Circumferential Hybrid Abdominoplasty Combining a Vertical Lipectomy with Belt Lipectomy
Book Online NowPatients presenting after significant or massive weight loss often have a pattern of excess skin and fat that affects the abdomen in more than one direction and extends beyond the front of the body. In these situations, excess skin may be present vertically and horizontally across the abdominal skin, while also involving the flanks, lower back, and buttock region.
Circumferential hybrid abdominoplasty combining a vertical lipectomy with belt lipectomy has been developed to treat this complex distribution of skin excess. Rather than relying on a single technique, this surgical procedure applies complementary principles from established body lift surgery approaches to manage skin excess across the entire lower torso.
This approach is most commonly considered for patients following massive weight loss, including those who have undergone bariatric surgery or achieved substantial weight reduction through lifestyle change, where standard abdominoplasty techniques alone may not provide adequate correction.
What Is a Circumferential Hybrid Abdominoplasty?
The circumferential hybrid abdominoplasty combines a vertical lipectomy with belt lipectomy into a single comprehensive body contouring approach. This circumferential lift surgery allows the surgeon to remove excess skin in both vertical and horizontal directions while also treating the entire lower torso.
By integrating these techniques, the hybrid approach aims to:
- Remove excess skin from the front of the abdomen
- Treat horizontal and vertical skin excess
- Treat the flanks and lower back
- Provide lifting of the buttock region (gluteoplasty)
This comprehensive body contouring strategy is typically reserved for patients with experienced significant weight loss and complex deformities.
Understanding Excess Skin After Weight Loss
Significant weight loss can lead to widespread skin excess due to loss of elasticity and reduced recoil of the skin and underlying tissues. The abdominal skin may hang in both vertical and horizontal directions, forming excess skin folds that can contribute to skin irritation, hygiene difficulties, and problems with clothing fit. In addition to the anterior abdomen, excess skin and fat often extend circumferentially around the lower torso.
While diet, exercise, and a healthy lifestyle are essential for long-term weight maintenance, they cannot remove excess skin once it has lost its ability to contract. Body contouring surgery may be considered for selected patients who have achieved a stable weight and are experiencing functional or physical concerns related to remaining skin.
Overview of Abdominoplasty Techniques
Abdominoplasty, commonly referred to as a tummy tuck (abdominoplasty), is a surgical procedure designed to remove excess skin and fat from the abdominal area and, where appropriate, treat underlying muscles. Several variations exist, each targeting different patterns of skin excess.
A standard abdominoplasty primarily focuses on the lower abdomen and anterior abdominal wall. However, patients with substantial weight loss often require more extensive approaches, such as Fleur-de-Lis abdominoplasty or circumferential abdominoplasty.
Book Online NowFleur-de-Lis Abdominoplasty (Vertical Lipectomy)
Fleur-de-Lis abdominoplasty, also known as a vertical lipectomy, is designed to treat horizontal excess skin on the anterior abdomen. This technique involves both a horizontal incision along the lower abdomen and a vertical incision in the midline, allowing removal of skin and fat in two directions.
The advantage of a vertical lipectomy is its ability to narrow the waistline and treat significant skin excess that cannot be corrected with a standard tummy tuck (Abdominoplasty) alone. However, one of the limitations of the Fleur-de-Lis technique is that it only treats the front of the abdomen and does not treat excess skin of the flanks, lower back, or buttock region.
Circumferential Abdominoplasty (Belt Lipectomy)
Circumferential abdominoplasty, often referred to as a belt lipectomy or circumferential body lift, extends the incision around the entire lower torso. This body lift (Belt lipectomy) surgery removes excess skin and fat from the abdomen, flanks, and lower back while also providing a lifting effect to the lateral thighs and buttock area.
A belt lipectomy is particularly useful for patients with circumferential skin excess following substantial weight loss. By removing a belt of skin and fat, the procedure treats the contour of the lower torso and may assist with functional concerns such as skin irritation and clothing fit.
Despite its advantages, a circumferential abdominoplasty primarily treats vertical skin excess and may not adequately treat horizontal laxity of the anterior abdomen.
Limitations of Single-Procedure Approaches
Both Fleur-de-Lis abdominoplasty and belt lipectomy are effective body contouring procedures when used for appropriately selected patients. However, each has inherent limitations:
- Fleur-de-Lis abdominoplasty treats horizontal and vertical excess at the front of the abdomen but does not treat the circumferential body.
- Belt lipectomy treats the lower torso and buttock region but may leave residual horizontal skin excess on the anterior abdomen.
For patients with complex patterns of excess skin and fat, these limitations can result in incomplete correction if only one technique is used.
Surgical Planning and Patient Selection
Careful patient selection is essential for body lift surgery. Suitable candidates generally:
- Have achieved a stable weight for several months
- Have completed further weight loss plans
- Maintain a healthy lifestyle and proper nutrition
- Do not smoke or have ceased smoking well before surgery
An initial consultation with a qualified specialist surgeon allows assessment of skin quality, remaining skin, underlying tissues, and overall health. Realistic expectations are discussed, along with the surgery and recovery process.
How the Surgery Involves Multiple Areas
The surgical procedure is typically performed under general anaesthesia. Surgery involves creating a circumferential incision around the lower torso, combined with a vertical incision on the anterior abdomen.
During the operation, excess skin and fat are removed, and underlying muscles of the abdominal wall may be treated if indicated. The remaining skin is repositioned to achieve a firmer abdominal contour and treat the lower torso shape.
This is a complex body lift (belt lipectomy) procedure and is typically performed in a hospital setting with an overnight stay or longer, depending on individual factors.
