TRANSVERSE FLANK-THIGH-BUTTOCK LIFT WITH SUPERFICIAL FASCIAL SUSPENSION

The tigh-buttock lift of Pitanguy was originally designed in 1964 to allow direct excision of trochanteric fat deposits. With certain modifications, it remains the standard procedure today for surgical treatment of buttock ptosis, thigh-skin laxity, and cellulite. However, Pitanguy's procedure is not commonly performed because of such problems as noticeable scars, early recurrence of deformities, unnatural contours, significant wound complications, long operative times, and prolonged postoperative disability. With the advent of liposuction and a better knowledge of the vascular anatomy of skin and the anatomy of the superficial fascial system, a more rational thigh-buttock lift can be designed. Laxity of interior trunk and thigh soft tissues along with cellulite may be better managed by a transverse resection of redundant skin and fat with an incisional scar placed within bikini lines and supported by repair of the superficial fascia. Advantages include improved skin-flap vascularity, a strong yet dynamic fascial support, simultaneous tightening of lax back and flank tissues, absence of distortion of buttock contour, a stable scar that remains hidden in bikini lines, shorter operation on an outpatient basis, and much less disability. Ten patients having transverse flank-thigh-buttock lifts alone and in combination with liposuction and other body-contouring procedures were followed for 6 to 24 months. Indications for surgery included trunk and thigh laxity, buttock ptosis, cellulite of laxity, pseudotrochanteric fat deposits, and deformities following liposuction or massive weight loss. The technique involves initial transverse resection of redundant inferior trunk and thigh skin and fat with incisional closure within standard bikini lines. The incision can cross the posterior midline safely in severe deformities. Releasing the zone of adherence of the superficial fascial system (SFS) by moderate subfascial undermining is necessary for optimal lift. Thorough repair of both the superficial fascial system and the dermal layer provides lasting support. Complications were minimal, and results were predictable and consistent. Most patients were outpatients and were back to work within 5 to 10 days.