Guest Columnist
Body Contouring Surgery — Is it for you?
By
Apr 12, 2009 - 9:26:04 AM

(HealthNewsDigest.com) - Over the past decade, Body Contouring surgery has grown far faster than any other procedural aspect of cosmetic surgery. Statistics released by the American Society for Aesthetic Plastic Surgery Cosmetic Surgery National Data Bank revealed last month that since 1997, when combined statistics were first compiled, there has been a 333.5 % increase in abdominoplasty, 251.5% increase in breast augmentation, and a 642 % increase in arm lift compared to a 33.6 % increase in facelift. While a downsized economy over the past year resulted in an overall ten percent reduction is cosmetic surgery procedures (down from 2,079,032 to 1,766,695 operations), three of the most common operations are Implant Breast Augmentation (355,671), Liposuction (341,144) and Abdominoplasty (tummy Tuck, 147,392). For complete statistics on surgical and nonsurgical procedures visit www.surgery.org/download/2008stats.pdf.

The increased demand for body contouring surgery reflects the overall increased general approval of woman for cosmetic surgery at 62% with 40% considering cosmetic surgery for themselves. Successful minimally invasive Bariatric surgery is exponentially increasing the number of candidates for corrective body contouring. The phenomenal results in reshaping disfigured bodies after massive weight loss has fueled the public interest in aesthetic corrections of less severe changes with aging and after multiple pregnancies. Since sagging skin is pervasive, many individuals desire extensive plastic surgery. Plastic surgeons tend to approach these patients piecemeal with little integration of the different operations. Alternatively Dennis Hurwitz originated comprehensive correction of distorted body contour in as few stages as possible in 2002 and called it Total Body Lift (TBL) Surgery. In 2005, Dennis Hurwitz, M.D., F.A.C.S., Clinical professor of Plastic Surgery at the University of Pittsburgh, and director of the Hurwitz Center for Plastic surgery, headquartered in Pittsburgh, and offices in Philadelphia, Los Angeles and Newport Beach published the results of his first three years experience in Total Body Lift;. Reshaping the Breasts, Chest, Arms, Thighs, Hips, Back, Waist, Abdomen & Knees after Weight Loss, Aging & Pregnancies. Since then his experience has continued to expand the indications, scope and aesthetics of this surgery, which can be viewed in part on www.hurwitzcenter.com.

An academically oriented Plastic Surgeon since 1977, Dr. Hurwitz started to frequently contour massive weight loss patients when he joined University of Pittsburgh Bariatric Surgery team in 1998. At the time, the customary operations included brachioplasty, mastopexy with or without implant augmentation, abdominoplasty, lower body lift and medial thighplasty. Brachioplasty reduces sagging oversized arms by elliptical removal of skin and fat along the inner aspect of the arm from elbow to arm pit (axilla). Silicone/saline filled implant breast augmentation with nipple lift corrects undersized and sagging breast. The Lift or mastopexy uses a keyhole shaped pattern over the nipple to remove intervening skin and raise the nipple and sagging lower portion of the breast. Abdominoplasty and lower body lift is a belt-like removal of skin and fat between the umbilicus and mons pubis which extends around the back just above the buttocks. Sometimes an inverted V-shaped excision of upper central abdomen skin is added to narrow the waist. Medical thighplasty removes rolls of skin from the inner thighs. Because of the challenging anatomy of weight loss patients, I improved and integrate those operations.

So what do Dennis Hurwitz and his colleagues now do differently? We avoid the cumbersome hanging skin by taking advantage of gravity to accurately mark skin excisions by putting my patients through a variety of reclining positions. We change patient position only once during surgery from prone to supine, which necessitated a novel position for skin closure around the hips. We rapidly close our incisions with the latest in barbed suture technology, called the Quill SRS. We improved brachioplasty by removing half of the axillary skin, raising the back fold through a V shaped advancement flap, and leaving an aesthetic L shaped scar across the axilla. Except for severest breast atrophy, we abandoned silicone implants. Instead, we designed the Spiral Flap from unwanted mid torso skin excess to aesthetically and lastingly create natural appearing larger breasts. Furthermore, we now raise and securely position the breast and its inframammary fold. We usually remove moderately severe mid torso skin rolls along the bra line. When silicone gel implants are preferred, we have incorporated the latest techniques in acellular dermis hammock support to eliminate the problem of postoperative breast sag. We correct severe gynecomastia with a boomerang excision and UAL for a well positioned natural nipple, no bulge or loose chest skin. The narrowest waist follows a combined upper and lower body lift.
We now correct oversized and sagging mons pubis by Ultrasonic assisted lipoplasty (UAL) and a three sided skin excision continuous with an inner thighplasty. This “picture frame pubic monsplasty” sculptures a properly positioned, shaped and sensitive pubic mons. In fact, Hurwitz prefers UAL to reduce all oversized flaps, because of the gentle fat removal by VASER™ LipoSelection™. We have modified the vertical thighplasty for a less conspicuous scar and less problematic healing by using Excision Site Liposuction. We fully integrate medial thighplasty into the lower body lift.

