Lower Body Lift - Better All at Once or Two Separate Surgeries?

Question

I am 39 yrs. old lost 70 pounds. Had a Board Certified Plastic Surgeon recommend for best results a lower body lift as opposed to my originally planned tummy tuck. So far I have decided only on the extended tummy tuck due to fear that the lower body lift is more serious. He also said that I could come back if I decided to in the future to complete the other areas towards a lower body lift. What's the diff. between doing it all at once or seperately as far as safety? recovery?

John LoMonaco, MD, FACS · Answer

If you truly feel your backside (hips and buttocks) need correction, then I recommend doing it in one stage.  Personally, I feel this allows me to more accurately re-drape and tailor the skin.  Pulling the front and sides of the skin up is also easier this way. In fact, most of my body lifts also incorporate a breast lift at the same time.

	I have two dedicated assistants who help me full-time, so our team is very efficient.  Our surgery times are under 6 hours in almost all cases.  In the right facility, this has worked out well for my patients and allows them to experience only one downtime, one recovery, and one expsoure to anesthesia.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question about a lower body lift and whether it’s better to undergo it all at once or in two separate surgeries.  Thank you for your history in your pictures.  Congratulations on losing 70 pounds.  Your weight loss journey is quite an accomplishment.  Upon examining your pictures, you would benefit most from a 360 circumferential lower body lift.  The difference between an extended tummy tuck and a 360 circumferential lower body lift is that the 360 circumferential body lift also lifts and improves your hips and your buttocks.  During an extended tummy tuck and a 360 circumferential lower body lift, excess abdominal skin and fat are removed.  IN addition, the rectus abdominis muscle is plicated, the umbilicus or belly button is relocated, and the mons pubis or FUPA is elevated and reduced.  However, with the 360 circumferential lower body lift, the incision is continued around the hips and joins at the top of the buttocks.  Thus, the 360 circumferential lower body also lifts and reduces the hips and buttocks.  The extended tummy tuck does not.   The 360 circumferential body lift surgery takes approximately 6 to 8 hours to complete under general anesthesia.  Please allow yourself 3 to 4 weeks to heal.  Regarding the extended tummy tuck, the extended tummy tuck surgery takes approximately 4 to 5 hours to complete.  The extended tummy tuck has a recovery time of approximately 2 to 3 weeks.  An extended tummy, as the name implies, only includes a tummy tuck; an extended tummy tuck does not include the hips or the buttocks.  As far as safety is concerned, a solitary procedure, such as an extended tummy tuck, may be slightly safer due to its shorter operative time.    However, in terms of safety, the comparison between a lower body lift and an extended tummy tuck with a subsequent surgery for a hip and buttock lift (posterior lower body lift) reveals that the risk is relatively the same.  If you have an extended tummy tuck and then have to return for a hip lift and butt lift, it would require two surgeries, two anesthesias, two recoveries and two times off work.  Therefore, most experienced plastic surgeons perform a 360-degree circumferential body lift on an appropriate patient who has lost 70 pounds, rather than staging an extended tummy tuck followed by a hip and buttock lift.  Additionally, consider that a 360-degree circumferential lower body lift will yield better results with a single surgery, as opposed to an extended tummy tuck followed by a hip and buttock lift.  Good luck.  I hope I answered your question regarding lower body lift: is it better as one surgery or two separate surgeries? 
I hope this information helps you in your search for answers regarding the 360 circumferential lower body lift.  If you have any further questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please consult with an experienced, board-certified plastic surgeon.  Since the body lift is a major procedure, it is recommended that you consult an experienced, board-certified plastic surgeon with a proven track record of performing lower body lifts.  Do your research.  Ensure they have performed at least 150 circumferential lower body lift surgeries and have the before-and-after pictures to prove it. Please carefully look over their before-and-after pictures and check their reviews on RealSelf.   If you cannot find an experienced lower body lift surgeon in your neighborhood, consider traveling out of state if necessary. Sincerely, Dr.  Katzen, MD, MBA (Aesthetic, Cosmetic and Reconstructive Plastic Surgeon),  President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, , and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Richard J. Bruneteau, MD · Answer

It's not unusual for patients who undergo massive weight loss to develop loose saggy abdominal and back skin. This is often accompanied by weakened abdominal muscles and buttock sag posteriorly. When this situation arises, a variety of treatment options are available.In some cases, it may be possible to address the abdomen and back simultaneously by performing a circumferential lower body lift procedure. When this approach is taken, there's improved synergy, less expense and only one recovery.In other cases, it may be appropriate to stage these procedures. Under these circumstances, an abdominoplasty would be performed first followed by a buttock lift at a later dateWhen these procedures are performed together, safety has to be the first priority. For this reason, we believe it's important to minimize the length of these operative procedures. An experienced surgeon, first assistant and surgical team that focus on efficiency can minimize the length of the procedure and reduce the potential for complications.When these resources aren't available, it's appropriate to stage these procedures. Combination surgery isn't for everyone. Patients may have co-existing health problems which prevent this approach. If you're considering this approach, it's important that you discuss these issues with your plastic surgeon. Your surgeon should be able to formulate an appropriate surgical plan.

