I recently gave a lecture on the  body lift procedure to other surgeons in my hospital. In gathering the information for my talk, two things struck me when reviewing the literature published by other physicians. In summary, the current literature concludes that 1) surgeons are still reporting complications with the body lift procedure and 2) surgeons are still “learning about the procedure”.

My impression is that they are having these problems because they do not use the Lockwood technique of body lifting. I use the Lockwood technique and feel very confident with the procedure and my results.

Many published papers on the lower body lift procedure list seromas (fluid accumulations under the skin) and wound separation as the main complications of the body lift procedure. Another theme was that many of the lecturers stressed the point that “we are still learning about this procedure”. Well, its refreshing to know that even the surgeons in the lecture circuit are “still learning”, but I felt very fortunate because in the last three years (scores of procedures) I have only had 1 seroma, and two minor wound separations. However, there is a good reason for my success, and it has to do with the fact that I use the body lift technique developed by Dr. Ted Lockwood in the early 1990’s. I use the Lockwood technique and this technique yields the best surgical results.

The body lift is a variant of dermatolipectomy, which is cutting away excess skin from the stomach area. A dermatolipectomy that goes around the body like a belt is called a belt lipectomy. Prior to the 1980’s, the dermatolipectomy was used regularly to tighten the stomach area , but when liposuction came along in the eighties it quickly fell into disfavor. Who wanted a scar around the body when you could get a major liposuction contouring around the midsection with practically no scar?

Despite the dermatolipecomy falling out of favor in that time, a Midwestern surgeon by the name of Dr. Ted Lockwood kept working through the problems of unsightly scars from the dermatolipectomy procedure. He came up with a solution that at first was hard for most surgeons to accept. It was to use a layer of the fat tissues known as Scarpa’s fascia as the tension bearing part of the skin closure. He designed a procedure named high lateral tension abdominoplasty which sounded like it went against everything I had been taught as a plastic surgeon.

Plastic surgeons are taught never to close wounds under tension as it can lead to wound separation or bad scars. But Dr. Lockwood was promoting high tension for closing wounds! Dr. Lockwood,was using a method called lateral tension, which put the maximum stress on the far sides of the dermatolipecomy scar.

In the late 90’s this all sounded so bizarre that I thought Dr. Lockwood was totally confused or a genius, and I had to take his course to find out. Each year, plastic surgeons developing new techniques present their findings in special lecture courses at our Annual ASPS meeting.

After listening to his lecture and seeing the video footage of his results in the operating room, I concluded that he was a genius. Using Scarpa’s fascia, Dr. Lockwood was able to limit his dissection (the amount of tissue lifted from its attachments and blood supply). The skin from the belly that was being pulled down had both more tension (giving a better esthetic result) as well as better blood supply. This resulted in a safer body lift with a better scar and less complications.

I started using Dr. Lockwood’s technique right after I took his course.

Everything got better. A year or two later, I reviewed the video tapes of Dr. Lockwood performing the body lift procedure. Again I was amazed at his results because they were so much better than what you could get with just liposuction or even Tummy Tuck plus liposuction. However, the body lift procedure didn’t really take off yet because patients were still hung up with the scar. Some people just couldn’t get over the scar.

The explosion of bariatric (stomach stapling, weight loss) surgery changed everything. It was creating a group of people with large skin folds after massive weight loss. To them, the belt scar was much better than hanging skin and these patients were more than happy for a procedure that could get rid of the folds of skin, never mind the scar.

Unfortunately, Dr Lockwood died just as the greatest need for his procedure came about. As other surgeons started reporting their experience, I took a course on post bariatric reconstruction. This course was not based on the Lockwood technique. After taking this course, I made some modifications to Lockwood’s technique based on information learned in the course. However, I started noticing that I was having small wound problems and in 1 patient a bona fide wound separation. The small changes were resulting in problems instead of improvements! A procedure which had worked so well for me in the past was now “acting up”. The Lockwood procedure was better without the modifications!

After a lot of tinkering and pondering, I decided to go back to Lockwood’s basic technique. To make a long story short, I stopped doing all of the small changes that were being taught in the post bariatric reconstruction courses! It was a mistake to cut the excess tissues “at rest”, or as they lay in the operative field. By the time you pulled the tissues together there was too much tension. By pulling on the tissues and cutting where I expected the tissues to be at the time of wound closure the tension on the wound closure was “just right”.

This seems like a minor point, but it had a big impact. Once I went back to the Lockwood technique all of my wound problems disappeared. To summarize, I think that some of the lessons of Dr Lockwood have been forgotten or misunderstood. My own experience tells me the complications seen with this procedure are not so much due to the post bariatric patients themselves, but to the operative technique being used.

Dr. Lockwood’s technique of body lifting is the one that I use and I am confident that it is far superior to other body lifting techniques.

Ricardo L Rodriguez, MD