BMI Drives Body Contouring Results

DANA POINT, CALIF. – Three factors affect the results of body contouring outcomes after bariatric surgery: body mass index at presentation, fat deposition pattern, and quality of the skin-fat envelope, according to Dr. Al S. Aly.

"The fat deposition pattern is genetically controlled; we cannot alter that," Dr. Aly, professor and vice-chair of plastic surgery at the University of California, Irvine, said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF). "The quality of the skin-fat envelope is very important. If you have a very loose skin-fat envelope – meaning that they’ve had a tremendous drop in weight – you can do a lot more for them than with other patients."

The two main body contouring treatments for the lower trunk are abdominoplasty and circumferential belt lipectomy, said Dr. Aly. "Abdominoplasties are ideally suited for problems limited to the belly, or those located between the two anterior superior iliac spines. For larger patients you need to do something else."

The rehabilitation of larger patients involves a circumferential procedure commonly referred to as a body lift or belt lipectomy, which involves removing a circumferential wedge of tissue from around the trunk. "There are many reasons why we need circumferential excisions for these large patients, but the main one is that you need circumferential improvement above and below the area of resection as opposed to a regular tummy tuck," he explained.

Markings for the belt lipectomy "are the essence of the procedure," Dr. Aly said, who noted that about 10% of his patients are male. "The markings are adjustable guidelines, and they vary according to anatomy and desires. It’s a fairly complex set of issues but essentially you have to understand how tissues drape as the patient loses weight, and there are zones of adherence or areas of the body where the skin and the soft tissue envelope is stuck to the underlying musculoskeletal anatomy. It’s important to understand those before you can mark these patients. Surgical improvement is related to the amount of tension that you create above and below an area of excision."

Dr. Aly said that he routinely performs belt lipectomies with another surgeon and strives for surgical times under 6 hours. He uses a general anesthetic and an epidural for postoperative pain management. Moving patients into multiple positions during surgery is required, "otherwise you can’t accomplish the excisions," he said. "There is a variety of different approaches. Mine happens to be one of supine first then lateral/lateral."

Results of body contouring procedures generally correlate with the patient’s body mass index (BMI) at the time of surgery. "So people who present to us above a BMI of 35 kg/m² ... their results are okay," he said. "Results are better for patients with a BMI of 30-35 kg/m². If you’re lucky enough to get a patient at an ideal BMI – 26 kg/m² and lower – then you can create almost normal anatomy."

He noted that, compared with abdominoplasties, results of belt lipectomies take longer than most procedures to mature. "However, their results are also far superior to those attainable with a tummy tuck," Dr. Aly said. Complications, including an increased risk for seroma and formation of hematoma, "correlate with BMI," he said. "If you’re not ready to deal with complications, massive weight loss patients are a tough group to deal with. It’s part of the nature of these patients."

Other areas that often need contouring include upper arm reductions, upper back roll reductions, reconstruction of the breasts (in women and men), and thigh reductions.

Dr. Aly said that he had no relevant conflicts to disclose. SDEF and this news organization are owned by Elsevier.

DANA POINT, CALIF. – Three factors affect the results of body contouring outcomes after bariatric surgery: body mass index at presentation, fat deposition pattern, and quality of the skin-fat envelope, according to Dr. Al S. Aly.

"The fat deposition pattern is genetically controlled; we cannot alter that," Dr. Aly, professor and vice-chair of plastic surgery at the University of California, Irvine, said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF). "The quality of the skin-fat envelope is very important. If you have a very loose skin-fat envelope – meaning that they’ve had a tremendous drop in weight – you can do a lot more for them than with other patients."

The two main body contouring treatments for the lower trunk are abdominoplasty and circumferential belt lipectomy, said Dr. Aly. "Abdominoplasties are ideally suited for problems limited to the belly, or those located between the two anterior superior iliac spines. For larger patients you need to do something else."

The rehabilitation of larger patients involves a circumferential procedure commonly referred to as a body lift or belt lipectomy, which involves removing a circumferential wedge of tissue from around the trunk. "There are many reasons why we need circumferential excisions for these large patients, but the main one is that you need circumferential improvement above and below the area of resection as opposed to a regular tummy tuck," he explained.

Markings for the belt lipectomy "are the essence of the procedure," Dr. Aly said, who noted that about 10% of his patients are male. "The markings are adjustable guidelines, and they vary according to anatomy and desires. It’s a fairly complex set of issues but essentially you have to understand how tissues drape as the patient loses weight, and there are zones of adherence or areas of the body where the skin and the soft tissue envelope is stuck to the underlying musculoskeletal anatomy. It’s important to understand those before you can mark these patients. Surgical improvement is related to the amount of tension that you create above and below an area of excision."

