Panniculectomy and Belt Lipectomy

In very obese and morbidly obese people, including those who have no interest in a bariatric surgery, the skin and soft-tissue of the abdominal wall stretches and sags to create an “apron” of tissue that truly can become so large and pendulous that it can hang down to just above the knees, making routine body functions and hygiene virtually impossible. While the still obese patient is not a candidate for an abdominoplasty where the muscle wall is tightened and excess skin and tissue removed, a panniculectomy is indicated for comfort and disease prevention. If the laxity includes not only the abdominal apron but also lax skin and tissue around the back as well, all of the tissue – front and back – can be included in the removal in an operation called a “belt lipectomy”.  Some plastic surgeons use the terminology “belt lipectomy” interchangeably with "lower body lift". At Grossman Plastic Surgery ®, we make the distinction that a “belt lipectomy” does not include releasing the tissue of the buttocks and outer thighs to obtain a dramatic lifting effect of the buttocks and thighs that occurs in a "lower body lift". In addition, in a lower body lift, we usually include an abdominoplasty. Therefore, the lower body lift is intended for patients who have had a bypass procedure or by other means have lost their excess weight and have stabalized. They should be at a stable weight for at least 6 months months but preferable 1 year.

Patients who have had bypass surgery and have lost significant weight, yet who do not want body lift surgery can have a panniculectomy and belt lipectomy instead to eliminate the tissue apron but without lifting the laxity that exists below or above these aprons. For the post-bypass patients having these surgeries, their weight should have stabilized, and they should be about 1 year after bypass surgery. In this operation, the entire apron of tissue is removed without any attempt to tighten muscles. Depending on the length of the pannus (the apron of fat and skin), it may be necessary to reposition the umbilicus (belly-button).

The procedure is done under general anesthesia and the patient usually spends the night in hospital. Sutures are removed after 7-10 days. While Drs. Grossman and Capraro rarely use drains in abdominoplasties, they frequently do in panniculectomies and body lifts.