Back Rolls After Weight Loss: Best Treatment? (ie lipo, upper body lift etc) (Photo)

Question

I have had several consults with ps and all have different opinions on how to get the best contouring of my back which will go along with an extended tt. Some say other lipo is needed others have said that the rolls are loose skin and will need to be removed. What would you recommend?

S. Larry Schlesinger, MD, FACS · Answer

The rolls on your back are mainly fat covered by thick skin, and separated by thick membranes.  If suctioned correctly, the rolls or festoons disappear leaving no loose skin needing resection.There is a specific technique for removing these rolls of fat on your back.  Multiple midline incisions will allow your surgeon to liposuction each roll separately.  Then turning the canula (the tube that suctions out the fat) in a diagonal direction will allow your surgeon to pierce the membranes between each roll.  This allows the skin of each roll to flow into each other, therefore removing the possibility of loose hanging skin.  Once the festoons are suctioned out and the membrane between each is fenestrated (the strength of the membranes is broken up), then this will allow the backside of a lower body lift to tighten your back and obviate the need for an upper body lift.  The backside of the lower body lift will pull any loose skin on your buttocks and lateral thighs, and dovetail into the abdominoplasty incision lines, giving you a smooth, circumferential pulling of the tissue, both upward and downward, at the same time.Therefore, it is my opinion, based on years of experience at the Mommy Makeover Institute of Hawaii, that your best result would be a combination of a unique liposuction technique plus a lower body lift.

J. Timothy Katzen, MD, FACS · Answer

Based on your history and pictures, I would suggest an upper body lift.  A 360 lower bodylift or circumferential lower body lift will not address your upper back rolls. The front portion of the 360 lower bodylift pulls the abdomen down. The back portion of the 360 lower bodylift pulls the buttocks up. The back portion of the 360 lower body lift does not pull the upper back down.Due to the significant amount of skin and fat rolls in your upper back, liposuction is not a good option.  Liposuction will just result in a significant amount of sagging skin.Thus, the only way to address your upper back skin and fat rolls is with an upper body lift. There are two ways the upper bodylift can be performed. One is with an incision that goes across your back and follows your bra strap line. Another technique is to make an incision from the armpit to the hip; this scar is better concealed, but may not give you as good a result as the horizontal upper bodylift. I would suggest you undergo the upper bodylift with a horizontal incision. However, I would suggest you have the lower bodylift done before the upper bodylift. Good luck.

Richard J. Bruneteau, MD · Answer

Massive weight loss can impact almost any area of the body. When weight loss is severe, the upper back and lower back may both develop loose saggy skin. Your pictures demonstrate multiple rolls of fat and skin that involve both the upper and lower back. When this situation arises, a variety of treatment options are available. The choice of procedure will depend upon your anatomic findings and aesthetic goals.In this particular case, I feel it's appropriate to perform staged procedures to correct this problem. I would recommend a lower body lift as an initial maneuver. This procedure circumferentially removes excess skin and fat from the lower abdomen and back. It simultaneously lifts the buttocks and lateral thighs in an upward direction.Once recovered from this procedure, it would be appropriate to perform a bra line back lift. This procedure removes redundant upper back tissue and hides the scar beneath the bra strap area. It can be extended anteriorly and combined with a breast reduction procedure to optimize the result. All of these procedures are associated with excellent clinical results and high levels of patient satisfaction.If you're considering massive weight loss surgery, it's important to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic deformity and achieves your aesthetic goals.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question and including several pictures.It appears that you would benefit from an upper body lift -- breast lift, arm lift and excision/closure of bra and back rolls.

To be sure, see two or more board
certified and experienced plastic surgeons in your area for a full and complete
evaluation.

I hope this helps.

