Modified circumferential torsoplasty for the massive-weight-loss patient

Background: Obesity is an increasing national public health issue that has reached epidemic proportions over the past several decades. With new surgical advances in bariatric surgery, the massive-weight-loss patient population is on the rise. The generalized redundancy of skin following massive weight-loss, including lateral flank rolls, abdominal excesses, and buttock ptosis, is a problem amenable only by surgical excision. The circumferential torsoplasty has enabled the plastic surgeon to dramatically help this patient population. However, a problem exists in a size mismatch of the abdomen between the upper and lower circumferential flaps, leading to contour deformities. Methods: This study reports on 3 cases of circumferential torsoplasty, with modified lateral skin wedge resection treated by a single surgeon. The preoperative markings, technical aspects of the surgery, postoperative care, and outcomes are reviewed. Results: Patients in all 3 cases achieved improved body contour. To date, there have been no postoperative complications of the study participants. Conclusion: We propose a new modification to the circumferential torsoplasty that simultaneously eliminates the lateral dog-ears and prevents recurrence of saddlebag deformities commonly encountered in the traditional circumferential torsoplasty. A wedge excision of lateral thigh skin to deep investing fascia is primarily closed and simultaneously equalizes flap length and tightens the thigh area. The scars are well accepted by patients.