My coauthor and I thank the authors for their kind words and thoughts concerning the cosmetic body lift. Perhaps it would be helpful to discuss and compare the patient populations of the post–bariatric surgery candidates with the typical patients in our series and the ultimate goals of the surgery dictated by the type of practice of the individual surgeons involved and the body anatomy that they desire changed. As the saying goes, “it’s like comparing apples to oranges.”
Based on their publications, these surgeons work in the challenging world of massive weight loss patients and have obviously acquired a valuable experience dealing with this particular patient population. Their patients have significant nutritional and safety concerns in addition to poor tissue quality. In total contrast, the patient population in my practice is significantly different. The desires and the goals of the patients are purely cosmetic.
I have performed all types of aesthetic surgery over the past four decades and have developed mainly a face-lift practice. These same patients in my practice are very concerned about body changes and therefore seek body contouring surgery. My discontent with conventional abdominoplasties mirrored my discontent with conventional face-lift techniques. There was always an improvement, but the results were never optimal. Lockwood’s huge contribution changed everything.
My earlier nonpostbariatric cosmetic body lifts incorporated the 360-degree incision and autoaugmentation of the buttock. Over time, I found that the initial buttock improvement was not stable. In addition, the tension needed for the 360-degree incision in the nonpostbariatric subset added risk to primary incision healing. Conversely, the lower body lift in the massive weight loss population easily addresses the extraordinarily loose tissue and improves gluteal ptosis. In the face-lift type, nonpostbariatric population, the degree of gluteal ptosis is much less apparent and therefore less concerning to the patients. Whether body surgery or facial surgery, there is a common characteristic. The greater the redundancy, the more dramatic the result.
The postpartum patient has always had the triad of rectus muscle separation, extra skin, and extra fat, the three factors that have always led women to seek abdominoplasties. The majority of patients that consult me have never heard about the cosmetic body lift. Once they see the photographs of the preoperative situation and the postoperative results, they find it logical to request this surgical procedure. The abdominal overlay images published in our article explain to the prospective patient the impressive improvement in the comparable parts of the body. Most women have been terribly disappointed by their diet and exercise results in spite of rigid adherence to various routines. In addition, the fashion magazines promote an unattainable body image, and the diet and exercise industry, monumentally influential and profitable, perpetuates this propaganda.
I have tailored this procedure for my typical “face-lift” age patient—healthy, affluent, and beauty oriented. The 270-degree incision allows me to easily access the flanks, back, circumferential thighs, and knees without turning the patient to the prone position, a great relief to the anesthesiologist. I frequently combine breast surgery, upper arm surgery, and even composite face lifts at the same time with little loss of time from turning the patient on her abdomen. This approach is a 4-hour procedure that is safe and comprehensive. The authors are correct that the posterior portion of the 270-degree incision may be asymmetrical, but when the incision is well healed and is positioned under sports briefs, this potential asymmetric scar is of little concern to the patients who are ecstatic over their new body shape, the shape they have dreamed about having for years.
Without question, the massive weight loss patient with ongoing surgery for the arms, breasts, and thighs is in a different surgical world than the surgery patient I see. My philosophy for cosmetic body lifts is the same as my philosophy for surgery of the aging face, as I always use a composite rhytidectomy. There must be a comprehensive and global improvement in every part of the aging body just as I try to achieve with every part of the aging face. Although these operations may not be for every surgeon, they are appropriate for almost every patient because almost every woman has developed changes from pregnancies and inherited body shapes. Women all over the world have always wanted the most beautiful body contour possible. Aesthetic surgery has developed as a response to what anatomical area every person would like to change.
The author has no financial interest to declare in relation to the content of this communication.
Sam T. Hamra, M.D.
Department of Plastic Surgery
University of Texas Southwestern Medical Center
1. Hamra ST, Small KH. Cosmetic body lift. Plast Reconstr Surg. 2016;137:453461.
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