The Lipo–Body Lift: A New Circumferential Body-Contouring Technique Useful after Bariatric Surgery

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It was with great interest that we read the article entitled “The Lipo–Body Lift: A New Circumferential Body-Contouring Technique Useful after Bariatric Surgery” by Bertheuil et al.1 We congratulate the authors on this well-conducted prospective study. They described their experience with the lipo–body lift procedure. The main principles of this liposuction-assisted technique are the preservation of connective tissue and microvascular network and the smallest undermining to reduce the risk of complication, particularly, seroma formation.
The authors divide post–bariatric surgery patients into three groups depending on the type of residual excess after weight loss. Type I patients exhibit only excess skin, type II patients have both excess skin and moderate lipodystrophy, and type III patients exhibit moderate to poor excess skin and a moderate to major excess of fat. We agree with this point and, we consider that in massive weight loss patients, the most suitable procedure should be decided from case to case.
However, we would like to discuss one point. The authors considered that the best candidates for a lipo–body lift were type I patients. In our experience, when patients present with only abundant excess skin, we avoid unnecessary liposuction. In the posterior region, we only perform a resection of the skin excess in the plane of the superficial fascia without undermining the wound edges and proceed to direct closure, moving the buttock tissues centrally. For the anterior region, we perform high-superior-tension abdominoplasty.2 The very important skin laxity observed in the post–bariatric surgery patient with only excess skin allows us to reduce the undermining. We place high-tension sutures of both sides of the umbilicus and quilting sutures in the medial line under the umbilicus to reduce the tension on the scar and avoid the dead space and consequently reduce the risk of seroma. The wound edges are not infiltrated so the suture is facilitated. This technique allows avoidance of complications of liposuction,3,4 especially excessive postoperative swelling and liquid flow through the wound, which can lead to wound dehiscence. The operating time is significantly reduced.
In their study, the authors declared no major complication and no seroma, but they reported a 40 percent minor complication rate, including a 40 percent rate of wound dehiscence. The occurrence of complications was associated with the volume of liposuction.
In our opinion, a liposuction-assisted procedure such as the lipo–body lift is a good option for massive weight loss patients with adipose and cutaneous excess (type II patients). However, this technique should not be performed systematically because of the liposuction-associated risk. The excision-only body lift could be a safe and fast option that provides satisfactory results for massive weight loss patients with isolated cutaneous excess.
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