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Despite
the great advances that
have
been achieved since the
advent of
Suction Lipoplasty,
surgeons and patients
are still unable to restore
skin elasticity. When
weight gain and loss,
age, pregnancy and disease
cause skin to be loose,
more traditional surgical
techniques must still
be used to tighten skin
and re-contour it to the
underlying shape. |
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| Just
as when an individual
loses several inches around
the waist, clothing must
be altered by "taking
it in" or removing
a dart, in other locations,
the skin, which is like
the fabric covering the
underlying body, must
be altered by removal
of excess. |
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By body contour surgery,
we usually include suction
assisted lipoplasty and
procedures such as abdominoplasty,
thigh lifts, and upper
arm tightening (brachioplasty)
surgery. Suction assisted
lipoplasty may be used
to complement the other,
more traditional body
contouring procedures.
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The
most common body contouring
operation, aside from
liposuction, is abdominoplasty,
or the Tummy Tuck, as
it is commonly referred
to by lay persons. Though
there are mini-operations
available for the abdomen
that have become possible
since the advent of liposuction.
In the average patient,
who comes with skin laxity
and some fat accumulations
in the abdomen, flanks
and other regions after
one or more pregnancies
or previous surgical procedures,
a full abdominoplasty
with a lengthy incision
is required.
In fact, the most common
form of abdominoplasty
which I currently use
is not a lesser variation
of a traditional procedure,
but is, instead, more
extensive, because so
much more is now known
about how to achieve best
results. |
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Buttock and thigh lifts
are done via incisions
which are placed along
the panty or bikini line
through the hip and low
back region for the outer
thigh and buttock, and
high up the inner thigh
at the junction with the
groin and inner thigh.
These operations are similar
in concept to the abdominoplasty,
but are less commonly
done.
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Removal of a fold of skin
plus the underlying fat
dates back to the early
part of the 20th century.
In the 1960’s, the
operation was refined
considerably and popularized
by a Brazilian surgeon,
Pitanguy. He also did
early thigh and buttock
lifts. Many of his improvements
are with us to this day.
Further advances were
made, particularly in
incision design, by a
Quebec surgeon, Paule
Regnault, who also worked
on innovations in breast
lift and reduction surgery.
However, the two most
significant advances in
the last quarter century
have been the advent of
suction lipoplasty, which
allowed for treatment
of the abdomen fat, with
or without skin removal,
and the deep layer support
techniques of Dr. T. Lockwood
of Kansas City. He carefully
looked at the anatomy
of the abdominal wall,
and decided that there
was merit in using the
superficial fascia, a
layer of thin but strong
tissue, part way down
in the fat layer, as the
main means of support,
in repairing the skin
incisions during both
abdominoplasties and thigh
lift procedures.This layer
had been known to surgeons
and anatomists for many
years, but most plastic
surgeons never felt it
had enough strength to
be of significant use
in repairing the abdominal
wall and it was often
either ignored or only
loosely stitched.
Assessment
The usual patient presenting for abdominoplasty has had previous
pregnancies, and has usually decided not to have any more
children. ( Future pregnancies will tend to re-stretch the
skin and may cause recurrence of the shape the patient feels
is unsatisfactory). She may or may not have had Caesarean
sections, or other abdominal surgery. The low gynecologic
and Caesarean scar (called a Pfannenstiel incision by gynecologists)
is often adherent to the underlying muscle, and above the
incision, the non-adherent abdominal skin and fat often droop,
and fold over the site of the incision. In some cases, with
skin lying against skin, there may be so much problem with
moisture causing skin irritation, that the medical insurance
will pay for a procedure to reduce the overhanging skin, but
a formal, cosmetic abdominoplasty will usually require patient
payment. |
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The
vertical abdominal muscles (the rectus abdominis) have
often been stretched, and they may be separated down
the midline, giving bulging of the central abdomen.
In more severe cases, there may even be a hernia of
the belly button (umbilicus). In a hernia, not only
does the abdomen bulge, but some of the contents of
the abdominal cavity (internal organs, fat, etc.) may
bulge through a weak part of the abdominal wall. Other
old surgical scars may further distort the shape of
the abdomen.
Occasionally, I also have
male patients who want
abdominoplasty surgery.
Men often carry most of
their trunk fat inside
the abdominal cavity,
rather than under the
skin, and abdominoplasty
is somewhat less effective
at reducing and recontouring
in men. Yet, they
will usually have a reasonable
and satisfying result. |
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| In
patients with less dramatic
changes, a modified, or
mini-abdominoplasty is
effective. In this procedure,
there is less excess skin
and a significant amount
of fat, so the major procedure
is liposuction with the
addition of a smaller
skin tightening procedure.
At one time, about three
quarters of my patients
seemed to fall into this
category; the reverse
is now true. This is because
I feel I must do a full
abdominoplasty in most
of my patients to give
them the result they have
envisaged for themselves;
a lesser operation leaves
them somewhat disappointed. |
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Other
Contouring Procedures
Patients for buttock
and thigh lift may initially
come to their consultation
requesting liposuction,
complaining of unsightly
fat and “cellulite”
but, because of laxity
of the skin and deep tissues,
should be told that the
results of suction alone
may be quite disappointing.
While suction offers an
operation with little
in the way of post-op
scars, it will result
in further loss of skin
tone and likely significant
contour irregularities. |
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For
this reason they are offered
a lift procedure which,
despite the significant
scar, will result in a
much restored appearance
to the thigh and buttock.
Some of these patients
will have had suction
done in the past and wish
to have something further
done. The situation is
similar to patients who
have had only suction
done in the neck and have
residual neck skin and
muscle redundancy for
which the only treatment
is a face and necklift.
The same can be said for the sagging which may occur in the
arms. In the right patient, who can manage with the scars
during the time they are fresh, a brachioplasty
may be valuable: |
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Conclusion
Open body contour
surgery ( using incisions
to tighten or lift, as
opposed to suction surgery),
is a powerful way to re-shape
the torso, arms, buttocks
and thighs. The major
obstacles which may include
a longer recovery period,
greater expense, and significant
scars, may be more than
worthwhile, when the results
of surgery are considered. |
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Deciding whether Body Contour Surgery is right for you starts with a personal consultation with Dr. Gelfant.
You are invited to contact us at our Vancouver offices to arrange a meeting.
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