Lower Body Lift, Thigh Lift and Arm Lift Post Weight Loss Body Rejuvenation Surgery
Good morning, it’s Dr. Nick at Denver Body Doc (DenverBodyDoc). We’ve got a big day today, join us as we’re helping a patient and her self-improvement journey. We’re doing a body lift, arm lift, thigh lift case today. A lot of surgery in a patient who’s had massive weight loss. A tremendous amount of preparation has gone in on the part of our patient, on the part of our team. Getting ready for surgery today is a big event. We’ve got our full team in place, a skilled assistant surgeon. Our patient’s going to be staying overnight in our surgery center.
Alright! Let’s get started. DenverBodyDoc Wednesday Surgery Day features a comprehensive post weight loss body rejuvenation: Body Lift, Medial Thigh Lift, Brachioplasty and Liposuction to Thighs.
Today’s patient has lost more than 175 pounds and has a very dramatic amount of excess. Her pubic area is really up in here. We’re going to treat all the way around today with a circumferential body lift, that’s a tummy tuck and on the back side where we’ve started now, a buttock thigh lift.
We’re started and now she’s over laying on her stomach. We’re doing the buttock and outer thigh lift where we remove tissue. We’ve also done liposuction of the waistline in the back. We’ll elevate the buttock as well as the inner thigh later for improvement of the thighs. The transformations we see in these massive weight loss patients are very rewarding, but they take a huge commitment and there are definitely limitations.
We’re just finishing closing up here. We’ve finished the back, including the inner thigh lift and the back side of the body lift. The outer thigh lift with the body lift has elevated the outer thigh re-supporting this whole body suit layer and smoothing the tissues.
For the inner thigh lift, we’ve raised tissues and brought up the inner thigh supporting and anchoring it very firmly along with shaping the buttock with the body lift. Next, we’re going to flip back over to the front side and finish up with the body lift and finish the rest of the middle thigh lift that comes up towards the groin.
We’re back on the front side of the body and I’m doing liposuction on the outer thighs. We’re going to get a good amount of volume off the thighs here. We get a lot of questions about the safety of doing combined procedures. That’s actually a very significant issue. To be a candidate for a longer procedure like this, you have to be very healthy. We do an extensive pre-op and supplementation including nutrition before surgery. In this case, we’re doing this as an overnight stay procedure where she’ll be monitored by a nurse overnight and that’s a big part of the safety of the procedure as well. It allows us to do more. For example, we can do more than five liters of liposuction versus outpatient, and we can give IV pain medication as necessary. Safety risks including blood clots are something we really carefully evaluate for, and in her case we’re also using a blood thinner after surgery.
A huge part of it as well is experience. We have more than 125 years of professional medical experience and 100 years of OR experience in the room with us right now, including 50 years of experience just between Virg, my surgical assistant and myself in the operating room performing surgery.
Our patient here is a young patient in her 20’s and has essentially always been overweight until successfully losing 175 pounds. Many people have used bariatric surgery as a way to lose weight, but our patient has simply done it through lifestyle change and has been very motivated and is now very stable at her weight. Even at this young age, that much weight change causes significant damage, essentially from head to toe in terms of changes within the body and its tissues. So preparation and recovery. Recovery is very significant afterwards and there’s always a chance that we’d have wound problems or some other complication. While it’s extremely rare to have hospitalization or other issues, minor complications that take time to heal can be something that we’ll see.
Despite the fact that this is definitely real and it’s serious, the transformations are incredible and this can be a major, major life-changing event. In fact, we’ve got many patients that we’ve gotten to know quite well. Some of you are watching now and have even sent questions in to us today. We really enjoy that.
Yes, don’t try this at home. We’re going inside the body so definitely viewer discretion is advised. We’ll get these blood vessels that need to be stopped and here’s one we can actually see. I’ll use a cauterizing tool and it’ll help shut down and cauterize the vessel. I’ve cauterized a couple vessels here, here’s one we just cauterized and that really shuts it down but it’s a decent sized vessel and it’s important that we find all these to stop the bleeding.
We’ve done a good part of our tummy tuck where we’ve raised up this tissue all the way up to the rib cage, gone around the preserved the belly button. I’ve tightened the muscle wall here in the middle and now I’m going to continue that shaping. Remove a little extra tissue to connect around the back where we’ve done the body lift on the back.