Larry S. Nichter, MD, MS, FACS · Answer

As you surmised there are pros and cons about doing many surgeries at once vs separately. One surgery, one recovery speaks for doing many surgeries at once. However there are more risks such as blood clots in your veins (DVT or PE), increased risk for infection, etc.  Typically, I do a combination of surgeries but limit my operative time to less than 6 hours, BMI within normal range, non smokers, use anticlotting strategies to prevent blood clots. The informed consent with your surgeon should cover in great detail all of the above and more. #bodylift#postweightlosssurgery

Young R. Cho, MD, PhD · Answer

Thank you for your question.  A consultation would help determine which of the following procedures is the right one for you:1) 
 Traditional tummy tuck:  Reduces a great amount of skin laxity, 
tightens the abdominal wall muscles and keeps the incision hidden in the
 underwear line.2)  An extended tummy tuck:  Same as a tummy tuck, but helps to reduce more skin laxity around the flanks.3) 
 A corset tummy tuck:  Adds a vertical scar and breast fold scar, but 
reduces a significant amount of vertical skin laxity in addition to the 
horizontal skin laxity and creates the most hour-glass type figure.  
Downside is more visible scar4)  A belt lipectomy (or lower body 
lift) helps lift the outer thighs and buttock in addition to the 
benefits of an extended tummy tuck.Options
 3 and 4 usually have a significant amount of skin laxity that is being 
addressed. Liposuction is usually added to all of the procedures to help
 improve the results.  I would recommend visiting with a board certified
 plastic 
surgeon who can spend time with you to explain the different options in 
more detail.

Richard H. Tholen, MD, FACS · Answer

Congratulations on your weight loss!

	Lower body lifting done in a hospital setting with hospital inhalation anesthesia is costly, requires 1-3 days hospitalization (in most cases), and exposes you to all of the "sick" patients and hospital bacteria (can we say "resistant" everyone?) during the time when your incisions have not yet healed, and nurses touch not only you but also those other sick patients. Splitting the operation into two only doubles those concerns! Which part of that list I just wrote do you find interesting? The sad thing is that even the careful hospital-based surgeon who moves along with celerity, precision, and excellent control of blood loss STILL has to expose his or her patients to the anesthetic "routines" of the hospital and the less-than-bacteriologically-ideal environment!

	How about outpatient lower body lift at a single stage for around $16000 TOTAL cost, with anesthesia techniques that allow you to walk to your car (assisted of course, and you not driving) an hour and a half after surgery is completed, with 2% risk of nausea or vomiting, good pain control (via multiple methods, each designed to help deal with a specific area or type of discomfort), NO exposure to sick patients, hospital bacteria, or operating rooms that are used for ruptured appendices, dead bowel, or "dirty" cases, a surgical team that does ONLY cosmetic surgery cases (and has 14 years of experience with outpatient lower body lifts), and did I mention that you get this superior and safer procedure for thousands less than the hospital version?

	We have done over 250 outpatient lower body lifts in our accredited office surgical facility over the past 14 years, so who would recommend that you do two operations, with double the (minimal, but still double) risks, double the time off work, and increased cost? The answer is that only those surgeons who routinely have or anticipate more blood loss, increased chances of nausea and vomiting that mandate overnight admission. or lack of experience that (understandably) makes them more cautious. If you have other medical issues, then of course, outpatient lower body lifting  may not be for you, but I truly have only needed to do hospital lower body lifts in a handful of cases, and greatly prefer the safety, anesthesia skill, staff experience, and confidentiality of my office surgical facility. Lest you think I am some sort of surgical "cowboy" that takes unnecessary risks, I can truthfully tell you that we have performed over 16000 operations in our facility in the almost 20 years we have offered general anesthesia--all  without any deaths, heart attacks, or strokes. We routinely employ active anti-embolic foot pumpers to reduce the risk of blood clots, ambulate our patients early (obviously, since they go home!), and utilize full anesthesia monitoring and skilled CRNA anesthesia providers (Mayo Clinic cardiac experience, Twin Cities metro level 1 trauma hospital experience, etc.), not to mention our recovery room RNs with ACLS skills and over 45 years of combined experience (2 RNs).

