What happens on the day of my lower body lift surgery and for the first week?

WHAT HAPPENS ON THE DAY OF MY LOWER-BODY LIFT SURGERY AND FOR THE FIRST WEEK AFTER MY LOWER BODY LIFT?

A lower body is an extensive surgical procedure that addresses the abdomen, pubic region, hips, and buttocks in one surgery. Many patients ask what exactly happens on my surgery day. Dr. Katzen has written this blog to address this question as well as what happens for the first week after your 360 lower body lift.

WHAT HAPPENS ON THE DAY OF MY LOWER-BODY LIFT SURGERY?

You will arrive at the designated time. Please do not eat or drink anything along the way. Plan to leave all your jewelry and anything of value at home. Please bring all your medications, garments, and leg compression device to the surgery center. Since a lower body lift is long, please arrive early at the surgery center or hospital. Please map out the driving route and plan for parking so you are on time. Once you arrive at the surgery center or hospital, there are some forms they will need for you to complete. These are additional forms that the surgery center or hospital requires, in addition to the forms that you sign for your plastic surgeon. Once the forms are completed, you are escorted into a changing room. You will put on a surgical gown. You will place your belongings in a personalized, secure locker. Please leave your phone in your locker.

IN THE PRE-OPERATIVE HOLDING AREA

You will proceed to the waiting room. Two sets of professional medical pre-operative pictures are taken in the waiting room. One set of pictures depicts your anatomy without markings. Surgical markings are placed on the anticipated incisions. Additionally, areas of skin and fat resection are outlined. A second set of pictures is taken to show the markings. During this time, you should ask your plastic surgeon any final questions. Many patients ask where the incisions are placed and what is to be removed. Once the pictures are completed, you are taken to the pre-operative holding area.

Your nurse will ask about your medical and surgical history, medications, and allergies in this setting. At this time, your prescribed medication are checked to ensure that you have all the medications needed for a successful recovery. An IV is established. You are given a shot of Lovenox to thin your blood. This shot should be continued for the next 13 days at about the same time. The shots will help to minimize blood clots. Also, a nausea patch is placed behind your ear to minimize intra-operative and post-operative nausea. You will meet with your anesthesiologist. Your anesthesiologist will review your medical history, chest X-ray, EKG, and labs and ask generalized health questions. Leg squeezers are placed on your calves to minimize the chance of blood clots. Once you are all cleared, you are wheeled to the operating room.

IN THE O.R. AND OFF TO SLEEP

Before going to the operating room, you are given some medication to help you relax. In the operating room, you are placed on monitors to measure your blood pressure, heart rate, and oxygen levels. A grounding pad is placed for the electrocautery to work. Once all your vital signs are optimized, you are given an anesthetic through your IV to help you completely relax. A breathing tube is inserted once you are completely asleep and without pain. A bladder catheter is inserted. You are moved to the operating room table and placed face-down. Strict care is taken to avoid undue pressure on your face, eyes, arms, breasts, shoulders, and knees. Your back, buttocks, and upper legs are sterilized with an antiseptic. You are draped with surgical drapes. A “time-out” will confirm the correct patient with the correct surgery. Once the anesthesiologist and plastic surgeon are completely satisfied that you are asleep and without pain, the surgery will start.

THE SURGERY COMMENCES: THE BACKSIDE

The surgery is initiated by injecting a local anesthetic into the proposed incision. The local anesthetic consists of lidocaine and epinephrine. Lidocaine helps with intra-operative and post-operative pain levels; epinephrine helps to minimize bleeding. After waiting for about seven minutes, the surgery is initiated.

BUTTOCK AND HIP ELEVATION

The surgery is started by making an incision in the upper portion of the buttocks. Tissue dissection is carried down to the gluteus maximus muscle. The thickness of the flap will depend on the amount of fat to remain. Tissue dissection is carried down to the sides of your hips. The surgical field is checked for any bleeding; any bleeding is controlled with electrocautery. Manual dissection is done to ensure symmetry. The anticipated resection is checked multiple times to ensure symmetry and a maximal resection of buttock and hip skin and fat with minimal tension. The excess buttock skin and fat are removed with a scalpel.

Further blood loss is controlled by electrocautery. To minimize further blood loss and mobilize any blood in the flap back into your circulation, the specimens are wrapped in a tight bandage. Drains are placed on each buttock. The incision is enclosed with dissolvable sutures in multiple layers. Once the skin is closed, you are wiped clean and dry of any blood and skin prep. You are flipped on the operating room table into a face-up position.

