Lower Body Lift
Also known as belt lipectomy
Dramatic weight loss, weight fluctuation or natural aging frequently results in sagging skin in areas below the waistline. Lower-body-lift surgery tightens and sculpts the buttocks, back of the thighs, outer thighs, inner thighs, hips and abdomen. Loose skin that looks aesthetically displeasing or causes mobility restrictions is removed. A lower body lift is appropriate if you are near your ideal weight and may precede or follow an upper body lift procedure. Every year, thousands of people undergo successful lower-body-lift surgery and are pleased with the results.
When to Consider a Lower Body Lift
- If you have had dramatic weight loss due to bariatric surgery or dieting.
- If you have relatively thin layers of fat below the skin in the hip, thigh, abdomen and buttock areas.
- If overhanging skin in your lower body restricts your mobility and/or causes painful chafing, rashes or infection.
- If you are distressed by sagging skin in your lower body.
- Loose skin will be removed, and your contour sculpted, so you can see the results of your weight loss.
- You will experience the improved self-esteem that comes from looking better.
- You will get rid of overhanging skin that may cause painful chafing, rashes and infections.
- This is a demanding surgical procedure with a lengthy recovery.
- You will probably need one to three days of hospitalization or skilled nursing care at home.
- You will have a scar that will be hidden in the bikini line.
These are the top three pros and cons to weigh when considering a lower body lift. If you want to focus on those specifically unique to you, please consult with your aesthetic plastic surgeon.
Are you a good candidate for a lower body lift?
After you’ve struggled to achieve a healthy weight or have undergone bariatric surgery, you may still feel frustrated by your appearance if you have excess skin along the lower abdomen, relaxed abdominal wall muscles and loose and wrinkled skin along the thighs and buttocks. A lower body lift, which leaves a circumferential scar hidden in the bikini line, can dramatically improve areas of sagging skin and/or cellulite below the waistline. The following are some common reasons why you may want to consider a lower body lift:
- You have undergone bariatric surgery or significant weight loss through dieting.
- Pregnancy and/or aging have left you with loose skin and cellulite below the waistline.
- You have loose skin on your hips, the sides and fronts of your thighs, your inner thighs and your abdomen.
- You have significant skin laxity, excess skin, ptosis (sagginess) of the buttocks and abdominal wall laxity.
- The layers of fat below your loose skin are relatively thin.
- You are willing to accept a thin circumferential scar around your waist.
- You do not smoke. Smoking slows down the healing process and increases the risk of serious complications during and after surgery. If you smoke, you must quit at least six weeks before surgery.
- Your weight has been stable for at least a year, with no further weight loss expected. For optimal results, body contouring should not be done for about two years after the start of any massive-weight-loss program. This time allows your skin to shrink as much as possible and your nutrition to be stabilized and optimized, factors that will aid in your recovery.
- You are in overall good health without chronic medical conditions such as diabetes or heart disease. People in poor health are not good candidates for body contouring procedures. You must obtain clearance for plastic surgery from your primary care physician or from doctors treating you for medical conditions.
- You have a healthy diet. Problems such as protein deficiencies can interfere with healing.
- You have mental stamina. Surgical contouring procedures require patience and endurance.
If you are in good general health and have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.
Detailed Procedural Info
A complete lower body lift has the advantage of treating the buttocks, abdomen, waist, hips and thighs in one procedure. Basically, the lower body lift extends the tummy tuck incision completely around the lower torso, which allows your surgeon to lift or resuspend the thighs and tighten the buttocks as well as to execute the traditional tummy tuck. The length and the pattern of incisions depend on how much extra skin is removed and where that skin is located. Your plastic surgeon will do his or her best to take your incision preferences into consideration. Here is a typical scenario for performing this procedure, although your surgeon may use a variation:
- Your surgeon will create a circumferential incision extending around your torso, through which he or she will remove an apron of excess skin and fat below the incision and reposition and tighten your tissues.
- The remaining skin in your buttocks and thighs will be pulled upward and your skin and underlying tissues will be suspended and tightened. You will be positioned on your tummy or side during this part of the procedure.