As Hurwitz gained skill and understanding of procedural interrelationships, a single stage Total Body Lift was conceived. An abdominoplasty, lower body lift and thighplasty were to be immediately followed by the upper body lift, breast reshaping and brachioplasty. While we found publications that demonstrate increased complications in morbidly obese patients (wound infections, thrombophlebitis, etc), there is none stating single stage body contouring unsafe.

TBL surgery is a culmination of 25 years of Hurwitz’s busy clinical practice. During his training, Plastic Surgery of complex congenital facial deformity and reconstruction after cancer ablation was staged over many months. Single-stage surgery was made possible with new awareness of anatomy, technology and leadership. In the mid seventies Hurwitz led the University of Pittsburgh craniofacial team, originated new flap reconstructions and performed some of the first microvascular free flaps in Pittsburgh. Maturing with lengthy and innovative operations, he went about applying the same principles to body contouring surgery.

Of understandable concern are General, Neurological and Orthopedic Surgery reports that show longer operations are more likely to be followed by complications of infection, lower extremity thrombophlebitis (leg vein blood clots) and transfusions. Extrapolation of these increased risks to single stage Total Body Lift surgery is understandable but not entirely rational. Long operations in other disciplines are different, because those patients suffer from advanced disease, multi system injury, obesity, comorbidities (other illnesses) and intraoperative complications (technical mishaps). In contrast, TBL patients are at their healthiest condition.
Regarding increased infections, the other specialty patients were acutely ill, traumatized and immunologically compromised. Their single cavity wounds are exposed to contamination throughout the operation. TBL patients are elective with multiple skin deep wounds (no muscle, bone or bowel injury) that are being closed almost as soon as the next one is being created. The plastics patients are much less stressed and exposed to less contamination. In over 50 single-staged Total Body lift patients’ only one required early readmission to the hospital for incision and drainage of a small thigh abscess.
The incidence of thrombophlebitis, with its feared sequel of pulmonary embolism, increases with long operations, obesity, cancer, advanced age, hormonal therapy, prior thrombophetitis and hypercoagulable state. Multiple risk factors dictate intraoperative blood thinners such as heparin. TBL patients often have multiple risk factors. We also employ proven preventative sequential pressure stockings from before the operation through the early post operative period. Since it may cause excessive bleeding, heparin is reserved for highest risk patients, who may have only limited surgery.
Longer operations increase the need for transfusions. TBL interrupts numerous oversized blood vessels with significant bleeding. Despite the use of vasoconstrictors (epinephrine) and electrocautery dissection, we often transfuse several units of blood. Patients donate and we rely on well-screened banked blood from volunteer donors.
As soon as weight loss patients learn of our comprehensive approach, they request as much treatment in one operative session as possible. They prefer not to interrupt their busy lives for a year or two of surgery and recovery. Some tell us that we get one good chance to do as much as possible and that is it. With the understanding of the first patients, we confirmed that a single stage body lift was possible. Thereafter, Hurwitz went about streamlining technique, refining patient selection and monitoring outcomes. So far the group of Total Body Lift patients has no more complications; however, they do require more transfusions. This information was published in the May/June issue of the Aesthetic Surgery Journal pages 294-304 in 2008.
Without sacrificing quality, we tinkered with every facet for improved efficiency, safety and teamwork. We insist on optimal arrangements. Our capable surgical coordinators will usher you through the information process and complex scheduling of accommodations and surgery. Usually Hurwitz performs his surgery to the beautifully remodeled Magee-Womens’ Hospital, of the University of Pittsburgh Medical Center. The administration kindly schedules me three full days every week in their state of the art operating rooms. This tertiary care teaching hospital offers first class nursing and anesthesia. Dedicated and experienced technicians and nurses offer skill, endurance and camaraderie. Assured by my consistency, they are fully prepared for the complicated sequence of events.
