Should I get a back lift or belt lipectomy? (Photo)

Question

I am in the process of finding a surgeon as i've lost 50kgs and am ready for the next part of my journey. I've been advised I may need a extended tummy tuck, breast lift, arm lift and side lift... but am not sure what I would need when it comes to the excess skin on my back. I have spoken to 2 surgeons so far and been recommended a bra line back lift and a belt lipectomy and i'm not sure which would be best in my case and feel quite lost. I would greatly appreciate any feedback for my case.

J. Timothy Katzen, MD, FACS · Answer

Hi Salz777, thank you for your question regarding getting a back lift or a "belt lipectomy".  First of all, lets talk about each procedure and its goals.  A "back lift" is also called a horizontal torsoplasty, upper body lift, bra strap lift, or bra straplasty.  During a back lift, an incision is made across the back in the bra strap line.  Dissection is made from the upper part of the back towards the buttock.  The back is then pulled towards the bra strap line.  A butterfly shaped of excess back skin and fat is removed.  Excess rolls of upper skin are removed.  Usually, the incision is hidden in the bra strap line.  The back lift is performed under general anesthesia and takes about 3 three to four hours to complete.  The back lift can be performed as an inpatient or outpatient basis.  A belt lipectomy is also called a lower body lift, 360 circumferential lower body lift, belt lipectomy, or belt dermo lipectomy.  Personally, I do not like the term "belt lipectomy" because it only describes removal of fat from the belt region.  During a 360 circumferential lower body lift, a incision is made all the way around your body.  Excess abdominal, hip, and buttock skin and fat are removed.  During the 360 circumferential lower body lift, on the front, dissection is made upwards to the rib cage and the abdomen is pulled down.  During the 360 circumferential lower body lift, on the back, dissection is made downwards to the bottom of the buttock and the buttock is pulled up. A 360 circumferential lower body lift takes about 6 to 8 hours to complete under general anesthesia.  A 360 circumferential lower body lift can be performed as an inpatient or outpatient basis.  
In regards to your back, a 360 circumferential lower body lift will not remove these bra strap or rolls of back fat.  Only a back lift, horizontal torsoplasty, upper body lift, bra strap lift, or bra straplasty will eliminate the rolls of bra strap fat.  Thank you for your questions regarding how to manage your back skin rolls and bra strap rolls.  I hope that I have answered your questions on how to manage your back.  
Before you make any decisions regarding a 360 circumferential lower body lift, back lift, horizontal torsoplasty, or brastraplasty, I would suggest you seek consultation with an expert in the field of reconstructive plastic surgery after massive weight loss. Please seek an experienced, board-certified, plastic surgeon.  Travel out of state if you must to find such an expert. If you have any more questions regarding a 360 circumferential lower body lift, horizontal torsoplasty, bra straplasty, back lift, or plastic surgery in general, please contact my office.  Sincerely, Dr. Katzen. ("Verified" by RealSelf, certified by the American Board of Plastic Surgery and member of the American Society Plastic Surgeons, International Society of Aesthetic Plastic Surgery, American Academy of Cosmetic Surgery, and Fellow of American College of Surgeons and American Board for Metabolic and Bariatric Surgery, Awardee: RealSelf 100.)

Matthew Peters, BSc, MBBS, FRACS (Plast) · Answer

Hello, and thank you for your question and photos.
I would suggest a belt lipectomy / lower body lift to address your abdominal skin excess, and a back bra lift for the upper back concern. I would usually recommend that these be done separately.
A consultation with an appropriately qualified plastic surgeon will help determine the best path forward.
All the best,
Matthew

Alejandro J. Quiroz, MD · Answer

Thank you for your question.   Base in your pictures the most benefit  to your body will be obtain with a 360 LBL with a flour du Liz

George Bitar, MD · Answer

Hello and thank you for your question. Congratulations on your weight loss! In regards to your abdomen I would recommend a fleur de lis abdominoplasty to achieve the best contour. For the areas on your upper flank, I would recommend a flankplasty for this area, as a lower body lift would not address the areas of the bra line. You should seek a consultation with a board certified plastic surgeon in your area to address your concerns