THE SURGERY CONTINUES: THE FRONT SIDE

You are given another dose of IV antibiotics. Your abdomen and upper legs are prepped with an antiseptic and draped in the usual sterile fashion. The proposed incision is injected with lidocaine and epinephrine. An incision is made across the pubic region and tissue. Dissection is carried down to the rectus abdominis, or six-pack muscle and extended to the umbilicus or belly button. The belly button is released from the anterior abdominal wall, like unbuttoning a button from a shirt. The incision across the pubic region is connected to the hip incisions on the back. Again, the blood loss is controlled with electrocautery. Tissue dissection is extended to the sternum and the costal margin, or the lower portion of the rib cage. This exposure allows complete visualization and manipulation of the rectus abdominis muscle. Due to significant weight loss and weight loss fluctuations, the fascia, or layer on top of the rectus abdominis muscle, is usually weak. Therefore, almost all weight-loss patients require rectus abdominis muscle plication.

RECTUS ABDOMINIS MUSCLE PLICATION

Muscle plication is accomplished with a two-layer closure. First, sutures are placed from the belly button to the pubic region, and then, from the belly button to the xiphoid or the bottom of the sternum. These sutures are placed in an interrupted, buried fashion. “Interrupted” sutures mean that approximately 20 to 30 sutures are placed individually or in an interrupted fashion. “Buried” means these interrupted sutures are placed with their knots buried deep in the muscle. A second layer of permanent sutures is placed to reinforce this layer. The second layer is placed like a running baseball stitch from the xiphoid to the belly button and to the top of the pubic region.

REMOVAL OF ABDOMINAL SKIN, PLACEMENT OF BELLY BUTTON AND BEYOND...

Two drains are placed on the abdomen. The two drains placed on the buttocks are tunneled to the pubic region. All drains are anchored with sutures in the pubic region. A pain pump is inserted to control post-operative pain. The abdominal flap is mobilized inferiorly. The anticipated resection is confirmed multiple times to maximize skin and fat resection and minimize tension. Having confirmed the amount of skin resection, the abdominal skin is removed. The abdominal flap is pulled down and anchored using multiple sutures. The sutures are absorbable or dissolvable. The final step in the completion of the 360 circumferential lower body lift surgery is the insertion of the belly button. The operating room table is flexed 45°. Measurements are made to accurately make an incision on the abdominal wall to place the belly button. An incision is made on the abdominal wall, and the belly button, which had previously been unbuttoned, is anchored to the anterior abdominal wall. The belly button is anchored with multiple absorbable sutures. The abdominal drains are placed on suction reservoirs. The pain pump is connected to its local anesthetic reservoir. You are wiped clean and dry of any blood and antiseptic. A sterile dressing is placed around your lower torso. A garment and an abdominal binder may be placed. Medication is given to reverse the anesthetic, the breathing tube is removed, and you are gently awakened. You are transferred to the gurney.

BACK TO THE RECOVERY ROOM

You are taken to the recovery room for close post-operative monitoring. Multiple monitors are placed in the recovery room to monitor your blood pressure, oxygenation, and pulse. Typically, you are monitored for about two hours. Once your vital signs are stable, you are transferred to the recovery center for further monitoring.

WHAT HAPPENS AFTER I LEAVE THE SURGERY CENTER OR HOSPITAL?

MEDICAL TRANSPORTATION

You are taken by medical transportation to the recovery center. Medical transportation is essential because there is significant tension on the incision line. Since the incision goes 360° around your lower abdomen, there is tension when you sit and lay flat. Therefore, the ideal position is flexing your back at approximately 45°. If you sit 90°, there is too much tension on the back, which could cause the buttock incision to open. Alternatively, suppose you lay flat on your back. In that case, there’s too much tension on the abdomen, and it could tear the abdominal incision open. In addition to optimizing post-operative positioning, the medical transport team will also be able to monitor your vitals in case any abnormalities arise. The medical transport team will transport you from your gurney at the surgery center to your bed at the recovery center.

RECOVERY CENTER

At the recovery center, you meet your new team of nurses, who will also check your vital signs and review your medical history. The nurses will continue administering IV fluids and monitoring fluid output with your bladder catheter. The nurses will also be able to administer your medications. At the recovery center, the nurses will take all your medications for safety. The nurses are in control of dispensing your medications. If you have pain, you must communicate this to your nurses, who will dispense pain medication appropriately.