- Once your back and sides have been addressed, you will be positioned on your back so the surgeon can treat your front side.
- At this point, two options are available, which will be discussed with you preoperatively. One option is to combine the lower body lift with abdominal contouring, otherwise known as a tummy tuck (abdominoplasty). The other option is to combine the lower body lift with an inner thigh lift, if your abdomen does not require contouring or if you have already had an abdominoplasty.
- Your incisions will be closed in multiple layers over drains to control stretching and swelling. Deep support sutures within the underlying tissues help to form the newly shaped contours. Sutures, skin adhesives or tapes are used to close the skin incisions.
In this single procedure, incisions extend around the body to remove excess skin and fat from the abdomen, outer thighs, buttocks, hips and waist.
What are my options?
Liposuction combined with lower body lift
You may benefit from liposuction in addition to a lower body lift to achieve the best possible contour. Liposuction can smooth and contour areas separate from the effects of the body lift excisions. A thorough discussion and examination are essential to determine a comprehensive surgical plan.
Abdominoplasty or inner thigh lift
You can combine the lower body lift with abdominal contouring, otherwise known as a tummy tuck (abdominoplasty) or combine the lower body lift with an inner thigh lift if your abdomen does not require contouring or if you have already had an abdominoplasty.
Further weight loss or liposuction
Because the lower body is lifted and suspended to the skin closure, excessive heaviness in the thighs and buttocks at the time of surgery may prevent a long-lasting effect. In such cases, your surgeon may recommend further weight loss before you undergo a lower body lift. If this is not feasible, you may undergo liposuction to thin the thighs and buttocks before undergoing excisional body lifting.
The lower body lift scar, which extends around the circumference of your torso, is designed to be hidden in your underwear or bikini. Your surgeon can place it higher or lower based on your preference.
What will my lower body lift incisions and scars be like?
The incision used for lower body lift produces a permanent, noticeable scar around the entire lower trunk. The scar is placed low on the stomach, just above the pubic hair area, and extends toward the hip bones. At the hip bone the scar gently curves toward the top of the buttock crease to meet the incision from the other side. Your scar placement is determined by how you wear your clothing and your scar will be easily hidden by clothing.
Selecting a Surgeon
It’s important to choose your surgeon for based on:
- Education, training and certification
- Experience with lower body lifts
- Your comfort level with him or her
After finding a board-certified plastic surgeon in your area who is experienced in performing lower body lifts, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.
Your initial consultation appointment
During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a candidate for lower-body-lift surgery and clarify what a lower body lift can do for you. Understanding your goals and medical condition, both alternative and additional treatments may be considered
You should come to the consultation prepared to discuss your complete medical history and answer the following questions:
- Do you have any medical conditions or drug allergies? Are you being treated for any medical conditions?
- Have you had any previous surgeries?
- What are your current medications and vitamin and herbal supplements?
- What is your current use of alcohol, tobacco and recreational drugs?
- What is your history with any noninvasive cosmetic procedures?
- What outcome do you expect from the surgery? What is your chief motivation in undergoing lower body lift?
Your surgeon may also:
- Ask you to look in a mirror and point out exactly what you would like to see improved.
- Take photos for your medical record and use computer imaging to demonstrate the improvements you can expect.
- Evaluate your health status, including preexisting health conditions or risk factors.
- Evaluate the elasticity of your skin.
- Discuss your options and recommend a course of treatment.
- Discuss likely outcomes, including risks or potential complications.
- Discuss the type of anesthesia that will be used.
Your treatment plan
Based on your goals, physical characteristics and the surgeon’s training and experience, your surgeon will share recommendations and information with you, including:
- An approach to your surgery, including the type of procedure or combination of procedures.
- The outcomes that you can anticipate.
- Your financial investment in the procedure.
- Associated risks and complications.
- Options for anesthesia and surgery location.
- What you need to prepare for your surgery.
- What you can expect to experience after surgery.
- Show before-and-after photos of cases similar to yours and answer any questions.
Questions to ask your aesthetic plastic surgeon
For a general list of questions to ask your surgeon about his or her background, to find out about plastic surgery safety and to plan your procedure.
