Lower Body Lift (Belt Lipectomy) Surgery Guide

Substantial weight loss could leave excess skin and fat 360 degrees around your waist, affecting your abdomen, flanks, upper pubic zone, buttocks, and thighs. Belt lipectomy surgery removes excess skin from these areas with a 360-degree incision around the belt line. This surgical procedure is often performed in one or two stages and is one of the most comprehensive options for post-weight-loss patients with sagginess after losing more than 30 kilos.

Illustration of belt lipectomy | BCSC

Preparing for a Belt Lipectomy

Before your body contouring surgery, you’ll meet with the surgeon for a consultation. Your surgeon will review the following:

Who is a Candidate for a Belt Lipectomy?

Belt lipectomy | Dr Beldholm

Disclaimer: Operation performed by Dr Bernard Beldholm. Adult content, surgery has risks; individual results vary, seek 2nd opinion. Please see the full disclaimer.

There are many body contouring procedures available to post-weight-loss patients with sagging skin. Your surgeon will examine you to determine if you are a good candidate for a belt lipectomy or other procedures. Some factors they will consider include the following:

Your Physical Presentation

Belt lipectomies are for patients with loose skin on the abdomen, hips, lower back, and surrounding areas such as your buttocks, mons pubis, and thighs. It is important to tell your surgeon which body areas you want to address specifically. They will customise your surgical plan to match your goals and body.

Your Weight Loss History & Body Mass Index

BMI

Most patients eligible for this surgical procedure have excess skin after massive weight loss. A belt lipectomy should only be performed when you are at or close to your goal weight. If your body mass index indicates you are still significantly overweight, you likely will not be a candidate.

Belt lipectomies only remove loose skin and fat that remains after massive weight loss. It is not a weight-loss surgery. Instead, it will refine and contour your body by removing excess skin after you have already lost weight. Additionally, you must maintain a stable weight for at least six months before the surgical procedure.

Contraindications & Risks

Your surgeon will ask about your medical history in detail during your consultation. If you are pregnant, a smoker, have diabetes, cardiovascular or respiratory disease, or haemophilia, or if you are mentally impaired, a belt lipectomy might not be appropriate.

Body contouring surgery carries possible risks, even for the healthiest patients. Your surgeon should discuss these with you and inform you about all of the known risks before proceeding.

Major weight loss

Possible Risks and Complications of a Belt Lipectomy

DVT after surgery

Belt lipectomy risks are possible no matter which surgeon performs your operation. Some possible complications to be aware of include the following.

• Seroma: Sometimes a pocket of clear serous fluid can build up in the tiny gaps between the tissues that have been dissected. (Ref 2) Seromas can often be drained during a quick, in-office procedure. This would be considered a minor complication.
• Necrosis: If the skin at the incision site becomes infected, there is a chance it could become necrotic if left untreated. This could cause some of the skin locally to die off, which could result in undesirable scarring or deeper infections.
• Blood Clots: Blood clots can form in the legs from resting for prolonged periods while healing from a belt lipectomy. Blood clots can sometimes break off and travel to the lungs, which could lead to a fatal pulmonary embolism. You must walk for a few minutes every few hours starting from day one to keep your blood circulating.
• Haematoma: Bruising is expected after a belt lipectomy, but occasionally blood may pool outside the blood vessels. This is considered a minor complication. A haematoma can usually be drained in the office if needed. Some haematomas resolve on their own. (Ref 3)
• Poor Scarring: A belt lipectomy leaves a long scar around the waistline. The scar is unavoidable, permanent, and not considered a complication. However, sometimes scars heal poorly due to genetic or other factors. Other times, the scar may have an irregularity, such as a dog ear or flap of excess tissue which can usually be revised to look significantly better. (Ref 1)
• Nerve Damage: Tiny, superficial nerves are inevitably damaged during a belt lipectomy. It is normal to have some numbness for approximately three months until these nerves heal. Although highly unlikely, deeper nerves can be damaged during the operation.
• Uncontrolled Bleeding: Excessive bleeding is possible during any surgery. 
• Complications From Anaesthesia: Possible complications from anaesthesia can occur, ranging from difficulty waking to heart or breathing issues to a potential fatality. A licensed anaesthetist will oversee you during your surgical procedure and monitor your vitals.
• Undesirable Cosmetic Result That Requires a Revision: Surgery is an art and every patient is unique. The results may not always be perfect, although your surgeon will strive to get as close to perfect as reasonably possible. If after a year, you have remaining excess skin or a scar that needs revising, it can usually be resolved with a revision procedure.
• Wound Infection: Infections are possible so it’s vital to keep your healing incision clean.
• Loss of Skin Sensation: Numbness should be expected to some degree during the first three months or so of recovery. If not all of the superficial nerves cut during surgery regenerate, you could experience longer-lasting numbness in the operable areas. 
• Asymmetry: Your surgeon will make an effort to remove excess skin and fat evenly on both sides of your body, but there may be a discrepancy. Usually, asymmetry is unnoticeable to anyone but the patient. If you have noticeable asymmetry, your surgeon may need to perform a revision procedure to correct it.