Recovery Process After Circumferential Hybrid Abdominoplasty
Recovery following circumferential hybrid abdominoplasty within Dr Bernard Beldholm’s practice is structured, closely supervised, and deliberately hands-on, reflecting the complexity of this body lift surgery.
The operation is performed at Maitland Private Hospital, where patients are admitted under general anaesthesia. Hospital stay is typically several days, depending on individual health factors, extent of surgery, and early recovery progress. Daily inpatient review is undertaken while admitted.
Early Post‑Operative Care (First 2 Weeks)
The first two weeks after surgery are considered a critical phase of the recovery process. During this period, patients are reviewed frequently in practice by Dr Beldholm and the nursing team, usually two to three times per week. These appointments focus on:
- Wound assessment and wound care
- Monitoring for fluid accumulation or early wound breakdown
- Review of swelling and bruising
- Adjustment of dressings and compression garments
Negative pressure dressings (PICO dressings) are routinely used following surgery. These are typically removed at day 7, at which point dressings are transitioned to standard wound support as appropriate.
LED light therapy is incorporated during early follow‑up visits to support wound care and assist the healing process. All wound care is supervised by the clinical team to ensure proper healing and to identify any issues early.
What to Expect: Week‑by‑Week Recovery
While recovery varies between individuals, the outline below reflects the typical recovery timeline for patients undergoing circumferential hybrid abdominoplasty within Dr Bernard Beldholm’s practice. This guide is general in nature and individual recovery may differ.
Week 0–1 (Hospital Stay and Early Healing)
Patients remain in hospital at Maitland Private Hospital for close monitoring. Swelling, bruising, and tightness across the abdomen and lower torso are expected. PICO dressings remain in place, compression garments are fitted, and mobility is encouraged with assistance. Pain management, wound monitoring, and prevention of fluid accumulation are priorities during this phase.
Week 1–2 (Intensive In‑Practice Review)
PICO dressings are typically removed around day 7 during an in‑practice review with Dr Beldholm and the nursing team. LED light therapy is commenced as part of wound care. Patients attend frequent follow‑up visits (usually two to three per week) for wound checks, dressing changes, and monitoring of swelling and healing progress. Walking is encouraged, but activity remains limited.
Week 3–4
Swelling and bruising generally begin to settle, although they may still be present. Compression garments continue to be worn. Wounds are monitored closely, and scar care advice may be introduced. Most patients can gradually increase light daily activities but should avoid heavy lifting and vigorous exercise.
Weeks 5–6
Mobility and comfort increase further. Many patients are able to return to desk‑based work, depending on individual recovery and job demands. Compression garments may still be required. Ongoing wound and scar assessment continues during scheduled reviews.
Weeks 7–12
Activity levels are progressively increased under guidance. Swelling continues to reduce, and scars begin to mature. Patients attend their routine 3‑month follow‑up, where healing, contour, and recovery progress are reviewed.
Beyond 3 Months
Healing and scar maturation continue over many months. Long‑term follow‑up appointments at 6 and 12 months allow assessment of final outcomes and ongoing recovery.
Ongoing Recovery and Follow‑Up
Compression garments are worn for several weeks to support the abdominal wall, reduce swelling, and assist with optimal healing. Patients are advised to avoid vigorous exercise and heavy lifting during the initial recovery period, with activity levels increased gradually under guidance.
Standard follow‑up appointments are scheduled at 1, 3, 6, and 12 months after surgery. These visits allow long‑term monitoring of scar maturation, contour changes, and overall recovery.
The recovery timeline varies between individuals. Adherence to post‑operative instructions, maintaining proper nutrition, and allowing the natural healing process to occur all play important roles in recovery. Results vary between individuals.
Risks and Complications
As with all body lift surgery, risks may include:
- Fluid accumulation (seroma)
- Excessive bleeding
- Wound breakdown
- Infection
- Delayed healing
Factors such as smoking, poor nutrition, or impaired circulation can impair healing. These risks are discussed thoroughly during consultation. Results vary between individuals.
Scarring and Long-Term Considerations
Circumferential hybrid abdominoplasty involves long incisions, which result in permanent scars. While efforts are made to minimise scarring, visible scars are an expected outcome.
Over time, scars typically soften and fade, but individual healing varies. Long-term results depend on maintaining a stable weight and healthy lifestyle.
Combining Procedures
In selected patients, additional body contouring procedures such as thigh lift (Thighplasty), arm lift (Brachioplasty), breast reduction (Reduction mammoplasty), breast lift (Mastopexy), or breast surgery may be staged separately. Combining too many procedures in one operation may increase risk and is assessed carefully.
Frequently Asked Questions
What is the difference between abdominoplasty and belt lipectomy?
Abdominoplasty focuses on the anterior abdomen, while belt lipectomy treats the entire lower torso as a circumferential body lift (belt lipectomy).
What is a hybrid tummy tuck (Abdominoplasty)?
A hybrid tummy tuck (abdominoplasty) refers to combining techniques to treat multiple dimensions of skin excess, such as vertical and horizontal laxity.
What surgeries can be combined with a tummy tuck (abdominoplasty)?
Procedures may include breast surgery, thigh lift (Thighplasty), or arm lift (Brachioplasty), depending on patient health and surgical planning.
Final Thoughts
Circumferential hybrid abdominoplasty combining a vertical lipectomy with belt lipectomy represents an advanced option for patients with extensive excess skin after massive weight loss. By treating the limitations of individual techniques, this approach offers comprehensive body contouring of the lower torso.
A detailed consultation is essential to determine suitability, understand risks, and develop realistic expectations.