Carmina Cardenas, MD · Answer

First of all I have to congratulate you for the decision of loosing weight!!!Your back rolls represent two different conditions: some fat and flaccid skin. If we remove only fat, the saggy skin will remain. If we only remove skin fat will remain.So my opinion is to fix both issues: I would recommend to do a thorough liposuction to your upper and lower back and then do a back lift (bra-line incision)You have to know that the skin attachments on the back have an upward position, that means that back skin can not be pulled down, that skin can only be pulled up to fix the back rolls.Your abdomen will need a Lower body lift (circumferential Tummy Tuck) in order to get rid of the saggy skin on your abdomen and sides (pull the skin down) and lift your butt area (pull it up).I do not recommend to do all in one single procedure for safety reasons.Be encouraged. You started a wonderful journey, you will be loving you results!!Dr. Cardenas

Armando Soto, MD, FACS · Answer

Hi there,In my opinion, and based only on the photos you posted (in other words, I would need to see you in person to be able to give you a strong opinion), you are going to require a body lift type procedure to achieve improvement in the rolls you point out. Whether or not liposuction is also done, and how much, will depend on the surgeon you choose- but you should not use what they tell you about this as a determinant of who you ask to do your procedure...Rather, I would weigh the opinions you get based on the outcomes produced by those giving you the opinions. In other words, if a surgeon is able to show you many photos of patients like yourself who have lost a lot of weight and after surgery looked beautiful, then I would give their opinion a lot of weight. Don't get confused by the details- find the best surgeon you can and trust what they recommend.

Henry Mentz, MD, FACS · Answer

Thank you for sharing your photos. While body lifting is a substantial operation it may be you best option. Your skin on your back may contract somewhat, a full body lift will maximize your result. The loosness on the tummy requires a tummy tuck. The body lift includes the front part, the tummy tuck, and would provide a nice improvement. Here are some tips:1. Keep your scar low so that it is hidden in the smallest bathing suit2. Have your surgeon use Experil, a long acting pain reliever injected at the time of surgery for reduced pain and shorter recovery3. Have your surgeon use Xeralto or Lovenox to reduce your risk of blood clots4. Have your surgeon tighten your rectus diastasis and flatten you tummy muscles5. Have your surgeon use progressive tension sutures to stitch your tummy skin down and not use a drain 6. Use incrimental compression garments during and after surgery to reduce risk of leg blood clots7. Have your surgeon use dissolvable sutures so you have no stitch marks8. Have your surgeon make your belly button a pinch on the small side since they stretch bigger9. Have your surgeon gently shape your abdominal flap to create a more athletic appearance and muscular contour10. Have your surgeon use Prineo tape bandages that stick on for six weeks to improve your tummy tuck scar.11. Begin post operative massage one to two weeks after surgery to speed recovery12. Begin with a board certified plastic surgeon and visit several offices13. Seek a surgeon who does at least 100 tummy tucks per year14. Internet discussions do not replace the advice of your physician

Darryl J. Blinski, MD · Answer

Thanks for the series of posted photos. Continue weight loss regime!!!! But you have more excess skin than fat therefore only a surgical contouring operation with the scars can obtain a better result and appearance NOT liposuction..//

David L. Cangello, MD, FACS · Answer

Hello and thank you for your question.Judging by your
photos it appears as though some combination of the procedures you mentioned
may work for you. Perhaps a belt lipectomy which is a bit more than an extended
tummy tuck it actually goes all the way around the trunk as opposed to just
slightly extending the tummy tuck incision. An upper body lift for the upper
back roles would likely benefit too.  I recommend that you see a
board certified plastic surgeon in consultation to get more specific answers to
your questions which can best be addressed after a thorough history and
examination is performed.
Best of luck to you!

Timothy Fee, MD · Answer

I do not believe liposuction is in your best interest unless some form of skin excision is performed at the same time. I have performed both and in my experience liposuction of back rolls following MWL is a failure.

Back Rolls After Weight Loss: Best Treatment? (ie lipo, upper body lift etc) (Photo)

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More Body Lift Questions

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More Body Lift Questions

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