*Other risks may be possible. Your surgeon should provide you with a complete list during your consultation process.

Major weight loss

Surgery Guide: Belt Lipectomy Operation Steps

The surgical steps and technique will vary from patient to patient as each patient is unique. Many post-weight loss patients have minimal fat present in the tissues and will therefore not need liposuction. Others may have fat accumulations in certain areas only. Many patients have loose skin on the outer thigh area. For these patients, it is important to apply enough tension to lift the outer thigh area up. If there is fat in the thigh area, then this can be removed with liposuction. The initial part of the operation is generally the same as an abdominoplasty. The patient is then turned from side to side to remove the excess skin on the sides and back.

1. Surgery Preparation

• Markings: Before your operation, your surgeon will meet you in the anaesthetic bay at the hospital to draw surgical markings on your skin. You will stand upright as this is done since lying on the operation table can mask the areas where excess skin and fat are present due to gravity.
• Body Positioning on the Operating Table: Next, you will lie down on the operating table. The hospital staff will then wheel you into the operating theatre.
• General Anaesthesia: You will receive general anaesthetic which is typically administered through an IV. Once you are anaesthetised, a tube will be placed to assist you with breathing during your operation.

2. VASER Liposuction Procedure

If your surgical plan includes VASER liposuction or any other form of liposuction, it should be performed at the beginning of your operation before your surgeon removes any loose skin.

• Applying the Wetting Solution: First, your surgeon will inject tumescent fluid into the liposuction areas. Doing so helps to stiffen and isolate the fat cells as well as reduce bleeding during the operation.
• Making the Incisions: Liposuction incisions are generally tiny, just large enough to pass the liposuction probe or cannula through.
• Protecting the Skin: If your surgeon is performing VASER liposuction, they will need to protect your skin from burns by applying a small, heat-resistant port. The reason for this is that the VASER probe gets hot as it oscillates rapidly to break up the fat cells.
• Fat Melting: VASER liposuction differs from standard liposuction techniques in that it liquefies the contents of the fat cells using ultrasound waves. The fat almost appears melted, which makes it easier for surgeons to extract the fat.
• Fat Removal: Once liquefied, the unwanted fat cells will be suctioned out through a hollow suction tube.

3. Removing the Excess Skin From Your Abdomen

Initial abdominoplasty incision, operation performed by Dr Beldholm

Traditional Abdominoplasty (Tummy Tuck)

• VASER Liposuction on the Abdomen: If your surgery plan includes VASER liposuction, your surgeon will extract the excess fat from your abdomen and sides as needed.
• Belly Button Incision: Your surgeon will make a circular incision around your belly button. Your belly button will later be repositioned so it does not sit unnaturally low on your abdomen once your incision is closed later in the surgery.
• Abdominoplasty (Tummy Tuck) Incision: A horizontal incision will be placed between your hips. The incision lines will extend around your waist to meet the lower back incision your surgeon made earlier.
• Creating the Epigastric Tunnel: The skin flap at the incision line will be lifted to expose your underlying tissues. Your surgeon will begin to dissect the underlying tissues, creating a tunnel to reach the uppermost layer of abdominal muscles.
• Abdominal Muscle Repair: Through the epigastric tunnel, your surgeon may suture your six-pack muscles together in the middle. This step is often necessary for post-bariatric and postpartum patients, among whom abdominal wall muscle separation is common.
• Removing Excess Skin and Fat From the Abdomen: Your surgeon will measure and trim off the sagging tissues.
• Belly Button Repositioning: Your surgeon will measure where your belly button will be placed. This is done by pulling the remaining skin to close the incision and determining where your navel would sit naturally.
• Closing the Incision: Now that your excess skin and fat have been removed, your surgeon will close your abdominal incision using layers of permanent and dissolvable sutures. They may also apply a spray sealant to lower the chance of unwanted fluid accumulation in your tissues.

