A tummy tuck works on the front of the body. After a large weight loss, loose skin often wraps around the hips, the lower back and the buttocks as well, and a front-only operation leaves much of that skin in place. Surgeons use the lower body lift for that wider pattern.
The procedure removes excess skin and fat below the waist through an incision that circles the torso. At Leo Lapuerta, MD, Plastic Surgery, which serves patients in Houston, Katy and Pearland, Dr. Lapuerta sometimes calls it a body lift 360, a name that describes the reach of the surgery: the lower abdomen, hips, lower back and buttocks in one plan.
Causes of loose skin below the waist
The practice lists several causes. Patients who lose a large amount of weight often end up with skin that has stretched beyond its ability to retract. Others notice sagging as they age, and pregnancy and sun damage can reduce elasticity in the skin and the tissue beneath it.
The complaint goes past appearance. Overhanging skin can cause mobility problems, chafing, painful rashes and infections. A body lift addresses both sides of that. Dr. Lapuerta removes excess fat and skin, tightens the underlying muscle and tissue, and the surgery can improve skin that looks dimpled or irregular.
The circumferential incision
During the operation, Dr. Lapuerta makes a horizontal incision across the lower abdomen that continues around the body. Through it, he uses liposuction to remove pockets of excess fat, pulls the underlying tissue and muscle tight, and trims away as much loose skin as he can while protecting the incision area.
Scars are part of the trade. The practice tells patients to expect noticeable scarring around the lower stomach and hips in particular. The surgeon places the incisions as low as possible so they follow the bikini line and sit under most clothing and swimwear, and the scar lines continue to heal and fade with time.
Dr. Lapuerta performs lower body lifts under general anesthesia in an accredited surgical facility, and he works with physician anesthesiologists rather than nurse anesthetists. A surgery of this scope often runs three to four hours or longer, depending on its extent and on whether other procedures are added.
Those additions can include liposuction elsewhere, an arm lift, or a breast lift and augmentation. The lower body lift is often part of a mommy makeover for women who have had their last pregnancy or lost a great deal of weight. The number of procedures a surgeon can combine in one session depends on the length of the operation and the recovery it will demand.
Timing comes before technique
The practice is direct on one point: candidates should be at or near their goal weight. A patient who expects to lose more should do that first, through diet and exercise or through liposuction if lifestyle changes stall. After the weight comes off, a physical exam confirms the body has stabilized enough for surgery.
Good overall health and realistic expectations round out the profile. A body lift can smooth the skin and tissue along the stomach, back and thighs, but the final result will look different from one person to the next.
Because the surgeon removes the excess skin and tightens the muscle, the practice describes the result as long-lasting. The body still ages, though, and a dramatic change in weight can bring back loose skin. A stable weight and a healthy routine help protect the outcome over the years.
Insurance may cover a portion of a body lift for some patients after massive weight loss, for example when chronic skin infections or other obesity-related problems are present. Coverage depends on the patient’s condition, the policy and the procedure, and the practice’s billing and insurance coordinators review benefits at the pre-op meeting.
The first weeks of recovery
Most patients spend a couple of nights in the hospital after a lower body lift, where staff monitor them and they receive prescribed pain medication. Surgical drains remove fluid from the incisions, and bandages and a compression garment reduce swelling and support the tissue.
Walking starts on the day of surgery to help with soreness. Patients should plan on two weeks or longer before returning to work and normal activities, and they should avoid strenuous activity for at least four to six weeks, depending on how healing progresses. Several post-op appointments follow, during which Dr. Lapuerta checks the incisions and removes the drains and sutures when the time comes.
Planning starts with measurements
The process begins with a consultation to decide whether the surgery fits the patient’s health and goals. If both sides agree to move forward, a separate pre-operative appointment follows, where Dr. Lapuerta takes measurements, assesses skin elasticity on the lower body and explains the exact technique he plans to use.
That plan varies. Some patients want to focus on the stomach, while others want to treat excess skin across the hips, buttocks and thighs too. Dr. Lapuerta, a triple board certified plastic surgeon with more than 30 years of experience and more than 30,000 procedures, sets the incision pattern and the extent of the lift from those measurements, before a surgery date goes on the calendar.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.
