The Sliding Fat Fascia Hip Flap Technique in Lower Body Lifting Surgery: Single Surgeon’s 10-Year Experience
Skin redundancy and volume deflation following massive weight loss (MWL) surgery is a common aesthetic and functional problem that affects MWL patients. Even moderate weight loss and/or genetic predisposition can result in significant skin laxity, ptosis and soft tissue contour irregularity. Surgical excision of the excess skin and lifting is the only effective treatment. MWL patients present with distinct common physical findings: skin laxity and excess, loss of skin tone, gluteal ptosis, flat ”board-like” appearance with loss of natural curvature transition from the lower back to gluteal region. Many techniques have been described to remove the excess skin and correct gluteal ptosis with autologous rotation flap augmentation and or fat grafting, but there is a paucity of descriptions addressing the lateral hips. Those previous described lower body lifting techniques can leave the female patient with a masculinized, flattened hip region, instead of smooth curvy transition from a narrow waist to a fuller hip projection. We present a single surgeon’s 10-year experience, successfully performing over 450 cases using this unique technique with excellent outcome.
Methods/Technique:
Each patient recommended for lower body lift surgery was treated with circumferential body lift with a sliding fat fascial hip flap and gluteal fat grafting technique. In the lateral decubitus position, sub-SFS (Superficial Fascial System) liposuction of the flanks and minimal liposuction in the superficial subcutaneous plane beneath the planned excision is performed and followed by wedge excision of redundant skin and superficial subcutaneous beveling from inferior to superior. Careful attention is given to not excise all superficial fat over deep lateral fat compartment by beveling from inferior to superior. The inferior skin and subcutaneous fat including SFS are elevated inferiorly by continuous dissection until sufficient lift is achieved of the hip and buttock region. Additional discontinuous dissection with the Lockwood elevator is performed over the inferolateral buttock and outer thigh to fully mobilize the soft tissue. Creation of the sliding fat fascial hip flap from the hip prominence to the midline posteriorly is then elevated inferior to superior including SFS and deep fat for about 50% of the vertical dimension of the flap. The lateral hip flap is advanced “slid” inferiorly over the continuously dissected lateral most aspect of the hip prominence and secured with running progressive tension suture (PTS) technique. The inferior skin flap is then advanced over the previously secured fat fascial flap using same PTS technique. This allows tension free closure of inferior and superior skin flaps, providing smooth transition from a thinner waste to fuller lateral hip region. Autologous fat grafting is then performed, injecting into the discontinuously dissected lateral gluteal depression, outer thigh and remaining buttock region within a subcutaneous plane. Patient is then turned to the contralateral decubitus position and the same technique is again performed. Once complete, the patient is returned to supine position where the abdominoplasty portion is performed. Complete procedure details are described.
Results/Complications:
Between 2010 and 2020, over 450 patients have undergone this sliding fat fascia hip flap procedure. All procedures were performed by the senior surgeon. Patient demographics and complications, such as hematoma, skin necrosis, flap necrosis, seroma and wound dehiscence were recorded and analyzed.
Conclusion:
The sliding hip fat-fascia flap preserves hip fullness under the skin flap where fat grafting cannot be performed during LBL surgery, and provides a more harmonious transition from the waistline to the hips, It is an excellent use of otherwise discarded tissue, which fills a potential space where the inferior skin flap elevation is performed. When combined with autologous fat grafting of the buttocks a more natural feminine silhouette can be restored. The progressive tension sutures are key to advancing the sliding fat fascia closing the potential space reducing the risk of seroma and wound healing complications.