I unraveled the operations so that skilled assistants work concomitantly. With the aid of specially trained plastic surgeons, physician assistants, there are times during your operation three different procedures being completed simultaneously. Time flies by as the lead surgeon must not only execute the most arduous and artistic maneuvers, but also monitor all else.
This team effort is not for every patient. For those who want the surgeon to execute every step much less can be accomplished during a single operative session. Either the goals are limited or the TBL is multi-staged.
Patients spend at least three days in the hospital for medical and pain management to be discharged to home or a nearby especially equipped hotel. Single stage TBL patients have more places that hurt, and need an extra week recovery. Specialists from our nearby MediSpa provide Endermologie® message treatments, lymphatic drainage, vibratory (Hyvamat) and Light LED treatment and assist in nutrition and hygiene management to speed and ease recuperation.
You are an ideal candidate for single stage Total Body Lift surgery if you are not overweight; you are under fifty years old; you are not only healthy but also physically fit; and you are highly motivated. The operation may be too long and too traumatic for thick and heavy tissues. Older individual may not respond as well to the stress of surgery as the young. Chronic diseases tend to complicate recovery. The physically fit have the physiologic reserve for quicker recovery. Our TBL patients should prepare as if competing for a marathon (in a way they are). But of all the criteria, motivation is the most important. Intense desire accepts higher risk and gets you through the tough post operative period. Otherwise multiple stages are better for you. Although touch-up procedures are often indicated, no well-selected TBL patient regretted single stage surgery.
Plastic Surgeon reaction to single stage TBL is mixed. Despite recognizing the quality of my results, some object to the extraordinary length of surgery. Stipulating that Dennis Hurwitz can do it, some surgeons fear the steep learning curve of less accomplished surgeons and know the difficulties in assembling and maintaining a skilled team. Yet no one has proven that one 8 hour long set of operations is riskier than two five hour sets of operations. As my work is timely and respected, Hurwitz have been an acclaimed speaker to many American and international scientific meetings. His frequent surgeon teaching courses are well-subscribed and videotaped for repeated viewing. His first TBL article in a peer review journal was the lead paper in the May 2004 issue of Annals of Plastic Surgery. “Single Stage Total Body Lift” was nominated by a committee of the American Association of Plastic Surgeons for the best scientific paper of the year. His innovative methods are published in over a dozen scientific articles and book chapters.
Hundreds of surgeons have taken my brief courses with some traveling from around the world to visit my operating room and clinic to witness Total Body Lift Surgery for themselves. Some of these surgeons either considering or starting to perform single stage TBL.
World wide television has embraced Total Body Lift surgery. All stories were authentic news. In October 2005, Matt Lauer of NBC’s Today Show questioned the single stage approach, but then understood and congratulated Hurwitz and two patients on its fine results. INSIDE edition gushed with praise as it ran different stories on separate patients with single stage TBL’s in 2004 and 2005. Discovery Health Channel is airing four different patient stories, including a rare hour long feature about a family with an obesity problem called “Head to Toe.” These shows receive high ratings so are repeated often on “Plastic Surgery Before and After.”.
Star Jones of The VIEW was amazed at the transformations and quality of the scars of the three patients that Hurwitz brought to her New York studio last year. In January 2009, the new and highly acclaim nationally syndicated medical program, The DOCTORS, featured a story with Dennis Hurwitz and a single patient having successful single stage TBL at the Roxbury Surgery Center in Beverly Hills, California.
Seven years after its inception, Total Body Lift Surgery continues to grow in popularity. We remain committed to monitoring the results and improving quality. In either single or multiple stages, Total Body Lift surgery safely satisfies the needs of weight loss patients as they strive for improved appearance, self esteem and quality of life. For many worldwide distressed by generalized sagging skin with loss of appealing contours that means Total Body Lift surgery in a Hurwitz Center

Dennis J. Hurwitz, M. D.
Clinical Professor of Surgery (Plastic)
Director of the Hurwitz Center for Plastic Surgery
3109 Forbes Avenue
Pittsburgh, Pennsylvania, 15213
412.802.6100412-802-7700

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