The “Total Body Lift"

By Dennis J. Hurwitz, M.D.

Published on August 01, 2006

This revolutionary new procedure combines the upper and lower body lifts into a single stage surgery

According to the American Society of Aesthetic Plastic Surgery's Ten Cosmetic Plastic Surgery Predictions for 2004, "the number of body lifts will increase, as post-bariatric surgery patients seek plastic surgery to rid themselves of the excess skin left hanging after massive weight loss." This is consistent with the findings of the American Society of Bariatric Surgery, which indicate "gastric bypass surgery jumped last year to more than 103,000," leading to a significant increase in demand for body contouring procedures.

In a world obsessed with the Atkins and South Beach diets, where the number of diet pills sold is increasing, it should come as no surprise that thousands of people are successfully losing significant amounts of weight each year. Unfortunately, this can leave loose, hanging skin behind. But whether it's weight loss, a case of bad genetics, or just an abundance of loose skin on the abdomen or thighs, a new plastic surgery procedure being performed by a handful of board certified plastic surgeons can help. Known as the "Total Body Lift," this revolutionary body contouring technique is much like a facelift for the body. It can be used to remedy loose skin problems in a variety of areas, from the shoulders to the knees – it is specifically designed to assist people who suffer from sagging breasts, abdomens, buttocks and inner/outer thighs.

When is it Necessary?

With increasing age or with weight loss, there is often an excess of skin and/or fatty tissue. In mild cases, this can be managed by procedures such as a tummy tuck and/or liposuction. However, in more extreme situations, especially where the excess is circumferential in nature – that is, around the abdomen, hips, back, buttocks, and outer thighs – the more extensive Total Body Lift procedure is required. The operative plan I use takes seven to ten hours. For those patients who are not physically fit, two stages are indicated.

One Step or Two

The Total Body Lift is the only way to change the abdomen, thighs and buttocks, while correcting the upper back, breast shape and loose skin of the upper abdomen in one procedure. In a more conventional situation, a staged procedure is performed to take care of the abdomen and the lower body. In this case, I place the patient on his or her stomach in order to remove a large segment of skin above the buttocks, up to the mid back and along the thighs. Skin from the lower body is then brought up to cover these areas. Next, the patient is carefully turned while still under anesthesia and I continue with the thighs and abdomen, resulting in a circumferential abdominoplasty. The second phase, which is used to correct the upper body deformity, can be performed as early as four months after the first operation.

At this point, I either complete the operation in 4 to 6 hours or move on to the upper body lift. The upper body lift consists of a reverse tummy tuck, removal of mid-back rolls and reshaping of flattened and hanging breasts. If the plan calls for a single stage, I take out sagging skin from the upper back and stomach while the patient is still prone. Most of the excess tissue can be saved as a flap that is buried under the flattened breast – this allows me to naturally shape and augment the breasts, without the use of silicone implants. The technique I use allows for the scar to be under the breast and along the bra line, so that the incisions are well hidden. The nipples are raised to the optimum position and the breasts are beautifully shaped. A distinct new fold is secured under the breast to help maintain both breast shape and a flat upper abdomen.

Important Elements of the Surgery

I use several other important techniques while performing the Total Body Lift. Preoperative marking of the intended incisions takes a little over a half-hour and is done with the patient lying down, sitting up or standing. I use gravity to smooth out lax skin and rolls. A gender-specific, sculptured result is envisioned. In order to expedite things, I rarely change the plan, and I use only one position change to increase the likelihood that the patient's scars will be level and symmetrical.

With regard to the thighs, I always attempt to achieve the "tightest" lift possible. (It should be noted, however, that the so-called "saddlebags" some patients have on the outside of their thighs is difficult to correct in massive weight loss patients.) After removing excess skin around the waist, I move the leg onto a side table and remove additional skin. After the leg is replaced on the operating room table, the taught skin has the effect of smoothing out the outside thigh. Quite often, weight loss patients and those with severe skin laxity also have sagging skin above the genitalia. By removing a picture frame-shaped piece of skin around this region and performing direct liposuction, I can smoothe and nicely sculpture the skin of the mons pubis.

While the goal is to achieve an improved cosmetic result, I always strive for safety. It is imperative that the surgeon you choose has an experienced support staff, as well as access to the latest equipment and technology. Preliminary injection of solutions containing vasoconstrictors and local anesthetic can decrease bleeding, speed the operation and provide early postoperative comfort. The operation should be a study in time usage and efficiency. This way, patients recover more quickly.

