Body Contouring
Body contouring is a general term that includes procedures that change the shape of the trunk and/or extremities. These procedures include liposuction, fat grafting, abdominoplasty, thigh lifts, buttock lifts, and brachioplasty (arm lifts). All these procedures have in common the fact that they remove excess fat but not all these procedures remove excess skin.
As physicians we promote a sensible diet and exercise regime as an important part of living a long and healthy life and although rigorous exercise can tone the body’s muscles it does not by itself tighten the skin. In many patients, exercise leads to weight loss which can actually cause the skin to loosen further. In patients with excessive weight loss, such as Gastric Bypass procedures for morbid obesity, we see extreme loosening and sagging of the skin. Pregnancy is another common contributing factor for not only loose skin but also a separation of the abdominal muscles along the midline. Finally, no amount of exercise or creams can remove the notorious “stretch marks” that many people develop. Body contouring procedures that remove and tighten skin are an option for people who have experienced extreme loosening of the skin. Loose skin around the abdomen, buttocks, groin, thighs, or upper arms can be removed and tightened and thus improve the tone and appearance of the area. In addition, body contouring procedures often address loose muscles and excess fat accumulation.
For patients who have good skin elasticity and only moderate fatty accumulation, liposuction is a good alternative. As a procedure, liposuction is somewhat limited because it does not directly remove skin, but for the properly selected patient, liposuction can contour areas such as the abdomen, thighs, hip, and arms with imperceptible scars and quicker recovery. In many cases, a combination of liposuction and removal of skin is performed in order to obtain optimal results such as an “abdominoplasty with liposuction of the hips and thighs”.
Abdominoplasty or a “Tummy Tuck” is a procedure in which excess loose skin and underlying subcutaneous fat are removed from the abdomen. This procedure also corrects the loose muscles along the midline that are affected due to pregnancy or weight gain. Although the incision for an abdominoplasty varies depending on how much skin is removed, most of these incisions are easily hidden with a garment and tend to improve significantly over time. Following an abdominoplasty, patients can expect a flatter more contoured abdominal area with tighter skin and muscles. Abdominoplasties are generally categorized as “Mini”, “Full”, or “Circumferential”.
A Mini Abdominoplasty has a shorter incision than a “Full Abdominoplasty” and is ideal for patients with loose skin concentrated below the belly button. Unlike the “Full Abdominoplasty”, it does not significantly correct loose skin above the belly button.
A Full Abdominoplasty is the most commonly performed abdominoplasty procedure and although the incision is longer than the “Mini”, it removes more excess tissue of the lower abdomen and significantly tightens the tissue above the belly button. It also corrects the loose separated muscles of the abdomen thus providing a tight “inner girdle”. It is the procedure of choice for woman who have had multiple pregnancies and are unhappy with loose skin and muscles.
Finally, a Circumferential Abdominoplasty is known by many names. It is often referred to as a “Total Lower Body Lift”, a “360 Degree Tummy Tuck”, “Dimple to Dimple Abdominoplasty”, or “Full Abdominoplasty with a Posterior Lipectomy”. It involves combining a Full Abdominoplasty in the front with a Lateral Thigh lift and Buttock Lift in the back, thus the incision goes completely around the body. This procedure is usually reserved for patients that have had either massive weight loss or simply have extreme hereditary loose skin.
With the exception of a Mini Abdominoplasty, most abdominoplasty patients require an overnight stay after surgery in a certified facility to ensure proper recovery and one to two weeks to fully recover and return to normal daily activities. Often, these procedures are combined with Liposuction and Breast Surgery.
A Mini Abdominoplasty has a shorter incision than a “Full Abdominoplasty” and is ideal for patients with loose skin concentrated below the belly button. Unlike the “Full Abdominoplasty”, it does not significantly correct loose skin above the belly button. The incision is slightly longer than a Cesarean section incsion and is easily hidden by the patient’s panty or bathing suit. There are several modifications to the Mini Abdominplasty. Usually the abdominal wall is tightened from the belly button to the pubic area. In some cases the surgeon may chose to tighten the abdominal wall above the belly button. Unlike the Full Abdominoplasty, much less skin is removed and the abdominal wall tightening is not as complete.
Despite a consistent diet and exercise regimen, some people still experience “problem areas” that cause self-consciousness. Liposuction offers a surgical solution to address areas that have excess fat and are resistant to other forms of slimming down. Liposuction can safely and effectively remove excess fat deposits of the abdomen, waist, thighs, hips, buttocks, upper arms, back, knees, chest/breasts and neck. Often, Liposuction is combined with Fat Grafting, especially of the buttocks. When combined with Fat Grafting, many plastic surgeons will refer to the procedure as Liposculpture.
Patients seeking Liposuction must be carefully selected since not everyone is a good candidate. Although Liposuction removes fatty deposits, it does not remove any skin. Patients who have excessive or loose skin, stretch marks, poor skin tone, or of a certain age group may not be good candidates. These patients are likely to have excessively loose skin after the procedure. Also, liposuction is not meant to replace a diet for a patient seeking weight loss and usually obese patients are not good candidates. Liposuction does not correct “cellulite” and in certain situations may worsen the appearance of the skin. The best way to obtain a good result with Liposuction is to have an honest and candid conversation with your plastic surgeon in order to determine if Liposuction can meet your goals and needs. More than any other procedure, selecting the correct patient prior to surgery is crucial in obtaining the best cosmetic results.
Like the abdomen, these areas are commonly treated with either Liposuction, the excision of excess skin, or a combination of both. Just like other areas of the body that are treated with Liposuction, patient selection is very important. In cases where the patient is not a good candidate for Liposuction because of loose skin, the excess skin will need to be surgically removed.
Removing excess arm skin is referred to as a “Brachioplasty”, while removing excess skin in the buttocks or thighs is simply called, “Buttock Lift” and “Thigh Lift”. All “lifting” procedures help reduce excess skin and tighten the surrounding area. Incisions are usually placed in strategic areas of the body that either allow for garments to hide the scars, or the scars will be hidden within skin folds or creases.
Another popular technique for enhancing the buttock area is Fat Grafting to the Buttocks. This technique is utilized to shape and contour the buttocks and it can be safely used in combination with liposuction of the surrounding area. When liposuction and fat grafting are used in combination it is often referred to as Liposculpture.
There are numerous combinations of plastic surgery procedures that can be safely performed either on the same day or in multiple stages. The most common combinations are procedures of the Breast and Body. The media has popularized these combinations as a “Mommy Makeover” or “Total Body Makeover”. These procedures can include a combination of Breast Augmentation, Breast Lift, Breast Reduction, Breast Lift with Augmentation, Full, Mini, and Circumferential Abdominoplasty, Liposuction, Fat Grafting, Thigh Lift, Arm Lift, Buttock Lift, etc. The possible combinations are endless, but they all have in common the fact that they must be performed by experienced plastic surgeons in properly accredited surgical facilities. When combining procedures, the plastic surgeon must take into account the patient’s goals and wishes with the amount of surgery that can be safely performed in one setting. Proper discussion and planning is critical, especially when multiple procedures are to be performed on the same day. An accredited surgical facility with proper anesthesia care and the ability to keep the patient overnight for an extended recovery is crucial to a safe and comfortable experience.