THE DAY AFTER YOUR SURGERY: PROTEIN, POSITIONING, AND DEEP BREATHING

You will continue to recover. The day after your lower body lift surgery, you are given your antibiotic pills and other required medications. You are encouraged to drink or eat about 100 g of protein. Most patients get the protein through drinking Premier Protein, which has 30 g of protein in a box. Therefore, you will need to drink three or more boxes a day. Maintaining your position in bed at a 45° incline is very important. Equally important is the use of the incentive spirometer. This plastic machine is a plastic tube that helps to inflate the lungs. The body lift surgery creates pressure on the breathing muscle or diaphragm. This pressure is due to rectus muscle plication, skin tightening, and garments. In turn, this pressure causes the collapse of the lower lung sacs and the accumulation of lower fluid in these sacs. The collapse of these lung sacs is called atelectasis. The incentive spirometer is essential because it allows your lungs to expand fully and minimizes the collection of lung secretions. You are encouraged to cough. Coughing eliminates lower lung secretions. On the first day after your surgery, your plastic surgeon will determine if you are ready to walk.

THE SECOND DAY AFTER YOUR SURGERY

This day is like the first day after your lower body lift. Ideally, you will have less pain and less need for narcotics. Also, it would help if you were less sleepy because the anesthetic may have worn off. Essential things to accomplish during your second day after your body lift are to continue using the incentive spirometer and maintain your goal of 100 g of protein daily. During your second day, you are encouraged to walk. Walking is vital to minimize the chance of blood clots, help with circulation and breathing, and stimulate G.I. motility. You should focus on achieving at least 100 g of protein daily and use the incentive spirometer. Incentive parameters should be used every hour while you are awake. It would help if you focused on taking 15 to 20 deep breaths and holding each breath for as long as possible.

Usually, patients can leave the recovery center the second day after their lower body lift. There are, however, exceptions. Suppose you leave the recovery center the second day after your body lift. In that case, the medical transport team will help assist you. Much like the initial transport, the medical transportation will take you from your bed at the recovery center to your local bed. Depending on the circumstances, your local bed may be your home, friends, home, Airbnb, or hotel.

WHAT SHOULD I DO AFTER I GET HOME BEFORE MY FIRST POST-OPERATIVE VISIT? EAT, GI ISSUES, AND DRINK

EAT PROTEIN

It would help if you continued achieving 100 g of protein daily. Most patients achieve this goal with protein drinks and protein shakes. If you prefer to use solid food, that is acceptable. Please read more about what to eat after a lower body lift at https://beverlyhills.timothykatzenmd.com/blog/what-to-eat-after-your-body-lift-and-other-plastic-surgery-procedures And

https://beverlyhills.timothykatzenmd.com/blog/meal-plan-for-post-op-body-lift-sample-menu-8

CONSTIPATION

Almost everyone is constipated after a lower body lift. Constipation is expected because of the general anesthesia, narcotics required during and after the surgery, abdominal tightness, being in the garment, and being on bed rest. The day after surgery, you were given a stool softener. However, most plastic surgeons do not suggest you take anything more substantial than a stool softener like Colace. If you take medication to treat your constipation, you may create the opposite effect, namely diarrhea; diarrhea is far worse than constipation after a lower body lift. Diarrhea would mean that you would have to go to the bathroom multiple times a day. Going to the bathroom would create unnecessary pressure and tension on the incision due to the walking, removal of the garment, and sitting on the toilet. In addition, diarrhea can lead to dehydration and even wound infections if the stool gets into the incision. Therefore, a slight constipation in the setting is acceptable.

DRINK WATER

It is essential that you stay hydrated after a lower body lift. After a lower body lift, tissues swell. This swelling can be witnessed along the incision, areas of dissection, as well as in the face and the hands. Dehydration also minimizes constipation. Your goal should be to drink approximately one gallon of water daily in addition to your protein intake.

You should continue your other medications as instructed. Required medications include antibiotics and your blood thinner shots. Try to decrease your pain medication as much as possible; too much pain medication can lead to problems with addiction, withdrawal, and the worsening of constipation. Also, if you have continued nausea, you may have to change your nausea patch every three days.

WHAT HAPPENS DURING MY FIRST DOCTOR’S VISIT? DRESSINGS AND DRAINS

During your first doctor’s office visit after surgery, your plastic surgeon removes all the dressings. The incision is closely examined. Your plastic surgeon will instruct you on how to care for the incision. Dr. Katzen advises painting the incision with betadine once daily and applying pads 360 around the incision. The betadine and the pads should be changed daily. The medical-grade garment may or may not be changed during the first post-operative visit. Also, the pain pump will probably be removed.

Please bring your records of the drain output. If the drain output is low enough, some of your drains are removed during this first post-operative visit.

