Solution to the back fat above my lower body lift scar? I want a more defined transition. Is lipo the only solution? (Photo)

Question

Lower back / elongated butt crack after lower body lift.

Semih Yildiz, MD, FEPOBRAS · Answer

Liposuction can help if the fullness above the lower body lift scar is mainly residual fat, but it is not always the best or only solution. In the visible photos, there appears to be a transition step/roll above the scar with some skin and soft-tissue laxity, so the key question is whether the problem is fat, loose skin, scar tethering, or a combination.

If there is good skin tone and localized fat, careful liposuction may soften the area. If the issue is loose skin or a tight/tethered scar, liposuction alone may not improve the elongated cleft or may even make the skin look looser. Options can include scar revision, limited skin excision, release of tethering, contouring with liposuction, and sometimes fat grafting to smooth a depressed transition. An in-person exam with pinch testing and scar assessment is needed to decide which part is fat versus skin versus scar position.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding if there is a solution to the backfat above your lower body lift scar. There are two ways to address this area above the lower body lift. It can be addressed with liposuction or an incision. During liposuction, excess fat is removed. The concern is that your skin may not recoil, and you may be left with loose hanging skin. This is a valid concern because I assume you have lost significant weight. The other alternative that may give you more of an hourglass shape and permanently eliminates excess skin and fat in the love handle or superior iliac crest region is a vertical torsoplasty. During a vertical torsoplasty, an incision is from your armpit down your sides towards the body lift and sometimes even below. During the vertical torsoplasty, a sizeable elliptical area of skin and fat is removed from your armpit to the hip. The skin eliminates excess skin and fat in the posterior love handle region. Some surgeons also call this vertical torsoplasy a hourglassing procedure because the result is an hourglass figure. Vertical torsoplasty is not standard, so you must look for a specialist. I hope my answer suggests what to do with the back fat after a lower body lift.

Miguel Mota, MD · Answer

Congratulations on loosing the weight. Yes! Liposuction is your best option. Vaser Liposuction would be my preferred method of treatment. This will also help get rid of the elongated butt crack as well.

Lipo of your back and waist and stomach, if you’re interested, would be the perfect combination. I would avoid very aggressive lipo so as not end up with loose and sagging skin. But Vaser Lipo would be great on you!

Best wishes,
Dr. Miguel Mota

Daniel Barrett, MD · Answer

Dear berica,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you 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

Zoran Potparic, MD · Answer

Unfortunatelly, your buttock incision is placed too low; this takes much off the buttock shape and projection! Placing this scar higher on your buttocks, where it should be, will give a chance to take some of the tissue above current scar and place it underneath, in the form of viable flap, to increase bulk and projection of upper pole of buttock. This will also lift your butt. Agressive liposuction of flanks and lower back would further improve shape of back/buttocks area. Hope this helps.

George Marosan, MD · Answer

Thank you for your question and photos. It seems that you had a belt lipectomy with the obvious expected results. There are two issues here. First, you have lots of excess fat on your whole back and above your scar. Liposuction is the best way to get the most contouring. Second, the scar in the mid lower back needs to be extended downward, like a gull wing to do away with the elongated buttock crack. This will need to be done after you heal from the liposuction. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Michele A. Shermak, MD · Answer

Hello!
There are 2 issues here. One is the focal fat above your scar. The other is the manner in which your gluteal cleft looks superiorly elongated. Sometimes this is hard to avoid in the primary procedure. The best solution is liposuction of the back and revision of the midline area to treat what looks like an elongated gluteal cleft. There will be a residual scar but the contour will be flattened there.
I would recommend you see a board certified plastic surgeon. You can find one at plasticsurgery.org.
Best of luck to you!

Finny George, MD · Answer

Hi, thank you for sharing your question. Liposuction is a great option for you. The other option would require a much more invasive approach to removing the skin and fat if you choose.

Camille Cash, MD · Answer

Liposuction will be the best to help contour the lower back area.  The contour can be further improved with a second stage to address the scar which currently gives the illusion of an elongated buttocks cleft.  See a board certified plastic surgeon ear you to learn more.

Mats Hagstrom, MD (license on probation) · Answer

It looks like your fat distribution is contributing to a less than ideal body contour. Well done Liposuction should be able to correct the bulge just above your scar which is now somewhere between your waist and love handles.
Skin laxity due to weight loss is created both vertically and horizontally. with a wraparound tummy tuck or body lift there is still going to be a horizontal skin laxity because there is no vertical scar.
Your surgeon may have worked this excess skin towards your back. That’s the best explanation for the skin fold above your gluteal crease. I don’t think there’s an easy solution but Liposuction should at least reduce the appearance to some degree.
Delivering consistent quality liposuction results is not as easy as people believe. For that reason I recommend patients be highly selective when it comes to choosing Liposuction providers.
I recommend having multiple in person consultations with local board-certified plastic surgeons who seem to have a lot of experience doing quality liposuction.
Simply being board-certified and plastic surgery with an overall good reputation and years of experience does not necessarily mean somebody is good at Liposuction.
Personally I treat the entire torso as a single anatomic unit when doing liposuction. by treating the entire torso there are no transition zones between treated and untreated areas. treating the entire torso as one unit leaves patients with an even natural thin fat distribution of their entire torso. A full torso includes upper abdomen, lower abdomen, love handles, ways to come a full back and under arms all the way to the side of the breast.
That should pretty much get you where you need to be in regards to contour.
The goal is to create a feminine S-curve scene from the backside that goes from the armpit to the knee. The curve should follow the thigh and buttocks then go in a long your love handles in the waist following with sitting at your back and under arm area. You’re a Abdomen is not included in your pictures and it probably looks better than before from your previous procedure. Most likely it could benefit from having some liposuction as well to improve your outcome.
I recommend patient schedule multiple in person consultations. Start with five consultations and consider scheduling more if needed.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures of abdominal or torso liposuction.
An experience provider should have no difficulty showing you at least 50 set of before and after pictures of commonly performed procedures like liposuction of the abdomen or torso.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that did not turn out as well as they had hoped. Providers are going to be tempted to want to show you on the preselected images representing some of the best work of their career. while this may be impressive your goal should be to get an assessment of what average results look like not the best results of the providers career. do you want to also get some type of assessment in regards to how many of these procedures they have actually performed.
In reality highly experienced surgeons should have 100s or even thousands of before and after pictures of this procedure.
Liposuction results are permanent and irreversible. You’ve done poorly people can be left disfigured.
It is very difficult and sometimes not possible to improve the outcome of badly done Liposuction.
Being board-certified in plastic surgery with an overall good reputation and years of experience does not mean somebody has mastered liposuction.
Continue having consultations until you feel quite confident you found the best provider in your community for Liposuction.
You can ask them to address the issue with your lower back and see if they have some possible solutions.
It’s a little hard to assess that skinfold by looking at pictures only.
Best,
Mats Hagstrom MD

Solution to the back fat above my lower body lift scar? I want a more defined transition. Is lipo the only solution? (Photo)

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