Medical & Trade Publications

January 2006

by Amy M. Ortega, M.D.
Medical / Plastic Surgery

Lower Body Contouring

Another year has passed and while we are busy meeting life's everyday demands, gravity continues to take its toll. You may have gained or lost weight in the past year, perhaps your body has endured a pregnancy or maybe even age has caused loose, sagging skin.

Many people have experienced the frustrations in trying to obtain a flawless figure, but unfortunately, even a great diet and exercise cannot always beat gravity and time, and the added effects of dramatic weight change or pregnancy only add to the problem.

Usually, when people think of a proportioned lower body, they often picture a flat abdomen with gentle contours to the waist, hips, buttocks and thighs. The surgical approach to address all of these areas is lower body contouring, or lower body lift, which refers to a combination of approaches—usually liposuction, abdominoplasty (tummy tuck), and gluteal lift (butt lift).

Not everyone will need all three, although for some patients, this will produce the optimal result. This approach allows the surgeon the greatest flexibility in creating a beautifully proportioned lower body.

Why liposuction?

Liposuction is used to remove those stubborn areas of fat that are resistant to diet and exercise. In women, these areas are typically around the hips and thighs, and in men, they tend to be around the abdomen. Liposuction does not lift and tighten skin.

Gluteal lifts are especially helpful in cases of massive weight loss, wherein the excess skin is producing redundant rolls that reach around the entire body.

Why abdominoplasty?

An abdominoplasty or tummy tuck is different from liposuction in that it can correct both excess fatty tissue in the abdomen and muscle weakness, as well as remove excess skin. Muscle weakness is often what causes the "pooch" of the lower abdomen that plagues so many, especially after pregnancy.

Pregnancy permanently separates the rectus muscles, the vertical muscles of the abdomen, which provide support. This can also happen with dramatic weight gain. With damaged rectus muscles, all the stomach crunches in the world will not flatten the abdomen. An abdominoplasty enables the surgeon to remove any stretched or excess skin and fat from the lower abdomen and tighten the muscles to restore support.

Why gluteal lift?

Gravity's effects over time, combined with the weakened support of aging skin and soft tissues, produce a "sagging" look to the thighs and buttocks, and many people believe that liposuction will address this undesired look. While liposuction can definitely improve contour if excess fat pockets are the problem, keep in mind that it can only remove fat under the skin, leaving loose, redundant skin behind. Depending on the skin's ability to retract or return to its previous form, the sagging may still remain even after liposuction.

While the typical gluteal lift only addresses the buttock area, a more current approach also addresses the lateral (side) thighs and can stretch tissue down from the back if needed. This is especially helpful in cases of massive weight loss, wherein the excess skin is producing redundant rolls that reach around the entire body.

The procedure

A lower body lift brings the incisions of the abdominoplasty and the gluteal lift together for a lift around the entire body. The major advantage to a lower body lift is that the incisions that extend around the sides of the body enable the surgeon to contour the particular area, producing a slimmer waist and thighs.

It also facilitates a more effective contouring of the abdomen and buttocks. Adding liposuction not only improves contour, but also decreases the weight and bulk of the tissues for a more effective lower body lift.

In my experience, the key to getting the most "lift" on the sides of the body (for waist and thighs) is by actually placing the patient on each side during surgery (in addition to the typical front and back positioning to address the abdomen and buttocks). Although it does add time to the procedure, this method significantly improves the surgeon's ability to obtain a beautiful result.

Who is a candidate?

Anyone who has lax tissues or excess skin around the lower body is a candidate for a lower body lift. This procedure can take eight hours or longer, depending on the size of the patient, and is typically done in the hospital with an overnight stay. Because of the procedure's length, patients with certain medical problems may not be ideal candidates or may have to undergo the surgery in two stages for safety reasons.

The recovery

While many patients are concerned about a lengthy recovery period and possible increased pain with this procedure compared to other options, the healing process is similar to an abdominoplasty or other comparable procedures. Most patients are able to return to their desk job in one week, but two weeks off is optimal.

Patients typically take pain medication one to three days following surgery, and they are walking within hours. A surgical compression garment must be worn, which looks like a high-tech girdle, for up to six weeks post-surgery. All of this hides nicely under clothing and generally does not limit daily activity. Moderate activity such as walking is encouraged and heavy exercise can be resumed after six weeks.

Amy Ortega, M.D. is a board-certified, double fellowship trained cosmetic plastic surgeon with a special interest in breast and body contouring. She can be reached for consultation at her Atlanta office at (404) 751-2500. For more information ABOUT DR. ORTEGA visit www.ASAbeautiful.com.