83 Postbariatric Body Contouring: Lower Body Lift

Jonathan P. Brower and Jeffrey A. Gusenoff

Abstract

The lower body lift is an excellent option to treat stigmata of massive weight loss in the buttocks, primarily skin excess and volume loss. The procedure can be performed with or without autoaugmentation to address volume deficit and contour irregularities. The lower body lift is often combined with other procedures, including medial thigh lift or abdominoplasty. It is essential to optimize nutritional status and manage expectations preoperatively to achieve patient safety and satisfaction. Markings are essential to ensure appropriate shape, symmetry, and tension. Suction-assisted lipectomy is a useful adjunct to improve contour and provide discontinuous undermining to assist in closure. Patients are generally admitted to the hospital for 1 to 2 nights to ensure adequate nursing care and facilitate early ambulation to combat venous thromboembolism.

Lower body lift – massive weight loss – body contouring – buttock reshaping – gluteal autoaugmentation – saddlebag deformity

83 Postbariatric Body Contouring: Lower Body Lift

Key Points

The lower body lift provides circumferential contouring of the trunk, buttock, and thigh regions particularly problematic in the massive weight loss (MWL) patient.
The lower body lift is “lower” than a belt lipectomy and aims to restore normal shape of the buttocks and saddlebag regions. The belt lipectomy is based higher and improves the lower back or love handles without much benefit to the lower buttocks or outer thigh.
The lower body lift can be performed with or without gluteal autoaugmentation, and can be combined with an abdominoplasty or inner thighplasty.

83.1 Preoperative Steps

83.1.1 Preoperative Evaluation

Optimizing Surgical Candidacy

A weight loss history is essential for appropriate patient selection. A body mass index (BMI) less than 30 kg/m² is optimal.
- A higher BMI before bariatric surgery and at the time of evaluation for body contouring after MWL are associated with higher complication rates.
- Patients may need to achieve further weight loss to be an appropriate candidate.
Patients should be at least 1 year out from their bariatric procedure and have stable weight for 3 months.
Medical history is focused on evaluating cardiopulmonary and metabolic comorbidities, including coronary artery disease, obstructive sleep apnea, and diabetes mellitus. Any history of thrombotic events should be further investigated.
Medications with antiplatelet activity, including some herbal remedies and supplements, are discontinued 2 weeks before surgery.
All nicotine exposure must be discontinued 4 weeks prior to surgery.
Physical examination should include noting of all surgical scars and hernias.
Nutritional deficiencies are common among patients who have had bariatric surgery.
- Goal protein intake is 70 to 100 g/day. Serum albumin and prealbumin should be measured as history alone is not adequate to rule out protein malnutrition.
- Common micronutrient deficiencies in bariatric patients include iron, calcium, B₁₂, folate, and thiamine.
A psychiatric history is an important part of the initial evaluation.
- Mood and personality disorders are prevalent in obese patients and typically do not resolve with weight loss.
Expectations are carefully managed, emphasizing that excess skin will be traded for a long scar.
- The goal is to achieve improvement in body contour, not perfection.
The social support system is evaluated, including living situation and availability of family and friends to assist the patient postoperatively.
Preoperative medical evaluation includes labs (complete blood count, electrolytes, renal function, coagulation studies, and blood type and screen).
An electrocardiogram (EKG) is obtained for patients over age 40.
The patient is evaluated by the primary care physician, any necessary specialists, and/or anesthesia to provide medical clearance and guidance for perioperative medical management.