Dennis J Hurwitz

• M. D.
• University of Pittsburgh

Background Twenty years ago, coordinated aesthetic surgery for laxity and lipodystrophy after massive weight loss (MWL), so-called total body lift surgery (TBL), encompassed circumferential hip hugging transverse lower body lift (LBL) with possible buttock auto-augmentation, and a transverse bra line upper body lift (UBL) with breast reshaping. Bra...

Optimal correction of generalized skin excess of the thigh is by lengthwise medial vertical and short superior horizontal skin excisions followed by tight two-layer barbed suture closure. Depending on extent of deformity, the operation is extended superiorly into a pubic monsplasty and posteriorly into an infragluteal posterior thighplasty. For lat...

Excess skin and adipose of the thigh may be an issue for women after pregnancy and aging, and for both genders after massive weight loss (MWL). For most, hanging tissues of the torso has priority over thighs, but patients usually want both improved. As the keystone of a Total Body Lift surgery (TBL) [1], circumferential body lift, either immediatel...

Contemporary management of gynecomastia includes transareolar excision of gland, disruption of inframammary fold, ultrasonic-assisted lipoplasty with muscular definition, bipolar radiofrequency tightening, pedicled NAC mastopexy with boomerang pattern excision and J torsoplasty, NAC grafts with hockey stick excision pattern, and pectoralis muscle l...

This chapter is limited to the tips and tricks that relate to an innovative approach to lower body contouring. The recently harnessed technology of bipolar radiofrequency skin tightening and the surgical technique of Oblique Flankplasty are game changers. A review of over 100 patients during the past 4 years permits the authors to glean 18 tips and...

The problems following correction of gynecomastia relate to poor healing or treatment that is inadequate or unsatisfactory. Unfavorable healing includes hematoma, seroma, wound separation, or skin loss. Unsatisfactory treatment ranges from incomplete or excessive resection, residual skin laxity to disturbing scars. Proper approach and careful techn...

Noninvasive and minimally invasive treatments are increasingly supplanting, or complimenting, abdominoplasty. For optimal delivery of patient care and to maintain a dominant share of the body-contouring market, plastic surgeons need to embrace these new technologies. High capital purchases, costly disposables, maintenance fees, lack of experience,...

In principle, VASERlipo with excisional body contouring offers two clinical possibilities. One is that the excision can be limited, which reduces surgical trauma and scar burden. Two is VASERlipo complements major excisional surgery which thins the patient, mobilized flaps, and lent broad impact across the entire body in a single stage. Through thr...

Introduction: Designed in response circumferential lower body lifts (LBL) failure to deepen waists, oblique flankplasty with lipoabdominoplasty (OFLA) not only aesthetically reshapes the waist, but also the hips, buttocks, and upper lateral thighs with minimal morbidity. Methods: OFLA technique was standardized with 3 of 53 cases presented. Clin...

Introduction Patients with sagging lax skin along the entire length of the upper arm are excellent candidates for arm reduction surgery extending from the elbow to axilla. In many patients and in all after massive weight loss, the axilla and along the upper lateral chest also have redundant skin. These patients are well served by an L-shaped brachi...

Plastic surgeons subspecializing in body contouring are meeting the challenge of postbariatric surgery massive weight loss patients. With an appreciation of the magnitude of the surface deformity, and altered metabolism, nutrition, and psychological makeup of these patients, innovative plastic surgeons have forged an organized approach to preparati...

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 exci...

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 excis...

Men idealize their body dominated by a broad-shouldered full upper torso with small flat nipples, a trim rippled abdomen and narrow waist, small rounded buttocks with generalized visible muscularity. The skin with a thin layer of subcutaneous tissue tightly envelops bulging underlying muscles. With the approach and techniques described in this chap...

Comprehensive body contouring surgery coordinates multiple procedures for complete artistic rehabilitation in as few stages as safely possible. There are eleven surgical principles that guide this approach. Regardless of the initial complaint, (1) conduct a comprehensive analysis and offer the entire package of operative opportunities to the patien...

After massive weight loss, pregnancies, and aging, women request removal of loose skin and excess fat of their body followed by suspension of remaining tissues. To that demand, the surgeon should add creating optimal adipose contours. A variety of case presentations have been selected to demonstrate the versatility of a comprehensive approach. Sect...

Individuals requesting body contour surgery prompts a comprehensive physical, medical, and motivational assessment. The goal is improved aesthetic topographical anatomy. Aesthetic surgical anatomy is those features that surgeons have the skill to modify or create. Massive weight loss leaves an androgynous form. Total body lift surgery attempts tran...

