On the illustration below you see the skin excision pattern for a posterior body lift. When you combine these markings with those of a tummy tuck, you get what is referred to nowadays as a Body Lift, or Belt Lipectomy. The ideal candidate for Body Lift has too much skin relative to fat. Getting the best results comes from taking out the right amounts of fat and skin. It is not proper to take out too much skin or too  much fat.

Shaded area represents skin excision pattern

The skin pattern of excision is marked out while the patient is standing. One can be reasonably accurate about the final placement of the scar by following some basic routines while doing markings on the skin.

First, you and the patient decide where the scar would be best placed. Then draw it on the patient’s skin. To draw the upper margin of the excision, keep the marking pen at the level of the proposed scar. Pull the upper skin down as much as possible, and have the marking pen, which is at the level of the proposed scar, mark the skin.  To mark the lower margin of the excision, repeat the same steps, but pulling the skin up before doing the marking. These pulling maneuvers are essential to a good result because they prevent taking out too much skin.

Most surgeons do the markings as I described above. At surgery, they cut through the skin and fat layers until they get to the muscle layer, then take out all the skin and fat between the upper and lower margin. I believe this leads to taking out too much fat.

To prevent that, I use the Lockwood technique. It basically cuts the excess skin and fat while putting traction on the skin, much the same way as when you were marking. This is a crucial step. It preserves more of the subcutaneous tissues, at the same time it minimizes the empty spaces between skin and muscle layers. This is important because reducing empty space helps healing and helps prevent complications such as fluid collections. In the picture below, I illustrate how the two techniques result in different amouts of fatty tissue excised.

On the left, the Yellow cutout pattern represents the amount of fat that would be removed with the conventional Body Lift technique. There is more empty space between the upper and lower margins of skin. On the right, using the Lockwood technique, there is less empty space. This helps healing because the tissues come together with minimal tension, so they don’t come apart as easily, there is less space for fluid accumulations, and the blood supply coming from the muscles below is better preserved.

In another post, I will do some line drawings to explain the technical details of how the empty space impairs healing. It has to do with blood supply, strength of tissues, and the fact that nature abhors a vacuum.