Over there on the side, we’ve got that outer thigh lifted, we’re going to continue and lift, lift all the way around towards the front to complete the thigh lift. We’re going to cut the extra skin off. This is the biggest part of the operation that she’s looking forward to. It’ll be about here. Underneath we have all the work that we’ve done.
I’m showing the lower abdominal skin area and the flap that we’re cutting off. This area above the blue line is the superficial fat, the deep fat is below this and I did the extra work here to remove the deep fat up into the flap that remains is for thinning of the flap.
Finishing the middle thigh lift here. We’ve done the back. We’re actually going to take a good bit more than we initially did so it’ll be several inches of elevation including a little off the top. The end game here is in the pull, everything up and into the middle will get all that tightening elevation of the thigh.
Anchoring down to the public bone and that’ll be a solid anchor to attach the flap up to. I’ve remarked her, I’m actually going to take a little bit more out. So part of the fun and the challenge here is how to sequence all of this to get the right result and do it safely. If I take too much, it’s going to be more prone to having wound problems. If I don’t take enough it’ll be loose and you won’t be as happy.
Another inherent limitation is the quality of the tissues and when there’s been this much weight change, we definitely expect more relapse so things definitely will loosen. Here where we’re doing the middle thigh lift with the body lift, we do the body lift first. You saw we anchored everything up so then we really know what’s left.
We got a question about the drains and what these tubes are. These tubes are actually drainage tubes in several locations. She has four. In this case, we need the drainage tubes because we’ve got so much space that’s opened up, dead space, that the body makes fluid we need to get out. I’ve gone and quilted down all of the dead space as much as possible and that helps things heal faster. Drainage usually stay for one to two weeks.
I’m fishing out the belly button here, we’re going to reattach it so that it’s got a new home but it’s the same belly button. The goal for the belly button, I like it to be small, pulled in and three dimensional and pretty.
We’re doing the arm lift now, so here’s the upper arm. I’m going to make my front incision, we’re going to remove all of this excess fat and tissue. Over here on the left arm, I’ve opened things up and I’ve basically raised thing along the muscle fascia where then we’ll remove the excess. However this procedures has some significant things to consider. The scar is long and it really can’t be fully hidden. I’ve designed the incision to put the scar as far to the front as possible where it’s basically hidden from the front view but just barely. Afterwards, though, that scar in the behind will always be visible with your arm down at your side. Unfortunately, this scar can heal unfavorably and be much more noticeable than other scars. That is definitely something to take into consideration.
The nerve sensation can also sometimes cause pain after surgery. That nerve pain or hyper sensitivity can happen anywhere but it’s more common in the arm. Sometimes it’s actually bad enough that we actually need to treat it. It does resolve.
Several people have asked about bleeding and why there’s not more bleeding. I’ve used liposuction fluid and that helped constrict the blood vessels to limit the blood loss. As you’ve seen if you’ve watched this, there are some areas that are bloodier than others, but we need to take very good care to stopping any of the bleeding areas as best as possible. I’ve checked my marks and I’m going to make the incision of tissue for the arm lift and so that scar will be all the way to the arm just past the elbow or a long scar.
We’ve had questions about the length of the scar in a mini arm lift or a short scar arm lift as well as about long versus short scar thigh lift. The long scar arm lift is absolutely necessary here because of the excess skin, it wouldn’t be possible to do a short scar. I’d like to get the arm as small as possible so we’ve done liposuction. If I make it too tight with the skin though, it’ll pucker the skin and that can cause problems.
Some patients are a better candidate for a short scar arm lift. In that case, the scar is really in the armpit, from the front of the armpit to the back of the armpit where we tighten things from above. In this case, we’ve done a shorter scar thigh lift in the inner thigh where it’s inside the groin crease and underneath the buttock for the scar.
This patient is a candidate for that long scar thigh lift. The trade off is that longer scar. Here she is a candidate probably getting about two thirds of the benefit. Where the short scar arm lift and the short scar thigh lift have the least power is down farther here towards the elbow or with the thigh down towards the knee.
Stapling things together here, then we’ll go ahead and close up and that’ll do it. We had a great day today, we finished up our patient’s headed to recovery and our overnight team is here. She’ll stay the night and we’ll see her in the morning. Special thanks to the patient, thanks for everyone watching and all the questions and comments and thanks to the great team for the hard work today.
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