We developed these questions to help you:
- Make the most informed and intelligent decisions about your procedure.
- Confirm that you have the right surgeon for your procedure.
- Make your initial consultation as rewarding as possible.
- Understand your options, potential outcomes and risks.
It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation:
- Am I a good candidate for a lower body lift?
- Are the results I am seeking reasonable and realistic?
- Do you have before-and-after photos I can look at for the procedure I am undergoing?
- Will my scars be visible? Where will my scars be located?
- What kind of anesthesia do you recommend for me?
- What will be the costs associated with my surgery?
- What will you expect of me to get the best results?
- What kind of recovery period can I expect and when can I resume normal activities?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?
Preparing for Your Procedure
Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery.
In advance of your procedure, your surgeon will ask you to:
- Stop smoking for at least six weeks before undergoing surgery to promote better healing.
- Avoid taking aspirin, certain anti-inflammatory medications, and some herbal medications that can cause increased bleeding.
- Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery and good outcomes.
- If weight benchmarks or lifestyle changes are recommended, do your best to comply with these to achieve the best results and minimize the chance of complications.
- You should be at a stable, dependable weight before you undergo a lower body lift. It is a good idea for your plastic surgeon to consult with your bariatric surgeon (if you have undergone this procedure) before surgery to determine whether you have achieved your final weight plateau.
- If your lower body lift is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and arrange for skilled nursing care for a number of days specified by your doctor.
- Establish a no-fail support system for the full recovery period advised by your surgeon. This is most critical to your recovery. If you have children less than five years of age, you must have someone to take care for them for at least two weeks. Lifting, driving, laundry and cleaning should not be attempted during your recovery.
- Prepare your home for recovery. Your doctor can suggest many conveniences that may help you. For example, it may be helpful to move objects off of high shelves so they are in easy reach.
- Prepare meals before you go to the hospital that can be easily reheated. Stock your refrigerator with lots of fruits, vegetables and lean proteins. Lean protein assists in healing. Salt increases swelling, so avoid it!
- Set up your nightstand with everything you’ll need within easy reach, including the telephone, TV remote and reading material. Prepare your bed with the necessary pillows or wedge pillows you might need for support.
- Ask your doctor about the most comfortable clothing to wear home from the hospital and wear slip-on shoes.
- Get all your chores out of the way and try to have as little to worry about as possible.
What can I expect on the day of lower-body-lift surgery?
- Your surgery may be performed in an accredited hospital, a freestanding ambulatory facility or an office-based surgical suite. Your surgeon will give you an estimate of how long your surgery will last based on the details of your procedure.
- You will receive medications to keep you comfortable during the surgical procedure. Local anesthesia combined with sedation may be an option, but general anesthesia is more commonly used for this procedure. An anesthesiologist or nurse anesthetist will be present to administer sedatives or general anesthesia and assist in monitoring you during surgery. After you are asleep, a breathing tube will be placed in your mouth to ensure that your airway is secure during position changes involved in the body lift procedure.
- For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
- Your plastic surgeon will follow the surgical plan discussed with you before surgery. Once the operation has begun, he or she may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
When you wake up, you may find the following:
- Surgical drains have been placed to remove fluid that accumulates within the incisions.
- You are wearing a compression garment, which controls swelling, supports the suspended tissues and smoothens and flattens the skin. This garment may be placed at the time of surgery or later.
- After your procedure is completed, you will be taken into a recovery area where you will continue to be closely monitored.
- You may go home on the day of surgery with skilled nursing care or spend two or three days in an aftercare center with a nurse or in the hospital, unless you and your plastic surgeon have made other plans for your immediate postoperative recovery. Under no circumstances will you be permitted to go home alone or stay home without another adult present. Follow your doctor’s recommendation in relation to this decision.
- Before leaving for home, you (or someone looking after you) should feel comfortable emptying and resetting your drains.
Aftercare and Recovery
Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:
- Drains, if they have been placed
- Normal symptoms you will experience
- Any potential signs of complications
See options for short-term recovery locations in Aftercare and Recovery (Planning Toolkit).