Recovery time

It generally takes patients four to six weeks to heal. They stay in the hospital for one to three nights and are limited to bed rest for one day. After discharge, they can progressively resume non-taxing, light activity. Within four to six weeks they can resume daily activities such as driving and deskwork. Elastic support garments are worn for one month to ensure proper healing and provide support for the incision sites. Results are already dramatically improved by the time they see the first dressing change. The Total Body Lift can remove anywhere from ten to thirty pounds of excess skin. At present, it is the only procedure that can address the excess skin issues that occur from the collarbones to the knees when patients experience massive weight loss.

3 Groups that Can Benefit from Total Body Lift

1.Women with sagging buttocks and a mild amount of excess weight in the belly, hips, and thighs. These changes are common in the mid-thirty to forty-year-old group. They are associated with early aging, and are often secondary to changes that occur after child bearing. While others might feel the changes are mild, these patients want to reverse the ravages of age and child rearing on their bodies.

2.Patients with moderate excess weight of the "trunk." Many of these patients have attempted for years to loose the excess 30 to 40 pounds without success. A traditional tummy tuck procedure in this group will often lead to less than ideal results, especially in the hip, flank, and buttocks areas. Their anatomy requires Total Body Lift to attain a striking improvement in their truncal contour.

3. Patients who have lost a significant amount of weight due to gastric bypass surgery, intestinal bypass surgery or a dramatic change in eating and exercise habits. These patients often have lost more than one hundred pounds when they decide to go see a plastic surgeon. They typically have hanging skin and fat in the area of the abdomen, excess weight on the outer thighs, excess hip weight (which sometimes hangs), back rolls, and ill-defined buttocks. Many of these patients are disheartened when they come to see the plastic surgeon. They have worked hard to lose weight but still cannot wear normal clothing because hanging skin robs them of a normal contour.

Who Is Not a Good Candidate?

Some patients are not good candidates for the procedure. Patients who are massively obese should not undergo Total Body Lift because it will not improve contour and their wounds may not heal. Patients who have medical problems that preclude them from undergoing general anesthetic are also not considered good candidates. In addition, patients who are deemed mentally unable to handle an extensive surgical procedure with its concomitant recovery period may not be good candidates and may require counseling and or antidepressant therapy prior to being reconsidered for the procedure.

In all cases, your surgeon will obtain a general medical history prior to surgery. This is necessary to ensure that the patient can tolerate the anesthetic and surgical stress involved. A good history on weight and contour changes that the patient has experienced is taken. To ensure the best results, in some cases patients who are capable of losing more weight are advised to delay the procedure until they have reached maximum weight loss. The Total Body Lift procedure is a complex operation and the multi-stage version is not offered by many plastic surgeons; even fewer surgeons perform the single-stage procedure for massive weight loss patients. It is an operation that requires both the skill of the surgeon and the cooperation of the patient, who must understand that this is an arduous process.

Since 1977, Dennis J. Hurwitz, M.D., F.A.C.S. has treated thousands of patients with cosmetic concerns, structural defects, and congenital deformities. At the University of Pittsburgh, Dr. Hurwitz is Clinical Professor of Surgery and former director of the Aesthetic Plastic Surgery Center. He is a skilled practitioner, teacher, and innovator and was recently recognized as one of America's Best Doctors and one of America's Top Doctors for specialist referrals -- the only plastic surgeon in Western Pennsylvania in the 2002-2004 editions of the Castle Connolly Guide. As an invited international lecturer, he has published over 100 articles in journals and books on such subjects as: facelift, lipoaugmentation, body contouring, ultrasonic-assisted liposuction, body, head, and neck reconstruction, vascular malformations, and cleft lip repair. Dr. Hurwitz is a diplomate of the American Board of Plastic Surgery, a member of the American Society of Plastic Surgeons, and the prestigious American Association of Plastic Surgeons. He is past medical director of the University of Pittsburgh Cleft Palate/Craniofacial Center. He has been president of city, state, and regional plastic surgery organizations, as well as the Allegheny County Medical Society. These activities allow Dr. Hurwitz to contribute to medicine, while advancing the welfare of his patients and improving his skills.

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