plastics for wannabes -- VERY LONG, but good information

[Guest guest]

Hi, friends,

It's late, and I need to get to bed, but I am seeing a lot of

interest on this list in reconstructive surgery following massive

weight loss, and tonight I received private mail from three members

of this list with questions. So, I wanted to share with you some

information that I had posted earlier on another list. Information

helps you make decisions; in the end, you have to make the decisions

yourselves. With good information, you can make better decisions for

yourselves.

Also, for those of you who do not know about the ossg-plasticsurgery

yahoo group, it is a good place to hang out and to ask questions of

others. Many people just beginning to investigate PS and many about

to undergo various procedures (ALL kinds of procedures: tummy, butt,

thigh, arm batwings, breasts, face and neck) post with questions,

and, like this list, they get compassionate and helpful answers.

OK, the first reference is to a VERY informative chapter on Plastic

Surgery after massive weight loss.

The second, which I excerpted below, is about suturing the

three-dimensional cellular structure under the skin that holds the

fat cells and gives our body its shape over and above the muscles and

bones. It is called the " superficial fascial system. " The fascia

are tough tissues. The muscle fascia are the silvery stuff on the

outside of a beef roast that you almost cannot cut through with a

knife--fascia are tough. The message is that suturing the

superficial fascia, rather than just sewing up the upper skin layers,

will make for much better healing with fewer complications.

Dr. Ted Lockwood, who pioneered this technique

(http://www.tedlockwood.com) is a GIANT in the field. Luckily, I

learned of this prior to my consult, and I asked my prospective PS

about this. To my delight, he told me that he learned the technique

from Lockwood, that he does it but with his own modification of using

dissolving sutures rather than Lockwood's permanent sutures because

of even less complications with dissolving sutures, and that, if I

wanted, I could view a video of the operation a la Lockwood (I

decided not to look--his explanation was enough for me,and my legs

started to get rubbery, if you get my drift). He even uses a long

spoon-like instrument, invented by Lockwood, to separate the

superfacial fascial system from the muscles in the thigh as part of

the outer thigh lift. (For those who are curious, he is Khosrow

Matini in andria, Virginia -- Mount Vernon, really-- a suburb of

Washington, D.C.)

Bottom line: based on my results (NO complications of any kind, such

as seromas--pockets of fluid needing to be drained--or

hematomas--pockets of blood--or infections or wound opening, etc.) I

would strongly endorse this procedure in reconstructive surgery, and

I would suggest that you discuss it thoroughly with any prospective

plastic surgeon during your consult. I cannot tell you how many

complications I read of on the ossg-plasticsurgery list, all the time

wondering to myself if their surgeons had sutured their superficial

fascial systems. To do it, by the way takes time: I was under for

about 7 hours! Some surgeons want to cut and run. Stay away from

them!!!

One more thing: some people have inquired about belt lipectomy or the

lower body lift (which is just about what I had). A good site to

browse (plenty of before and after pics, but not for the faint of

heart) is:

http://www.surgery.uiowa.edu/surgery/plastic/

Good luck,

Steve

==============

First recommended by a fellow member of another WLS list. Extremely

helpful for wannabes:

http://www.upmc.edu/obesitysurgery/presentations/Chapter42.pdf

You may also want to take a look at Dr. Ted Lockwood's work that was

alluded to in the Manual (a friend on another WLS list first called

my attention to this

article before my PS, and I was relieved to find that my surgeon

indeed used this technique; I had NO complications whatever from my

PS):

http://www.imedical.com/ijpas/lockwood/index.html

International Journal of Plastic and Aesthetic Surgery

Superficial Fascial System (SFS) of the Trunk and Extremities: A New Concept.

Ted E. Lockwood, M.D. (*)

Excerpt:

Abdominoplasty

Repair of Scarpa's fascia in abdominoplasty closures is ignored in

classic descriptions. 13 1 7 Skin-only closures rely on the tight

superficial fascial system adherence along and below the inguinal

ligament to tether the groin skin and prevent superior scar

displacement. In the pubic region, however, the thick superficial fat

layer negates this tethering effect and allows hair-bearing skin to

be pulled superiorly. Repair of the superficial fascial system prior

to skin closure will help solve three common problems of

abdominoplasty. First, the superior displacement of the pubic hair is

prevented. Second, reduced tension on the skin-flap closure may help

decrease the risk of skin necrosis. Last, late suprapubic scar

depression due to retraction of unrepaired superficial fascial system

and fat may be eliminated (Fig. 15).

Posterior Trunk and Thigh Lifts

Superficial fascia] system suspension also may be utilized in lifting

techniques of the back, flank, buttocks, and thighs in place of

deepithelialized dermal flap suspension. Advantages of superficial

fascial system suspension are several. Superficial fascial system

repair is more anatomic and reduces late scar depression. The

excursion of the skin-fat-superficial fascial system unit on the

underlying muscle with activities such as bending, sitting, and

walking is maintained with superficial fascia] system repair but may

be restricted when a dermal flap is sutured to muscle fascia or

periosteum. Also, attaching the dermis to the musculoskeletal system

can in time produce an unnatural " fixed scar " deformity as the soft

tissues above this point begin to descend with gravity. And finally,

skin tends to stretch more than the superficial fascial system with

age because of its inherent histologic architecture and

susceptibility to sun-induced relaxation. Comparative histologic

studies of the superficial fascial system and other collagenous

structures are currently in progress.

Superficial fascial system suspension has been combined with a new

transverse flank-thigh-buttock lift design to provide an improved

lift with fewer untoward side effects and incisional scars that

remain hidden within bikini lines. " The Colles fascial anchoring

technique for medial thigh lifting has been modified to include

repair of the superficial fascial system of the inferior thigh flap

to Colles' fascia of the perineum. "

Best,

Steve