Immediately after your lower body lift
Generally, you can expect to be bandaged and wearing compression garments, and you may have some surgical drains. You will likely spend at least two days in the hospital or another setting in which you are receiving skilled nursing care. During this time you will learn how to take care of your drains and feel comfortable walking and moving. Once you are comfortable with oral pain medications, you will be discharged.
- When the anesthesia wears off, you may have some pain. If the pain is extreme or long-lasting, contact your physician. You will also have some redness and swelling after the surgery. In some cases, the swelling will remain for weeks or even months. Contact your physician to determine whether your pain, redness and swelling is normal or a sign of a problem.
- Make sure you continue to have lots of help at home—this cannot be stressed enough. You’ll be tempted to try to help around the house quickly, but you won’t feel like yourself for at least two weeks, and you still shouldn’t do anything strenuous, including lifting, for four to six weeks. If you have small children, you must put someone else totally in charge of their care for at least two weeks.
- Ask your surgeon how to sleep, including the use of pillows, to minimize the tension on your incisions, reduce pain and facilitate a thinner scar.
- Swelling, which is commonly seen after body lift surgery, is controlled by compression garments, which reduce swelling, support the suspended tissues and smooth and flatten the skin.
- Drains, which also control swelling, are placed to remove fluid that accumulates within the incisions. Your doctor will ask you to measure the amount of fluid in your drains daily. Once the output falls low enough, your drains will be removed in your doctor’s office. Drains typically remain in place two to three weeks, but may be left longer.
- You will be encouraged to walk the day after surgery.
Recovery time frame after a lower body lift
Follow all postsurgical instructions, including guidelines about bandages, drains, taking an antibiotic, if prescribed and the level of activity that is safe.
- Weekly follow-up visits aid in your recovery by allowing for adjustments based on your progress.
- Your activity will be determined by the progress of your incision healing. Once the drains are removed, movement is easier.
- Discomfort will dissipate over a week or two after the surgery. Your doctor will prescribe pain medication for you to take after you return home. You will need to wear the compression garment for a few weeks after the surgery and your plastic surgeon may recommend that you follow a special diet.
- Sutures are typically removed about two weeks after surgery and this too is done in your plastic surgeon’s office.
- Full healing of the circumferential incisions may take four weeks or even longer.
- Wound separations may occur, delaying wound healing (but rarely requiring further surgery).
- You will need to take at least two to three weeks off from work and restrict normal activities for four to six weeks. You will have some discomfort. This is expected and typically is easily controlled with pain medications.
- You will have to wait approximately six to eight weeks before you can resume exercise.
- The bruising will begin to disappear in a few weeks, and the swelling should subside within a few months. Although the scars will be permanent, they will fade in about twelve months and can be hidden by clothing.
How Long Will the Results Last?
The lift effect from lower-body-lift surgery is permanent, for the most part. The contouring achieved by removal of excess skin and fat is permanent. The undermining, advancement, and tightening of the skin of the thighs and buttocks is also permanent. Naturally, there will be some relaxation of the skin early after surgery and the skin and connective tissues will loosen and sag gradually as you age.
Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes in your lower body lift. Do not hesitate to contact your surgeon when you have any questions or concerns.
The cost of a lower body lift varies from doctor to doctor, from one geographic area to another, and with the technique that is performed. Generally speaking, insurance companies will not pay for a lower body lift. Insurance companies will only pay for procedures they (not your doctors) have determined are “medically necessary” and usually have strict criteria for each procedure to be covered. For example, they may pay for a panniculectomy (removal of the overhanging “apron” of abdominal tissue) if they feel that your pannus is interfering with your functioning. Many surgeons offer patient financing plans to make the procedure more affordable.
Choose your surgeon based on quality, training and experience—not cost.
Limitations and Risks
Fortunately, significant complications from lower body lifts are infrequent. Your specific risks for lower-body-lift surgery will be discussed during your consultation.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
- Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
- Infection and bleeding
- Changes in sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may necessitate additional procedures
You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your lower-body-lift surgery.