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• W1992617042 abstract "Sir: There has been a rapid increase in body-lift procedures worldwide in the past few years.1–3 The gluteal region itself is one of the most challenging parts of the massive weight loss body. Gluteal lifting is commonly performed through central or lower body lifting. There is no doubt about having most patients seeking augmentation versus gluteal reduction. Nevertheless, some patients suffer from remaining lipomatosis in the gluteal and lumbar regions after massive weight loss. In the past, we noted the majority of fatty tissue in gluteal-lumbar lipomatosis to be located underneath the superficial fascial system.4,5 Only a minor portion was situated subcutaneously. In contrast, we have always used the superficial fascial system for preparation in body-lift procedures. Both aspects were determining for the surgical procedure described. Preoperative markings are performed with the patient in the standing upright position. The incision line and extent of assumed resectable tissue are marked. Drawings are performed according to the principles for central or lower body-lift procedures. Because of these criteria, the amount of gluteal-lumbar lipomatosis is assessed in the manner of a liposuction-like marking. This part of the preoperative planning is essential for the procedure, as the overwhelming tissue in the gluteal-lumbar area is best visible in the upright position. The operation starts with the patient in prone position (Fig. 1). We use methylene blue to mark the lipomatosis transcutaneously. The incision then starts at the superior line. Preparation is done at the level of the superficial fascial system. The margins of the lipomatosis become visible. The dots of methylene blue are connected. Retention stitches show the area of resection (i.e., the area of lipomatosis) inside the lining. Superficial fascia and subfascial fatty tissue are excised en bloc. One should leave enough fatty tissue on the deep fascia to prevent seroma formation. The edges of the superficial fascia are approximated with 2-0 Vicryl (Ethicon, Inc., Somerville, N.J.) single sutures. This maneuver leads to a plane superficial fascial system again. The most important side effect is the gluteal area being lifted with the approximation. The operation continues as is required for central or lower body-lifting procedures.Fig. 1.: Approximation of the superficial fascial system after resection of the area of lipomatosis marked with methylene blue.This method considers the goals of buttock aesthetics. These are best shown on lateral view: the presacral area has a lazy-S–shaped curve. Most of the gluteal volume is central, which is the most visible change after the operation. Preoperatively, these patients present with most of the gluteal volume in the lumbar and upper buttock area (Fig. 2).Fig. 2.: Preoperative (left) and postoperative (right) views.This technique is effective and easy to perform. In a body-lift procedure, it is a fast and cost-effective method of improving buttock aesthetics in this particular patient population. There is no further need for liposuction. Because of preparation on the superficial fascia and excision of fatty tissue slightly underneath this level, lymphatic vessel harvest is assumed to be low. Matthias Koller, M.D. Thomas Hintringer, M.D. Department of Plastic and Reconstructive Surgery Sisters of Mercy Hospital Linz Linz, Austria" @default.
• W1992617042 created "2016-06-24" @default.
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• W1992617042 date "2010-12-01" @default.
• W1992617042 modified "2023-09-25" @default.
• W1992617042 title "Gluteal Shaping in the Massive Weight Loss Patient with Remaining Lipomatosis in the Upper Buttock and Lumbar Region" @default.
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• W1992617042 doi "https://doi.org/10.1097/prs.0b013e3181f64055" @default.
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