Cırcumferentıal Abdomınoplasty

Introduction

Circumferential abdominoplasty, also referred to as a body lift, is the most powerful form of midbody or trunk contouring. It differs from belt lipectomy in its concurrent use of thorough tumescent liposuction, strong myofascial plication, and often subscarpal fat resection. In addition, the resection is usually centered lower on the trunk, with a final scar placement that is more caudal than in belt lipectomy.

Patient Selection

Patient selection criteria for circumferential abdominoplasty include the same criteria as for full abdominoplasty plus the addition of buttock ptosis, lateral and posterior thigh laxity, and patient acceptance of a circumferential incision. Patients will often demonstrate their desire for circumferential abdominoplasty by pulling their thigh and buttock skin upwards, demonstrating correction of anterior and lateral thigh soft-tissue laxity as well as correction of buttock shape and ptosis .

Relative contraindications for circumferential abdominoplasty

●  Smoking
●  Diabetes mellitus
●  Malnutrition
●  Various wound healing disorders
●  Bowel/bladder dysfunction
●  Immunodeficiency
●  Medications that inhibit blood coagulation
●  A significant history of pulmonary or deep vein thrombosis
●  Lower extremity lymphedema/ venous insufficiency
●  Significant medical problems, including COPD/pulmonary issues, renal insufficiency, anemia, and
other systemic issues that may make abdominal tightening surgery dangerous

Preoperative recommendations for circumferential abdominoplasty

●  Smoking cessation/avoidance of nicotine exposure for 6 weeks prior to surgery
●  Multivitamin Daily
●  Stop aspirin/other blood thinning products with primary care doctor’s permission
●  Abstain from all dietary/herbal supplements not approved by the surgeon
●   Basic laboratory work should be tailored to each patient. It may include CBC, Chem, Coagulation tests PT/PTT/INR.
●   Nutritional values, including albumin, may be warranted especially in gastric bypass patients

Operative Approach

●  The procedure must be individualized for each patient. The benefit of autologous buttock augmentation and other ancillary procedures should be considered.
●  Preoperative instructions/requirements must be methodically followed to maximize safety.
●  Preoperative markings and photographs are invaluable to achieve the best possible results
●  Concurrent liposuction of the abdominal soft-tissue apron is of great value, especially for the
patient with incomplete weight loss or those who have moderate to significant excess adiposity
●  The vertical resection should end inferiorly with the ends curving medially, similar to an
unfinished ellipse as opposed to a triangle
●  Subscarpal fat resection can be performed safely if needed

Buttock lift

Correction of the abdomen alone is often not enough to restore appropriate contour for many weight loss patients. Procedures have been devised to correct the entire lower-body unit, including the lower-body lift, belt lipectomy, and circumferential torsoplasty. Although the names are different, the principle in theory is similar; to affect a circumferential correction of laxity in the buttocks, lateral thighs, and abdomen with elimination of rolls and festoons.

The circumferential body lift is a very powerful operation, allowing correction of the abdomen, lateral thighs, and buttocks in a single stage.

Postoperative instructions for circumferential abdominoplasty

●  Maintain a partially flexed position at the waist for the first 1–2 weeks
●  Wear the abdominal binder at all times, except for showering
●  Make sure the binder is maintained low enough on the abdomen
●  Verify that there are no significant creases, folds, or the presence of drain tubes underneath the binder
●  Avoid smoking or exposure to nicotine-containing products
●  Breathe deeply and use the incentive spirometer frequently
●  Drink plenty of fluids.
●  Move legs frequently while resting, and walk regularly
●  Continue to take multivitamin daily. Resume medications as instructed
●  If buttock augmentation has been performed use ample padding when sitting
●  No vigorous activity or heavy lifting for 4–6 weeks. Submersion under water, including swimming, is prohibited until proper healing has occurred.