A Board Certified Plastic Surgeon in Scottsdale
Posts tagged lower body lift arizona
Lower Body Lift, MAP, and Lovenox: III.
0Scottsdale – This is the third and final part of a three part blog series in which we discuss the relationship between lower bodylift, mean arterial pressure and low molecular weight heparin, Lovenox®.
A Scientific Study in Plastic Surgery.
Here we summarize a recent plastic surgery study which looks at the effect blood pressure management on the risks of bleeding after major body contouring surgery. When using Lovenox®, there is always an increase in the risk of bleeding during and after plastic surgery, because it is a blood thinner. The study was performed by the Department of Plastic Surgery at the University of Texas Southwestern Medical Center.
Two groups of Plastic Surgery Patients.
The researchers looked at 2 patient groups. The first group, included 10 patients who experienced a hematoma (bleeding) after excisional body contouring surgery with perioperative Lovenox®. The second group, included 10 similar patients with respect to sex, surgery type, massive weight loss status, and Lovenox®, who did not have bleeding or hematoma. They looked to see what factors may have made a difference?
So, where are the Risks with Lower Bodylift.
According to the study, with lower bodylift surgery there is always a risk of developing deep vein thrombosis, either during or soon after surgery. Blood thinners work to reduce these risks, but what about bleeding?
The studyy looked at the mean arterial blood pressure before, during and after surgery. The mean pressure before plastic surgery for each group was the same (97.5 mm Hg vs 95.8 mm Hg). The mean MAP for the last 2 hours of surgery was significantly lower in the group with bleeding (66.7 mm Hg vs 82.4 mm Hg), and a higher mean arterial pressure after surgery reached significance in the group which experienced bleeding (96.3 mm Hg vs 88.5 mm Hg).
Both the difference between intraoperative versus the preoperative blood pressure (30.7 mm Hg vs 13.4 mm Hg) and between intraoperative versus postoperative blood pressure (29.6 mm Hg vs 7.0 mm Hg) were increased in the bleeding group versus the non-bleeding group.
Recommendations for Plastic Surgeons.
Prophylactic use of low molecular weight heparin, like Lovenox® works for decreasing blood clots from surgery and anesthesia. According to this study, maintaining a normal blood pressure during surgery and recognizing and treating high blood pressure after lower bodylift may reduce the bleeding and hematoma rate with the use of Lovenox®.
We hope that this 3-part blog helps all our patients to understand a little but more about the risk and potential complications of plastic surgery and what we can do to reduce the risks! Also, don’t forget that we have a newly scheduled Seminar about Plastic Surgery after Major Weight Loss on February 2nd, 2011.
Evidence-based Bodylift.
0Scottsdale – The lower bodylift operation is an extensive plastic surgery procedure which carries a significant amount of risk. It is performed with increasing popularity in America because more patients are finding out about this surgery each and every day. The lower body lift or belt lipectomy is the most popular plastic surgery after major weight loss available.
The bodylift has several variations, which we will review in this blog. Most of the variants have to do with the location and design of the incision. In some cases, the incision location can be placed quite low. This hides the incision better and allows for a very nice upward pull on the thighs and buttocks. This gives the patient an attractive outer thigh lift, buttock lift while simultaneously improving the figure.
Another popular version places the bodylift incision in a higher location, just above the pelvic bones. These incisions allow for the most amount of tissue to be removed at the waist and can create a beautiful hour-glass shape. The incision may be more noticeable in such cases.
The third variation is often used in patients with vertical scars from open gastric bypass surgery. The design of this operation can include either a low or high waist incision and a vertical component where the healed bariatric surgery scar is located. This creates a T-incision right at the bottom of your tummy.
We have to consider when and how to best use these three options. The decision about these incisions should be carefully considered by each and every patient. Once a patient decides on their best choice of incision, the pros and cons are discussed once more with their board certified plastic surgeon.
The vertical component is especially discussed with this type of cosmetic surgery. This incision, if it is opened and re-closed, at the same time as a bodylift, could increase the risks of wound separation, infection, and delayed in wound healing. We know that studies demonstrate about a 50 percent chance of wound breakdown because of the length of the incision and relatively poor nutritional status after bypass while using a circumferential incision. What happens if we add an extra incision to our bodylifts? Such as the T-incision?
The most likely scenario is the risk of incision breakdown would be even higher than 50%. This is, of course, is problematic for both surgeon and patient. We have already reviewed on this blog about T-incisions performed for surgery after major weight loss. Thankfully, most wounds delays in healing and separations are relatively minor and heal quite quickly. Therefore, the key to the T -incision with bodylift or tummy tuck, is going to be the identification of patients which will benefit the most from this incision while minimizing the risks.
What’s the bottom line? I recommend the extension to the T-incision with bodylift when the patient will get a big improvement in the contour of the body. When the patient is borderline, the judgment to proceed with the vertical incision may be made intra-operatively. The plastic surgeon reserves the right not to proceed depending on various factors which can occur during surgery. We always keep the patient’s safety in mind and ultimate outcome when making these decisions.
I use this incision when the patient will get a better cosmetic result with a tighter tummy and a smoother waistline. I also recommend that patients increase their nutrition with vitamin C and a high protein diet for 1 month before surgery to optimize their condition. It is my opinion that when the surgeon, patient, surgery center and technique are all optimized, then we can achieve very nice results with minimal risks.