Dr. Aly said that he routinely performs belt lipectomies with another surgeon and strives for surgical times under 6 hours. He uses a general anesthetic and an epidural for postoperative pain management. Moving patients into multiple positions during surgery is required, "otherwise you can’t accomplish the excisions," he said. "There is a variety of different approaches. Mine happens to be one of supine first then lateral/lateral."

Results of body contouring procedures generally correlate with the patient’s body mass index (BMI) at the time of surgery. "So people who present to us above a BMI of 35 kg/m² ... their results are okay," he said. "Results are better for patients with a BMI of 30-35 kg/m². If you’re lucky enough to get a patient at an ideal BMI – 26 kg/m² and lower – then you can create almost normal anatomy."

He noted that, compared with abdominoplasties, results of belt lipectomies take longer than most procedures to mature. "However, their results are also far superior to those attainable with a tummy tuck," Dr. Aly said. Complications, including an increased risk for seroma and formation of hematoma, "correlate with BMI," he said. "If you’re not ready to deal with complications, massive weight loss patients are a tough group to deal with. It’s part of the nature of these patients."

Other areas that often need contouring include upper arm reductions, upper back roll reductions, reconstruction of the breasts (in women and men), and thigh reductions.

Dr. Aly said that he had no relevant conflicts to disclose. SDEF and this news organization are owned by Elsevier.

DANA POINT, CALIF. – Three factors affect the results of body contouring outcomes after bariatric surgery: body mass index at presentation, fat deposition pattern, and quality of the skin-fat envelope, according to Dr. Al S. Aly.

"The fat deposition pattern is genetically controlled; we cannot alter that," Dr. Aly, professor and vice-chair of plastic surgery at the University of California, Irvine, said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF). "The quality of the skin-fat envelope is very important. If you have a very loose skin-fat envelope – meaning that they’ve had a tremendous drop in weight – you can do a lot more for them than with other patients."

The two main body contouring treatments for the lower trunk are abdominoplasty and circumferential belt lipectomy, said Dr. Aly. "Abdominoplasties are ideally suited for problems limited to the belly, or those located between the two anterior superior iliac spines. For larger patients you need to do something else."

The rehabilitation of larger patients involves a circumferential procedure commonly referred to as a body lift or belt lipectomy, which involves removing a circumferential wedge of tissue from around the trunk. "There are many reasons why we need circumferential excisions for these large patients, but the main one is that you need circumferential improvement above and below the area of resection as opposed to a regular tummy tuck," he explained.

Markings for the belt lipectomy "are the essence of the procedure," Dr. Aly said, who noted that about 10% of his patients are male. "The markings are adjustable guidelines, and they vary according to anatomy and desires. It’s a fairly complex set of issues but essentially you have to understand how tissues drape as the patient loses weight, and there are zones of adherence or areas of the body where the skin and the soft tissue envelope is stuck to the underlying musculoskeletal anatomy. It’s important to understand those before you can mark these patients. Surgical improvement is related to the amount of tension that you create above and below an area of excision."

Dr. Aly said that he routinely performs belt lipectomies with another surgeon and strives for surgical times under 6 hours. He uses a general anesthetic and an epidural for postoperative pain management. Moving patients into multiple positions during surgery is required, "otherwise you can’t accomplish the excisions," he said. "There is a variety of different approaches. Mine happens to be one of supine first then lateral/lateral."

Results of body contouring procedures generally correlate with the patient’s body mass index (BMI) at the time of surgery. "So people who present to us above a BMI of 35 kg/m² ... their results are okay," he said. "Results are better for patients with a BMI of 30-35 kg/m². If you’re lucky enough to get a patient at an ideal BMI – 26 kg/m² and lower – then you can create almost normal anatomy."

He noted that, compared with abdominoplasties, results of belt lipectomies take longer than most procedures to mature. "However, their results are also far superior to those attainable with a tummy tuck," Dr. Aly said. Complications, including an increased risk for seroma and formation of hematoma, "correlate with BMI," he said. "If you’re not ready to deal with complications, massive weight loss patients are a tough group to deal with. It’s part of the nature of these patients."

Other areas that often need contouring include upper arm reductions, upper back roll reductions, reconstruction of the breasts (in women and men), and thigh reductions.

Dr. Aly said that he had no relevant conflicts to disclose. SDEF and this news organization are owned by Elsevier.