Carmina Cardenas, MD · Answer

It is wonderful what you have achieved after weight loss!!!You have a beautiful body frame, so I can only predict you having an awesome result on the correct hands: a Board Certified Plastic Surgeon who is an expert in the AWLsurgery  After losing all that amount of weight you have developed saggy skin on all areas of your body, and all have differences on which anatomical area are attached and which direction should be lifted or pulled. So vectors of pulling  or lifting should never be opposed one to the other. So talking as an expert on AWLS and about your trunk area: it is very important to remove excess, it is extremely important to lift and also to create more feminine body shape. I am a believer that  square shapes are not ok. Based on your photos, you have developed significant saggy skin on your abdomen (length and width), most likely saggy pubic area, saggy lovehandles and saggy and deflated buttocks. PLAN:you will be a great candidate for the FIRST STAGE: Lower Body Lift with Fleur de Lis  because of the excess on length and width, and will include muscle repair to create a smaller waist and flatter abdomen, pubic lift and reduction if needed, front abs outer thigh lift ( not much improvement on inner thighs), real buttocks lift and I totally believe that adding some volume and shape will create the greatest outcome, so I will recommend Liposuccion to lovehandles and waist and use that precious fat to transfer to buttocks and a bit to hips. The saggy skin on your back will not improve with a Lower Body Lift because of the skin attachments, so the Next stage will be the upper body lift: Back Lift (brassiere line), arm lift, breast lift. Hopefully I was clear  enough  Be encouraged!!Dr. Cardenas

Jonathan Amspacher, MD · Answer

Congratulations on you weight loss, that is a fantastic job and obviously required a lot of hard work.  You want to be at or close to your goal weight when you have a lower body lift, because if you lose more weight after your lift you will get more loose skin and loose some of the benefit of the lower body lift.  You also want your weight to be stable for 3 to 6 months and all of your nutrition parameters to be in line.  A lower body lift is a very powerful procedure and makes a dramatic difference in the abdomen and the low back and buttock area if a purse string gluteoplasty is incorporated into the procedure.  The mid back excess skin will not be significantly changed with this procedure.  I would start with the lower body lift and then do a breast lift/augmentation, because they they are more dramatic in the improvement gained.  However, these will only make minor improvements in the mid-back skin excess.  This usually requires a separate procedure called a bra line lift, which should be done at a separate time.  The belt lipectomy and lower body lift have a lot of similarities but they may place their scars at different heights on the back or buttock.  I would talk to your surgeon carefully to find out where their scar ends up and if they do any procedures to help improve the flattened buttock.  I would starting with the procedures that make the biggest benefit like the abdomen, then breast, then arms and rank the mid back a distant 4th on your list of benefits from surgery.
Best of Luck on Your Journey
Jonathan Amspacher, MD

Daniel Barrett, MD · Answer

Dear Salz777,
Congratulations on your weight loss. Based on your photos, it looks like you have a lot of loose skin so you would need a number of surgeries in order to remove all the excess skin. It is hard to tell for sure without an examination. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ven Erella, MD · Answer

Thank you for your question. Congratulations on your weight loss. Lower body lift addresses abdomen, hips and buttocks and upper back lift addresses loose skin/rolls of back. Both combination will give optimal results in your case. Please talk to a board certified PS for evaluation.

Mary Lee Peters, MD (retired) · Answer

Thank you so much for your photos. They are very helpful.  You will get a lot of good change with a belt lipectomy (also called a lower body lift), which removes skin from the flanks and abdomen in a 360 degree fashion.  A lower body lift also helps body parts next to where you are operating.  For example, skin removal in the flanks will improve your middle and upper back, buttock and lateral thighs.  Skin removal in the abdomen will improve your pubis and the front portion of your legs.  A breast lift and an arm lift can easily be combined in one operation.  Most of my patients choose to do that as their second stage.  Find a plastic surgeon well experienced with patients who have had massive weight loss.  You will want to think carefully about your personalized plan.

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