Regional Dermoplipectomies after Obesity Surgery
good in all patients. The esthetic result was gener-
ally good and not adversely affected by the afore-
mentioned complications (Figures 2-6). However,
the scar size and quality was sometimes below our
expectations. Scar widening also occurred in some
cases causing many patients initially to express the
desire for scar revision later in time. However, only
one patient (3%) actually requested and had scar
revision done.
hold better in the long term than other, newer sim-
ilar techniques, due to superficial fascial system
repair with non-absorbable sutures.7,18-21 The pro-
cedure is time-consuming (average 5 hrs), but the
final result is impressive, leaving a narrow stable
scar, hidden in the bikini. Inner thigh redundancy is
corrected by semicircular, circular, vertical or com-
bined circular and vertical excision.22 The com-
bined technique is more applicable in the massive
weight loss patient because it elevates the skin of
the thighs, and at the same time, tightens the skin
in a circumferential manner.8 To prevent inferior
scar migration and lateral traction of the vulva, we
suspend the horizontal portion of the flap to Colles
fascia.23
Discussion
Reconstructive surgeons performing regional der-
molipectomies
use
various
techniques.
There are also several techniques for brachio-
plasty. We use Pitanguy’s technique, because it is
the only one that treats both the arms and the later-
al thoracic wall simultaneously.9 In some patients
who underwent dermolipectomies of the extremi-
ties, the initial scar was hypertrophic, but became
normotrophic with time.
Abdominoplasty techniques are classified, accord-
ing to the direction of the excision and the result-
ing scar, as horizontal, vertical, or mixed.10 The
most widely used, for esthetic purposes, are the
horizontal techniques with wide undermining up
to the costal margin and umbilical translocation,
the main reason being that the final scar is hidden
in the bikini. In our series, we use a mixed tech-
nique for three main reasons: the existing vertical
scar left from the previous bariatric surgery, easier
access to incisional hernia repair, and the superior
esthetic contour of the trunk and, especially, the
waistline. Our technique is similar to the fleur-de-
lis abdominoplasty in that no undermining is done
and the final scar shape is an inverted T, but differs
in the marking and execution.11,12
Some authors suggest a circumferential excision,
which combines abdominoplasty and flankplasty,
while others suggest a combination of two or more
procedures performed simultaneously by a team of
surgeons.13-17 We have no experience with these
procedures. However, they are very time-consum-
ing and almost always require blood transfusion.
Regarding mammaplasty, the techniques that we
use are well known and have passed the test of
time.
There are few studies of regional dermolipec-
tomies following massive weight loss in bariatric
surgery patients. The largest such study is that of
Donati et al24 involving 161 abdominal der-
molipectomies and 99 other regional dermolipec-
tomies over a 14-year period. The next largest
study by Palmer et al25 reports 55 regional der-
molipectomies in 38 patients. Following that are
some other studies involving a smaller number of
patients.14-17,26-29 Some authors agree that most
complications occur following abdominal der-
molipectomies, and, therefore, most of the studies
refer primarily to these procedures.24,25,30,31
Common complications include infection, seroma,
hematoma, and skin necrosis, while serious ones
include thromboembolic events.30 Donati et al24
report a mortality-rate of 1.2% due to thromboem-
bolic events and a morbidity-rate of 22.3% due to
wound infection, 3.1% due to seromas-hematomas
and 2.4% due to skin necrosis. Incisional hernia
repair was performed simultaneously in 54.6% of
patients.24 Palmer et al25 reported one case of mas-
sive leg thrombosis after a thigh plasty and some
cases of seroma, hematoma and marginal necrosis
without any other specific data. From the remain-
ing series involving a total of 96 patients, wound
infection developed in approximately 1%, seroma
For flankplasty, we use the transverse flank-
thigh-buttock lift technique, which tightens the
flanks and at the same time pulls up the lateral
thigh and the buttocks, as an isolated procedure.7
This technique does not have the disadvantages of
Pitanguy’s thigh-buttock lift, which was used as
the standard procedure for many years, and may
Obesity Surgery, 10, 2000 457