Enhancing Masculine Features After Massive Weight Loss

Aesthetic Plastic Surgery, Feb 2016

Dennis Hurwitz

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Enhancing Masculine Features After Massive Weight Loss

Aesth Plast Surg Enhancing Masculine Features After Massive Weight Loss Dennis Hurwitz 0 1 2 0 University of Pittsburgh Medical Center , 3109 Forbes Avenue, Pittsburgh, PA 15213 , USA 1 & Dennis Hurwitz 2 Presented in part at the 2014 meetings of the American Association of Plastic Surgeons in Miami, Florida; Northeastern Society of Plastic Surgeons in Providence, Rhode Island; and the Ohio Valley Society of Plastic Surgeons at the Greenbrier Resort , West Virginia , USA Background Whereas body contouring surgery after massive weight loss in women emphasizes sculptured adipose and broader lower torso, little attention has been devoted to accentuating the male physique. Objective To determine if boomerang excision pattern correction of gynecomastia with J torsoplasty combined with an abdominoplasty with oblique excisions directly over bulging flanks provide effective and safe optimizing of muscle visibility and upper torso dominance. Methods A description of comprehensive body contouring through an abdominoplasty and a series of obliquely oriented ellipses of the male torso is followed by review of 19 consecutive patients. Results Seventeen patients were performed in a single stage. Nine of the last ten cases included J torsoplasty and oblique excision extensions over the flanks. Of the 17 patients responding to a ten-question survey, 15 were satisfied with chest improvement. One of the first eight patients with a transverse lower body lift was satisfied with the flank bulges. All of the last eight cases with direct oblique flank excisions were satisfied with their lower body. Five patients (26 %), having a total of 74 operative procedures, had significant complications of chest hematoma, persistent hip and buttock seromas, superior NAC Male body contouring correction; Body contouring surgery; Boomerang correction of gynecomastia; Upper body lift; Lower body lift; Gynecomastia; Abdominoplasty; Liposuction - edge necrosis, and distal necrosis of the fleur de lis abdominoplasty. One boomerang correction underwent minor revisions. One transverse lower body lift underwent major revision. No complications occurred in the last ten patients, having oblique flank excisions instead of transverse lower body lifts. Conclusion Comprehensive excisional body contouring surgery of a central high tension abdominoplasty with a series of obliquely oriented ellipses throughout the torso appears to provide low risk improved body contour for the muscular male. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Introduction After massive weight loss (MWL), men seek body contouring surgery for the removal of excess skin and fat followed by tightening and suspension of residual lax tissues. Men generally have correction of pseudogynecomastia and an abdominoplasty extending into a lower body lift [ 1 ]. Since many men are obsessed with muscle show and upper torso dominance and are considering plastic surgery to achieve those goals [ 2 ], plastic surgeons should be prepared to accentuate those features. This is a preliminary report of total body lift (TBL) [ 3 ] surgery that seeks that transformation through abdominoplasty and a crisscross pattern of elliptical excisions across the torso (Fig. 1) [ 4 ]. By removal of most horizontal and vertical excess skin and fat, uniformly tight skin across the torso leaves upper body dominance, muscular show, and two sets of long zigzag scars (Fig. 2). This comprehensive surgery is presented and then followed by a review of 19 consecutive patients (Table 1). The indication for this male TBL is sagging pseudogynecomastia with moderate to severe skin laxity of the abdomen and flanks 1 year after stable MWL. The ideal patient is muscular, healthy, and frustrated that rigorous bodybuilding fails to reveal visible results. He desires a harmonious muscularity throughout the torso with the upper dominating the lower. Less sinewy and older men, seeking more muscular show, are also considered. Lengthy operations and scars throughout their torso must be accepted. All patients understand that the boomerang pattern originated with this author and that combining that operation with an abdominoplasty and posterior excisions is an exceptionally lengthy surgery. The operations are staged for BMI over 34, excessive skin resections, chronic illness, or patient concern. Patients agreed to be reported anonymously with consent obtained for photograph presentation. Case 1 (Table 1, patient 1) has generalized loose skin and residual adipose bulges of pseudogynecomastia, and lower body bulging abdominal pannus, mons pubis, and love handles (Fig. 3). This 27-year-old male lost 60 pounds, and regained 20 when frustrated by lack of muscular show. Through a 12-week HCG/500 calorie a day diet [ (...truncated)


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Dennis Hurwitz. Enhancing Masculine Features After Massive Weight Loss, Aesthetic Plastic Surgery, 2016, pp. 245-255, Volume 40, Issue 2, DOI: 10.1007/s00266-016-0617-x