The basics of the belt lipectomy

Many patients are familiar with tried-and-true classics like liposuction and the tummy tuck, yet they may be unfamiliar with belt lipectomy. Also known as a lower body lift, this aesthetic procedure addresses the appearance of the lower body by removing sagging skin and tissue that can result from aging or dramatic weight loss.

Tummy tucks are more popular than belt lipectomies. Yet, a tummy tuck is limited to the abdomen. A belt lipectomy can address a larger area of the body, including the stomach, hips, buttocks and thighs. This option is fantastic for treating both men and women who are looking for a tighter, more toned appearance in their lower body. To gather more insight into the ins and outs of the belt lipectomy, we reached out to ASPS Member Surgeon Fadi Chahin, MD, FACS, for a deep dive into the topic.

ASPS: When considering aesthetic procedures for the body, one that is often lesser known is that of the belt lipectomy. How would you describe this procedure to the average patient?

Dr. Chahin: Belt lipectomy is best described as an aesthetic procedure that addresses the torso in a 3D approach. It aims to restore and suspend the ptotic (droopy or saggy) lower body and recontour the abdomen, flanks, back and buttocks to achieve a more desirable and aesthetically appealing contour.

ASPS: How popular is belt lipectomy at your practice? Are there any other procedures that are often requested or performed alongside it?

Dr. Chahin: The belt lipectomy procedure is a more physically demanding surgery postoperatively for patients than a traditional abdominoplasty panniculectomy (a tummy tuck in which excess skin and fat are removed). Most patients are candidates for belt lipectomy surgery; however, if they are physically or financially unable to proceed with the full aesthetic reconstruction, opting to stage the procedure, starting with the abdominoplasty, is rather common as the first stage.

We often do see patients choose a combination of panniculectomy or extended abdominoplasty with posterior (backside of the body) liposuction with the possible addition of Renuvion tightening to address the posterior element of ptosis and aging. This helps to reduce the length of surgery and the recovery following surgery and lessen the length of the scars and visibility for the right candidate.

ASPS: How do you typically perform a belt lipectomy procedure at your practice? Does it vary greatly from patient to patient?

Dr. Chahin: There are many factors that play a role in the surgical approach, the first being patient selection. I take into consideration factors such as age, gender and medical history before even meeting with the patient. Once in the consultation, we discuss surgical options and what the patient is looking to achieve with surgery. I ask about what areas' laxity bothers them the most and then discuss options based on all factors. It is extremely important that the patient understands the physical limitations postoperatively and understands that this procedure, while extremely powerful in contouring the torso in 3D fashion, does come with limitations and requirements after surgery.

Looking forward to surgery, the patient will be marked in the standing position preoperatively. Surgery is started with the patient in the prone position with the back. Additional liposculpture is planned and performed as felt appropriate per the patient's desire. The customized portion is addressed first in the supine position. I extend the incisions over the abdomen, reducing and resuspending the tissue accordingly. At the abdomen, garments and supportive foam are then added to provide additional support along the incisions.

ASPS: What is the post-procedure recovery process like for this type of procedure?

Dr. Chahin: Following surgery, patients will have limitations with torso flexion (bending). It is recommended that patients sit at an obtuse angle for the first 10-14 days to minimize any avoidable stress on the posterior scar. The surgical drains generally stay in play anywhere from 7-10 days postoperatively. Ambulation (walking) immediately after surgery is adopted. We always recommend going to a postoperative credentialed recovery facility for assistance for 1-2 days.

ASPS: What are the typical results that can be expected from a successful belt lipectomy procedure?

Dr. Chahin: A successful belt lipectomy provides the patient with improvement to the trunk circumferentially. There will be a significant skin reduction with a strategically placed scar that sits lower along the abdomen and runs up along the iliac crest of the hips, followed by a lower incision that meets at the top of the buttock crease. The scar maturation will take around 18-24 months, so I always advise that sun protection during this period is vital.

ASPS: Do you have any advice or best practices for patients who are interested in pursuing a belt lipectomy procedure in order to set them up for success?

Dr. Chahin: It is important that the patient maintains a stable, sustainable weight for at least six to 12 months prior to surgery. I always advise an active lifestyle with proper cardiac conditioning or exercise prior to surgery. This will enable the patient to succeed during their recovery. One hundred percent of the time, when the patient goes into surgery in good cardiac condition, they experience an easier recovery. Follow all postoperative recommendations and make sure you allow for ample time to recover after surgery.

ASPS: Do you have any other insights around this topic that you'd like to share?

Dr. Chahin: Proper patient selection is vital. Ensure that you are choosing patients who are committed to a healthy lifestyle, which will provide long-term, sustainable results. Remember that not every patient is a candidate just because they want the surgery or have the resources to pay for the surgery. Lastly, the patients should be completely aware of postoperative physical limitations and requirements to ensure that they are set up to succeed. We are committed to patient safety, quality of outcome and satisfaction.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.