After massive weight loss (MWL), the patient’s face has more sagging skin than would be expected for the aging process alone. Accordingly, technique needs to include more skin resection than otherwise accustomed to. Facing the prospect of multiple operations, the body contouring patient with a sagging face should be offered an efficient, relatively...

There are increasing numbers of men and women seeking extensive body contouring surgery after massive weight loss (MWL). For MWL patients, there were more than 68,000 body contouring procedures performed in 2006, spawning subspecialty interest [1]. Since the senior author Hurwitz joined the University of Pittsburgh Bariatric Surgery team in 1998, h...

Sophisticated body contouring surgery combines excision with liposuction. Liposuction of flaps and neighboring tissues require liposuction that best preserves residual cytoarchitecture. Following a review of the literature and personal clinical assessment of a variety of modalities, VASER provides the gentlest extraction of fat along with lipoaugme...

The success and popularity of gastric bypass surgery has required that interested plastic surgeons respond to patient demands for correction of their generalized deflated skin deformity. Upmost is to understand these patients and acquire new skills for their comprehensive treatment. Ten plastic surgical principles have been proposed to guide therap...

After excess skin and fat are removed, a body-lift suture advances skin and suspends ptotic breasts, the mons pubis, and buttocks. For women, the lift includes sculpturing adiposity. While some excess fat may need removal, muscular men should receive a deliberate effort to achieve generalized tight skin closure to reveal superficial muscular bulk....

This up-to-date discourse on body contouring surgery is based on the experience of a plastic surgeon who is renowned as an innovator and repeatedly reports excellent results. Patient selection, preparation, surgical procedures, and aftercare are presented for those desiring body contouring after massive weight loss, pregnancy, and/or aging. The emp...

Aesthetic refinements in body contouring surgery after massive weight loss are evolving in an effort to improve patient appearance. This is a personal clinical review for the trunk. There are 10 essential elements to performing body contouring surgery after massive weight loss. Based on this generally accepted baseline, the author presents 16 outst...

This article contrasts the ideal appearance of the female upper arm, axilla, and upper midlateral chest with the sagging and/or oversized deformity. The constellation of postbrachioplasty aesthetic deformity is introduced. These aesthetic shortcomings are best avoided, because they are difficult to correct. The L brachioplasty with liposuction is d...

Background: Body contouring operations are concluded with suture closure of long incisions under tension. While an expeditious and secure repair without complications is the objective, wound closure typically consumes a substantial percentage of the operative time and too often leads to delayed wound healing and other problems. Objectives: The auth...

Total Body Lift (TBL) surgery is the aesthetic correction of skin laxity of the torso in as few stages as safely possible. The goal is to surgically address all of the body contour changes after weight loss. This is the photographic essay of a recent TBL operation on a 43-year-old massive weight loss patient, which not only removed undesirable exce...

Patients with massive volume or skin laxity typically are not ideal candidates for liposuction treatment due to the excess amounts of loose skin after the procedure. The feasibility, safety, and efficacy of a novel radiofrequency device (BodyTite system) for radiofrequency-assisted liposuction (RFAL) were prospectively evaluated with overweight and...

An abstract is unavailable. This article is available as HTML full text and PDF.

The L-brachioplasty is an L-shaped pattern of excision with the long limb from the elbow to the axilla and the short limb extending at right angles through the axilla and along the lateral chest. The width of the excisions through the arm, axilla and chest is based on preoperative assessment through anatomical point locations followed by pinch and...

INTRODUÇÃO: Muitos estudos já foram feitos para buscar uma abdominoplastia mais atrativa, segura e com menos riscos. Enquanto as táticas e técnicas variam, pouco se fala sobre a preservação e suspensão da fáscia de Scarpa. MÉTODO: Os autores realizaram um estudo retrospectivo, demonstrando sua experiência com a lipoabdominoplastia clássica com a pr...

Gastric bypass or massive weight loss (MWL) leaves a spectrum of changes and deformities that most patients find disturbing. The nature of the deformities is determined by the patient's gender, age, pre-bariatric weight, the actual weight loss, and genetic predisposition of the patient. After MWL, many patients experience significant changes in the...

Currently, many body-contouring patients are overweight or obese or recently have sustained massive weight loss. Often these patients need multiple surgical procedures with extensive incisions. The need for optimal healing in all these patient populations is, however, hampered by their existing nutritional deficiencies. Based on the authors' previo...

