Reply: The Lipo–Body Lift

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We have read with great attention the comments of Dast et al. concerning our article,1 and we would like to thank the authors for the interest they have shown in our new body contouring operative technique. This letter allows our team to reiterate our feeling about the benefit of extensive concomitant liposuction following body contouring surgery. Liposuction enables us to preserve the connective tissue. Moreover, we have recently demonstrated by flow cytometry and confocal microscopy that, inside the preserved connective tissue (which contain nerves, lymphatics, and blood vessels), a significant part of the microvascular network was also preserved. This probably explains the low complication rate of the liposuction-assisted body contouring technique by possible preservation of the physiology of the remaining tissue (e.g., fluid, gas, nutrient, and waste exchanges),2 even if this specific point must still be proven. Further studies are necessary to better understand the physiology and functionality of the remaining vessels. These data could be particularly useful in the field of abdominoplasty and lower body lifting, where such an approach remains debated, because most plastic surgeons are currently using liposuction combined with arm and thigh lift to obtain satisfactory outcomes (with very low rates of seroma).3,4
However, we do not agree with the authors with regard to restricting the indication for the technique to type II patients. Liposuction helps to avoid major complications such as bleeding and hematoma and reduce minor complications such as lymphedema and seroma, which were absent in our experience. In our original study1 of 25 patients, liposuction volume and smoking status were significantly associated with the development of complications. As mentioned in the Limitation section, it is a small cohort, and the lack of multivariate analysis does not make it possible to know whether they are two independent variables. Between January of 2015 and January of 2017, 46 patients underwent the lipo–body lift performed by the same surgeon (N.B.). With this wider series, the operative time and complication rate decrease (Table 1), probably because of the learning curve. It is interesting to note that liposuction volume (p = 0.139) no longer appears to be a risk factor, unlike smoking status (p = 0.002) (Table 2). Even if the remark of Dr. Dast is good on the wound dehiscence rate, which can be promoted by liposuction (swelling and liquid flow through the wound), currently there is nothing to prove it. In our opinion, smoking status is the main risk factor for wound dehiscence after the lipo–body lift.
In conclusion, we reserve the lipo–body lift for type I and II massive weight loss patients of our classification. This is a safe and less invasive operative strategy than traditional undermining, reducing the complication rate (all of our patients were grade I on the classification of surgical complications5) without decreasing the satisfaction of these complex patients.
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