	Just so you know this isn't just to brag up my own practice, there are other skilled plastic surgeons who provide similar care and facilities; these practices, however, are in a very select minority and you must search a bit to find plastic surgeons with these capabilities and experience. But that is why I must humbly submit that just because there are those who do not operate at this level, you should simply accept what's out there. Interview several ABPS-certified plastic surgeons with acknowledged experience in lower body lifting and see what sounds good and what sounds bogus! Good luck and best wishes for a great result!

Vishnu Rumalla, MD · Answer

I prefer a lower body lift in one stage when a patient has circumferential lipodystrophy after massive weight loss. However, if you have any significant medical problems, I will stage the procedre to minimize operative time, incision lengths to heal, and recovery.

Thomas Fiala, MD, FACS, FRCSC · Answer

My preference is to stage this (divide it into two operations).  Here's why:

	1)  When I flex the patient for their abdominoplasty, that could potentially limit the amount of skin I could resect posteriorly, or increase the chance of wound breakdown posteriorly.  I want to maximize the amount of skin I can resect at each stage for optimal results, and minimize wound healing problems.

	2)  Studies show a significantly higher complication rate (DVT/PE, transfusions, anesthesia etc.) with the one stage circumferential body lift than the two stage approach.

	3)  Most patients are not willing to spend 2-3 days in a hospital recovering from the huge circumferential lift surgery.  The tummy tuck (part one) and the lower body lift or flankplasty (part 2) can each be done with an overnight stay.

	Hope that helps clarify things.  All the best,

Armando Soto, MD, FACS · Answer

hi there-

	There really is no right or wrong answer to this question, and in the end you should do what you are most comfortable with...

	It IS important to realize, however, that a LOT of what you might be told about these options (including what you are told here on this forum) is going to be heavily based (appropriately so) on the individual experience of the surgeon answering your question at the time...

	In other words, some surgeons take 6 hours to complete a tummy tuck and much longer to complete a lower body lift- and their patients would therefore be at greater risk of postoperative complications related to the length of the surgery. They would also be more prone to need expensive hospital stays...

	Other surgeons are able (for many reasons) to be more efficient- and by shortening the time of surgery are therefore doing the same operation with less risk for their patient.... (a 3 hour tummy tuck would have MUCH lower risks than a 6 hour tummy tuck).

	So a lot of the answer to your question is going to be dependent on the surgeon you choose.

	If you choose a surgeon that is able to safely complete a lower body lift in a reasonable period of time (less than ~5 hours), the risks are NOT significantly greater than for a tummy tuck. 

	But either option could lead to an equally safe, good outcome in the right hands.

Bryan Curtis, MD · Answer

Whether to undergo a lower body lift as a single procedure or split it into two separate surgeries is a decision that should be made in consultation with your plastic surgeon. Several factors will influence this decision, including your overall health, the extent of excess skin and tissue, and your personal preferences. Here are some considerations for both options:Single Surgery (All at Once):1. Comprehensive Transformation: A single lower body lift procedure addresses excess skin and tissue around the abdomen, hips, thighs, and buttocks in one operation, providing a more comprehensive transformation.2. Reduced Overall Recovery Time: While the recovery from a lower body lift can be significant, undergoing one surgery means you'll only need to go through the recovery process once, potentially reducing overall downtime compared to two separate surgeries.3. Cost-Effective: In many cases, having all areas addressed in a single surgery can be more cost-effective than undergoing multiple surgeries separately.Two Separate Surgeries:1. Reduced Surgical Time: Splitting the lower body lift into two separate surgeries means each procedure can be shorter, potentially reducing the overall duration of each operation.2. Reduced Risk of Complications: Some plastic surgeons prefer to split the lower body lift into two surgeries to reduce the risk of complications associated with longer surgical times, such as blood clots or surgical site infections.3. Staged Recovery: By undergoing two separate surgeries, you may have a more manageable recovery process, allowing you to focus on one area at a time and potentially reducing the overall physical and emotional strain.Ultimately, the decision between a single lower body lift or two separate surgeries will depend on factors such as your overall health, the extent of correction needed, your plastic surgeon's recommendations, and your personal preferences. It's essential to have a thorough discussion with your plastic surgeon to weigh the pros and cons of each option and determine the best approach for achieving your desired results safely and effectively.

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