The medical advantages of massive weight loss (MWL) are well documented and often include the improvement or resolution of comorbidities like diabetes, sleep apnea, asthma, and hypertension to result in a much healthier and fit individual. Unfortunately, the anatomic hallmark of MWL can include widespread areas of tissue ptosis, including the face,...

The upper arm, axilla, and lateral chest are appreciated for their femininity, beauty, and erotic sensuality. Massive weight loss patients often suffer severe arm deformities that extend into the axilla and chest. Although there is considerable variability in the presentation based on the amount of preexisting adiposity, skin elasticity, and age, t...

Liposuction treats lipodystrophy and reduces the thickness of body contouring flaps. Patients are evaluated for suitability of deformity, skin quality, and understanding of the procedure. Inelastic and hanging skin is contraindicated for aesthetic lipoplasty. In general, a circumferential approach is taken to maximize skin shrinkage and harmonize t...

Central to body contouring after weight loss surgery is treatment of the abdominal region, often through a circumferential abdominoplasty. This procedure, however, neglects the laxity of the lower thoracic/upper abdominal region. A reverse abdominoplasty with reconstruction of a new inframammary fold (IMF) corrects this deformity through removal of...

Bariatric surgery is currently the most effective method of sustainable weight loss for the morbidly obese patient. In the months to years that follow, many patients develop nutritional deficiencies of proteins, vitamins, and minerals as they present for plastic surgery and body contouring operations. The aim of this review is to highlight the nutr...

Bariatric surgery, particularly the Roux-en-Y gastric bypass, is currently the most effective method of sustainable weight loss for the morbidly obese patient population. Unfortunately, the nutritional adequacy of the postoperative diet has frequently been overlooked, and in the months to years that follow, many nutritional deficiencies have become...

Until 2001, body contouring surgery after massive weight loss was uncoordinated, with few patients achieving compete rehabilitation. The authors report a 5-year, retrospective, 75-case clinical review to determine the effectiveness, reliability, and safety of single and multistage total body lift (TBL) surgery. Between January 2001 and June 2006, 5...

Following massive weight loss, patients evolve severe arm deformity, extending through the axilla and on to the chest. The L brachioplasty was developed to treat the entire deformity through the excision of two unequal ellipses at right angles in the form of an "L." More than 50 patients have been treated since 2002 with esthetic reshaping of the u...

Massive weight loss patients suffer severe arm deformity, extending through the axilla and onto the chest. We found current operations inadequate, often with conspicuous scars. The L-brachioplasty was evolved to treat the entire deformity through the excision of two right angle unequal ellipses, leaving natural contours and an unobtrusive L-shaped...

This article reviews immediate and delayed breast reconstruction with prosthetic implants, and the effect of irradiation therapy. Despite widespread use of breast conserving surgery for early breast cancer, many breast cancer patients still undergo mastectomy. Some of these patients choose breast reconstruction. Over the last 30 years, techniques f...

Surgical repair of the superficial fascial system (SFS) has been claimed to both increase wound strength and enhance surgical outcome through anchoring of deeper tissues. The authors assessed the biomechanical properties of the SFS to determine whether repair of the SFS layer improved early and long-term postoperative wound strength. Four complemen...

After massive weight loss, the breasts have poor shape, projection, and skin elasticity. Breast reshaping is recognized as difficult and may require excess nearby tissues. As the senior author's approach evolved over the past 4 years, breast reshaping with the spiral flap became integral to an upper body lift. After the weight loss has stabilized,...

An abstract is unavailable. This article is available as HTML full text and PDF.

Brachioplasty is aesthetic reshaping of the upper arm after removal of excess medial skin and fat. Massive weight loss patients evolve a severe arm deformity that extends through the axilla and onto the chest. Prevalent operations are incomplete and leave conspicuous scars along the bicipital groove that end as Ts or Zs in the axilla. The L brachio...

Contour deformities after post–bariatric surgery weight loss are varied and often complex. Existing classification systems do not adequately address the various post–weight loss deformities that can occur in every part of the body. At the University of Pittsburgh, we have devised the Pittsburgh Rating Scale, a classification system that allows grad...

Thighplasty after massive weight loss is daunting. The deformity is complex and difficult to treat. The therapeutic index is narrow. A range of only centimeters of medial thigh skin resection width can mean the difference between residual skin laxity and unsightly descended scars. Wound closure is awkward. The scar from vertical extension excisions...