Removing Loose Skin on the Back and Sides

• Turning You Over: During the operation, the medical team will reposition you on the operating table. They will turn you from one side to the other, starting with the right side and then the left side. This is done to access and lift the outer thigh area.
• Flank & Back Incision: Your surgeon will make a horizontal incision that is usually placed close to where the lower back and buttocks meet.
• Removing the Excess Skin and Fat: Your surgeon will carefully trim off any excessive tissue.
• Closing the Rear Incision: Next, they will pull the skin together and add sutures. As your incision is closed, the skin on your buttocks and lower back will become smoother and uplifted.

4. Finalising Your Surgery

PICO dressings at the end of the operation | Dr Beldholm

• Wound Dressings: Your surgeon will complete your operation by applying a wound dressing, which can range from a simple bandage to a high-tech wound dressing such as the PICO dressing. The goal is to keep your incision clean until it heals.
• Compression Garments: Many surgeons recommend wearing compression garments after body contouring procedures, and a belt lipectomy is no exception. You will likely be asked to wear your compression garment or abdominal binder for several weeks into your recovery process. It is hidden in most clothing styles so no one will see it.
• Results: Although you will no longer have sagging skin or loose skin folds in the treated areas, you won’t see your final results immediately. When you awake in the operating room and for several weeks, you may have a significant amount of swelling. Bruising is also common which typically resolves within two weeks or so. Expect a very early preview of your belt lipectomy results and an improved body contour within three to six months of your procedure, with final results at 12 to 18 months. Your abdominal region, hips, lower back, buttocks, upper pubic area, and thighs should appear firmer and tighter. Any remaining excess skin or fat can be removed with a secondary body contouring procedure such as a thighplasty (thigh lift) six months later.
• Maintaining Your Results: Keeping a stable weight long term is crucial to maintaining your results. Future significant weight loss or gain, whether due to dietary changes or pregnancy, could diminish your skin’s elasticity.

Recovery

Recovery

A significant recovery period is ahead, but you should be able to walk (bent slightly at the lower abdomen) from day one. Follow your surgeon’s instructions carefully as their specific surgical technique and aftercare advice may vary. Your aftercare instructions are designed to enhance healing and avoid surgical complications such as wound separation and deep vein thrombosis.

Remaining in the Hospital Following a Belt Lipectomy

After surgery, you’ll likely spend two to three days in the hospital before you’re cleared to go home. The hospital staff will oversee you and assist you with rising from bed or taking short walks as needed. It’s important to get up and moving to prevent skin irritation from prolonged bedrest and also to keep your blood flowing so as to reduce surgical risks such as a blood clot. Any surgical drains placed to remove excess fluid will likely be removed in 24-48 hours.

Showering After a Belt Lipectomy

You won’t be able to take a full shower until seven to nine days after your body lift. In the meantime, you can take a partial shower but must avoid getting your wound dressing wet. Once you are cleared for a full shower, you should remove your compression garment so it doesn’t get wet. Be sure to dry off completely before re-applying your compression garment.

Time Off from Working, Exercising, and Driving After a Belt Lipectomy

Exercise after Belt lipectomy surgery | BCSC

The typical time off work and driving after a body lift is approximately two to three weeks, although if you have a physically active job, you may need additional time off. Activities to avoid in the first 6 weeks include heavy lifting, jogging, and intense exercise. You should be able to take short walks starting from day one and increase your time walking each day. Early on, you may need to walk bent at the waist. Roughly ten days after the surgery, most belt lipectomy patients are walking fully upright, unassisted.

Bottom Line

Belt lipectomy operations are complicated. There are many steps your surgeon must perform. Although a circumferential abdominoplasty can last five hours or more, taking the time to do each step correctly is one of the keys to a successful outcome.

If you choose to undergo a circumferential abdominoplasty operation after massive weight loss, you could enjoy benefits such as a refined body shape, firmer-looking skin, and less irritation from your excess skin rubbing together. The main trade off to consider is that surgery carries risks, and you will have a long surgical scar, which is usually hidden in clothes.

