pittsburgh School of Medicine in Pittsburgh, Pa., and director of the Hurwitz Center for Plastic Surgery in Pittsburgh, says that patients who are selected for the total body lift, where breasts, chest, arms, thighs, hips, back, waist, abdomen and knees are reshaped, should be relatively fit and motivated.

Dr. Hurwitz recommends that patients do not have a body mass index of more than 30 and, generally, that they be younger than 50. While the procedure can be performed in both men and women, the vast majority (90 percent) of Dr. Hurwitz’s patients are women.

“Total body lift is a comprehensive and integrated approach to the skin laxity and sagging tissues of the weight-loss patient,” Dr. Hurwitz tells Cosmetic Surgery Times. “Patients have to realize that they are probably taking on increased risk of doing fewer stages of surgery. It’s important that they don’t try to return for operations every six months for the next two or three years.”

Patients can undergo total body lift for aging or after pregnancy as well, notes Dr. Hurwitz.

Surgeons who perform the total body lift should have a certain temperament and a supportive team around them, according to Dr. Hurwitz.

“Surgeons have to learn each operation and have confidence in performing each element of the operation,” notes Dr. Hurwitz. “You can’t just pick it up and do it. If you are not trained and skilled, then it is better to do this as many operations than as a single-stage operation.”

In his own experience, Dr. Hurwitz has not experienced any severe complications or deaths in performing the total body lift.

Two-Phase Procedure

In the procedure, no part of the body is actually suspended. Total body lift surgery essentially sculpts the body by excision of excess and reconstruction of what remains into attractive contours, explains Dr. Hurwitz.

The total body lift is a lower lift and upper body lift combined, which reshapes the abdomen, thighs, buttocks, mid back and breasts. For the lower body lift, the patient is positioned on her stomach, and the surgeon removes a large, belt-like segment of skin above the buttocks, up to the lower back. When the wound is closed, the thighs and buttocks are lifted.

The patient, who is under anesthesia, is turned over and the surgeon continues to work on the front of the thighs and abdomen, with the surgeon completing circumferential abdominoplasty. Indeed, when a surgeon performs a circumferential removal of skin and fat of the lower abdomen, and when combined with undermining of the thighs, it will lead to a lift of the buttocks and thighs. The upper body lift consists of a reverse abdominoplasty, removal of mid-back rolls, and reshaping of flattened and hanging breasts.

When combining the two types of lifts, Dr. Hurwitz describes this as breakthrough body lift surgery. Total body lift can be done in two stages, with a three-month gap between procedures, or as a single-stage surgery.

Rest & recovery

During the three-month rest between surgeries, if done in two stages, patients should be eating a healthy diet to restore protein and correct any anemia. The three months also allow surgeons to get past any period of possible infections or lower extremity thrombophlebitis, as well as allowing patients to get over the stress of the initial surgery. 

It’s key that patients regard the total body lift surgery as they would gastric bypass surgery. According to Dr. Hurwitz. It should be seen as a critical step in overcoming obesity, but patients need to take steps following surgery to maintain a healthy lifestyle, ensuring that their new shape will be long term.

Lipoplasty is a significant part of total body lift surgery. With lipoplasty, there is decreased body surface volume. Dr. Hurwitz says that optimal results are achieved when an even amount of fat is removed, and the overlying skin retracts to the smaller form. One of the advantages of lipoplasty is that it doesn’t result in extensive scars and has decreased down time.

‘Marking’ success

Surgeons who want to perform the total body lift must be resolute in making accurate markings to minimize intra-operative adjustments, notes Dr. Hurwitz. “They need to make planned incisions and must be willing to redraw lines until they are precisely right,” he says.

Similarly, surgeons need to be strategic in planning closure. Since weight loss patients have poor skin elasticity, closure must be as tight as possible, Dr. Hurwitz adds.

However, over-resection of skin followed by overly tight closure of massive tissues can lead to wound dehiscence or subsequently to broadly depressed scars resulting from suture pull through, breakage or premature dissolution. At the same time, insufficient removal of skin and low closure tension leaves nearby feature ptosis, skin rolls, skin laxity, and/or wrinkles.