Contour deformities after massive weight loss are diverse and often severe in nature. Current progress has necessitated a valid, accessible, and comprehensive rating system that correlates appearance and appropriate surgical treatment. Presently, no existing rating system addresses the breadth and variety of deformities that can occur or allows for...

An abstract is unavailable. This article is available as HTML full text and PDF.

Learning Objectives: The reader is presumed to have a broad understanding of plastic surgical procedures and concepts. After studying this article, the participant should be able to: Define the medial thighplasty and the indications for a vertical excision extension.Determine the effect of preliminary circumferential abdominoplasty and lower body l...

An abstract is unavailable. This article is available as HTML full text and PDF.

Skin redundancy of the trunk and thigh is treated by a circumferential abdominoplasty and a lower body lift. Despite preservation and tight approximation of the subcutaneous facial system, the authors have failed to adequately correct severe saddlebag deformity and midthigh laxity in the massive weight loss patient. The technique used in the last n...

After massive weight loss, breasts have poor shape, projection, and skin elasticity. The nipples are distorted and ptotic. Mastopexy is difficult and historically includes the use of excess nearby tissues. The senior author reviews his experience with 24 patients over the past 4 years. Body contouring is offered after the weight loss is stable. Bre...

This is a retrospective clinical report of a single-staged total body lift in 8 massive weight loss patients. While the combination of circumferential abdominoplasty, a modified lower body lift, and medial thighplasty adequately treats the lower torso and thighs, the residual skin laxity in the upper torso and breasts leaves an incomplete result. H...

The effectiveness and morbidity of bariatric surgery for severely obese individuals has significantly improved. 1-3 Hence, plastic surgeons are beset with an increasing number of patients seeking body contouring surgery because skin redundancy and residual adipose tissue remain even after weight loss in excess of 200 pounds. Over the past 2 years w...

This objective of this study was to determine the effect of presurgical nasoalveolar molding on long-term nasal shape in complete unilateral clefts. The study was retrospective, and the subjects were chosen at random. Nasal casts of the subjects were scanned in three dimensions. Each nose was best fit to its mirror image, and a numerical asymmetry...

Objective This objective of this study was to determine the effect of presurgical nasoalveolar molding on long-term nasal shape in complete unilateral clefts. Design The study was retrospective, and the subjects were chosen at random. Nasal casts of the subjects were scanned in three dimensions. Each nose was best fit to its mirror image, and a nu...

Anthropometry and clinical examination best evaluate the morphology of repaired cleft lip and nose. An original, accurate, and practical image analysis of the lip and nose, which takes advantage of the mathematic, geometric, and organizational capabilities of public domain NIH-Image software (http://rsb.info.nih.gov/nih-image/), has been developed...

Midfacial hypoplasia following primary cleft lip repair is a common clinical correlate. Recent experimental work has suggested that increased lip pressure following an undermined lip repair may contribute to midfacial growth inhibition. Soft-tissue expansion has been used to generate additional soft tissue for reconstruction in the cranial region....

Current measures for assessing the results of body contouring surgery are limited. The goal of our study was to analyze objectively and quantitatively the results of ultrasound-assisted lipoplasty by use of dual-energy x-ray absorptiometry (DEXA). A prospective study of nine patients who underwent ultrasound-assisted lipoplasty (Lysonics 2000® gene...

The most common complication of lower blepharoplasty is malposition of the lower eyelid. This deformity may present as scleral show, ectropion, entropion, or canthal dystopia, with dry eye or epiphora. These problems occurred frequently in our initial series of patients undergoing blepharoplasty with subperiosteal face lift. The key to prevention l...

The management of infants with bilateral coronal synostosis and resultant brachyturricephaly poses a significant therapeutic challenge. The application of total calvarial reconstruction to the treatment of this problem has represented a major recent innovation that has substantially improved the cosmetic results in this patient population. However,...

The Sure-Closure device, designed for wound closure, harnesses the viscoelastic properties of the skin. It has been used in clinical studies in the past. We have evaluated the role of this device in complex wound problems and compared it to closure achieved by conventional wound closure methods such as skin grafts and flaps. A total of 40 patients...

Forty years after its introduction by McNeil and Burston, presurgical orthopedics remains a controversial subject. Although the more extravagant claims for the technique have been dismissed, assessment of its proper place in cleft rehabilitation has been hampered by the poor design of early studies. Furthermore, although the principles of presurgic...