Ideal candidates for a circumferential abdominoplasty have sagging skin and resistant fat on the stomach, love handles, lower back, buttocks, mons pubic area, and thighs after losing significant amount of weight (SWL). If you’re considering this surgery, you will first need to reach a healthy weight and maintain a steady weight for six months. Smokers, pregnant women, and those with certain medical conditions may be ineligible.

FAQs

Is belt lipectomy surgery painful?

Due to general anaesthetic, you will not feel or remember your operation. Expect to feel extremely sore and achy during the first week or two. Although you may have discomfort and tenderness where you had tissue removal, it should fade over time. Most belt lipectomy patients feel significantly better after weeks two and three, which is around the time they can resume driving and heading back to work.

What are some other names for a belt lipectomy?

Belt lipectomies may also be called a circumferential body lift, circumferential abdominoplasty, lower body lift (LBL) or 360 degree abdominoplasty.

Will my surgical scar be visible to others?

Although scar placement can vary, your surgical scar should be hidden in most types of clothing. It’s important to have realistic expectations. If you wear clothing or swimwear that exposes your waistline, your scar may be seen by others.

Is it safe to combine liposuction and a belt lipectomy procedure?

If you have excess fat that remains after significant weight loss, you may be considering liposuction. It is considered reasonably safe to perform liposuction during a belt lipectomy procedure, although you should not have other extensive operations at the same time. For example, if you are considering a breast lift (mastopexy) or arm lift (brachioplasty) after you have undergone significant weight loss, these operations should be done at least six months apart to allow time for healing.

Are body lift procedures and a belt lipectomy procedure the same thing?

A lower body lift and belt lipectomy generally mean the same thing. Belt lipectomy procedures are also sometimes referred to as circumferential lipectomy surgery or circumferential abdominoplasty since the incision encircles the waistline 360 degrees.

Do I need a GP referral to see a surgeon who performs belt lipectomies?

The Australian government recently mandated that patients will need a referral from their general practitioner (GP) before meeting with a surgeon who specialises in body contouring. This is true whether you have lost weight the old-fashioned way or if you have undergone massive weight loss through bariatric surgery. If you have a significant amount of excess skin and resistant fat after you lose weight through gastric bypass surgery or other means, see your GP to ask for a referral.

Will a belt lipectomy procedure correct abdominal wall separation?

Abdominal muscles that have separated at the midline can be brought back together during a belt lipectomy procedure. The technique is similar to muscle repair performed during a tummy tuck (abdominoplasty).

Can I undergo a belt lipectomy if I smoke?

No. You will need to quit smoking before a belt lipectomy procedure and remain smoke-free as you heal.

Will private health insurance pay for my belt lipectomy?

If you live in Australia and have a top-tier private health policy, your plan may cover a portion of your hospital stay. Private health insurance generally only covers procedures that are done out of medical necessity; If you don’t have documented issues such as skin irritations caused by saggy skin, for example, you may be ineligible. If your goal is to improve your body contours from an aesthetic standpoint only, coverage might be denied. You will also need to document your weight loss journey, so it’s a good idea to see your GP regularly. They can refer you to a specialist surgeon to remove saggy skin who can tell you more.

Should I schedule my thigh lift or belt lipectomy first?

If your surgeon recommends a belt lipectomy, you should do that first since it will help tighten sagging thighs to a certain degree. Any remaining excess thigh skin can be corrected with a later thighplasty that may or may not involve liposuction.

References

1. Kang, Ajaipal S, and Kevin S Kang. “A Systematic Review of Cutaneous Dog Ear Deformity: A Management Algorithm.” Plastic and Reconstructive Surgery. Global Open, U.S. National Library of Medicine, 23 Sept. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7544318/. 
2. Kazzam, Muattaz E. “Postoperative Seroma Management.” StatPearls [Internet]., U.S. National Library of Medicine, 14 Aug. 2023, www.ncbi.nlm.nih.gov/books/NBK585101/. 
3. Shikhman, Alexander. “Abdominal Hematoma.” StatPearls [Internet]., U.S. National Library of Medicine, 10 Apr. 2023, www.ncbi.nlm.nih.gov/books/NBK519551/.