It is crucial that you record the drain output. You must bring this piece of paper to your first post-operative visit. Drain-out food should be checked every eight hours. The drains should be emptied and recorded every eight hours. If there is significant blood in the drains, contact your plastic surgeon immediately. The drains should always have a dent to ensure suctioning and functioning. For more information, please watch https://www.youtube.com/watch?v=eHGdKQIDUj4&t=167s

WHAT IS DRAIN REMOVAL LIKE?

Drains are an essential part of the 360 degree lower-body lift. Drains remove unwanted fluid accumulations in your body by applying negative pressure to a tube inside your body. Typically, the fluid removed is a mixture of blood and serous fluid. Serous fluid is your body’s natural “superglue” to help seal wounds. Since the 360 degree lower body lift is an extensive procedure, the body makes too much serous fluid. However, too much serous fluid floats the flaps away, and the dissected area cannot seal. Therefore, drains are essential for fluid removal in a comprehensive procedure like a lower body lift. When the drains are not removing much fluid, it is time for their removal.

The drains are secured to your skin with a suture. During drain removal, the suture is cut, and the drain is manually removed. Drain removal does hurt a little. Your plastic surgeon may wish for you to take a pain pill in preparation for drain removal, though it is usually unnecessary. Another alternative to a pain pill is the injection of a local anesthetic around the drain site; however, local anesthesia requires an injection with a needle. Another alternative is the application of a topical numbing cream to anesthetize the skin around the drain before removal; however, numbing cream requires about one hour of application for effect. Once the drain is removed, the hole where the drain was removed is left open. The hole is left open to allow further drainage of any remaining fluid. Over the next 36 to 48 hours, your body will form a scab over the drain site. Once the scab forms, the drain site wound will heal. About two weeks later, the scab falls off, and the drain site is healed.

WHAT IS THE PAIN PUMP REMOVAL LIKE?

The pain pump is a thin tube inserted inside your body to slowly drip in pain medication for up to five days after your 360 degree lower body lift. There are several types of pain pumps, from self-regulatory to automatic. The thin tube is connected to a local anesthetic reservoir, which helps numb the abdominal wall after a 360 degree lower body lift. The pain pump tube is usually attached to the drain. Pain pump removal is relatively easy. Usually, sutures are not used to anchor the pain pump. During pain pump removal, the pump slides out with manual traction. Usually, the pain pump is removed during the first postoperative visit to the office.

Pain pills are not required for the removal of the pain pump.

WHY IS A BLADDER CATHETER USED?

A bladder catheter is used for several reasons. A bladder catheter monitors the amount of fluid your body does not need after a 360-degree lower body lift. After a 360 lower body lift, there is significant swelling and a process called “third spacing.” This reaction is your body’s natural reaction to trauma and surgery. After any surgery, our body’s response is to absorb as much fluid as possible from your stomach and intestines. That is why drinking a gallon of water daily after your 360 lower body lift is so important. Your body will absorb as much water as it needs. Your kidneys process the excess water and then send this water to the bladder, which empties into the bag. Therefore, the bladder catheter allows for fluid monitoring and management. Also, a bladder catheter decreases the need to get up and down to the bathroom. Unnecessary ambulation and mobilization lead to significant unwanted tension on the incision, which can lead to wound openings. Therefore, the less active you are, the less chance there is of a wound opening. If a bladder catheter is kept in place, this leads to less activity.

WHAT IS THE REMOVAL OF THE BLADDER CATHETER LIKE?

The bladder catheter is a double-lumen tube that goes into your bladder. A double lumen means that it is a tube within a tube. On the outer tube, there is a side port that allows for balloon inflation at the tip of the catheter. Once you are completely asleep, the catheter is inserted into your bladder. Once the catheter is in your bladder, the balloon is inflated by injecting fluid into the side port. The balloon inside your bladder is about the size of a grape and ensures the bladder catheter does not fall out. The inner tube allows any fluid in the bladder to drain into the bag. The removal of the bladder catheter is relatively straightforward. The fluid in the balloon is removed, and the balloon deflates. Once the balloon is deflated, the bladder catheter gently slides out. Typically, the bladder catheter is removed at the first or second doctor’s office visit.

If you are considering at 360 circumferential lower body lift and have questions or would like to schedule a consultation, please contact Dr. Katzen. Virtual consultations can also be scheduled on platforms like FaceTime, Zoom, Skype, or WhatsApp. Dr. Katzen looks forward to meeting you. Call Dr. Katzen TODAY at (310) 859-7770 to schedule your personalized consultation and achieve the body of your dreams.

Before and After Photos: 360 Lower Body Lift