Operation Guide: Belt Lipectomy Surgery After Weight Loss


Dr Bernard Beldholm

After massive weight loss, it’s normal to have loose skin. Sure, your tummy may have skin folds…but what if you have looseness on your hips, lower back and buttocks, too?

A belt lipectomy is a 360-degree surgery that tightens loose skin on your tummy, sides and lower back. It also has a buttocks, mons and thigh lifting effect. After the surgery, your midsection will look tighter. Think of it as a way to put the finishing touch on your body after weight loss.

If you are considering a belt lipectomy after weight loss, you may be curious as to what happens during the surgery. This article shows how Dr. Bernard Beldholm performs the operation step-by-step so you will know what to expect on surgery day.

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What is a belt lipectomy?

The goal of a 360-degree belt lipectomy is to remove loose skin on your abdomen, sides and back. As the skin on your midsection tightens up, it lifts your buttocks, thighs and mons area as well.

It’s like three operations in one

A belt lipectomy renews your body after weight loss in several ways. It includes an extended tummy tuck, lateral thigh lift and buttocks lift. Since multiple body parts are addressed, the surgery is quite involved. Your recovery may take a bit longer than a standard tummy tuck, but the results are more dramatic.

What is a belt lipectomy for?

Doctor Bernard’s belt lipectomy is excellent for removing loose skin on your:

  • Abdomen
  • Flanks
  • Buttocks
  • Outer thighs
  • Mons pubis area

During your surgery, he can also fix abdominal muscle separation. This is fairly common among patients after major weight loss or pregnancy.

Operation Guide: What happens during a belt lipectomy?

Doctor Bernard’s belt lipectomy firms and tightens your entire midsection. For a sneak peak inside the operating room, keep reading. This is a step-by-step guide to belt lipectomy surgery with VASER liposuction.

Phase 1: Surgery Prep

1. Pre-operative appointment

On the day of surgery, you enter the hospital, meet with a nurse and change into a gown. Doctor Bernard meets with you before surgery to answer any last-minute questions or concerns you might have.

2. Surgical markings

Before surgery, Doctor Bernard draws on your skin with a surgical marker. You will be standing up while this happens. That is important, because when you lie down on the operating table, your skin and fat shifts due to gravity.

Belt Lipectomy Surgical Markings by Dr. Bernard Beldholm

The markings help to plan your operation. Another benefit of drawing the markings while you are awake is that you can see where he plans to put your incisions. Doctor Bernard works with you to make sure your surgical scars are placed in the optimal position. If you have a preferred style of swimsuit or undergarments, you can bring them to your appointment so he can make sure your scars are hidden.

3. General anesthesia

Now you’re ready to enter the operating room. A highly trained anaesthetist places an IV into your arm. Sedative drugs are administered to make you feel sleepy. As your body relaxes, you will drift off to sleep. You will have no memory or sensation of the surgery.

During your surgery, the anaesthetist watches over you the whole time. They keep an eye on your vitals to ensure you are safe from the moment you fall asleep until the moment you wake up.

Phase 2: Buttocks & Thigh Lifting

1. Positioning you on the operating table

Once you are sedated, your surgery can begin. The first step to a successful belt lipectomy is positioning your body on the operating table. Doctor Bernard will work on your lower back and buttocks first, so you’ll lie face down. Your head will be cradled in a foam block with an opening.

Belt Lipectomy Positioning you on the operating table by Dr. Bernard Beldholm

Doctor Bernard has a special operating table known as a Jackson table. This will make it easier to turn your body over when he is ready to work on your tummy area. Instead of the surgical staff turning you over by surgery, the Jackson table does all the work. It turns your body in a safe, controlled manner. There is less risk of an accident or slippage as you’re turned.

2. VASER liposuction on your lower back and buttocks

Next, Doctor Bernard performs liposuction on your lower back and buttocks. He uses special equipment called VASER liposuction to melt fat. VASER is a cutting-edge technology that liquefies fat cells with ultrasound energy. Melting fat makes it easier to remove with liposuction. VASER not only melts fat, it also helps to define your curves and muscles.

VASER is a three-step process
Wetting solution

First, Doctor Bernard injects a wetting solution into your tissues. It consists of local anesthetic, which has a numbing effect. The wetting solution helps to isolate the fat cells. It also constricts your blood vessels to reduce bleeding. This allows for safe liposuction of all your tissues. The local anaesthetic provides good pain relief for the first night and the next morning after your operation.

Fat melting

Instead of traditional liposuction, Doctor Bernard uses special equipment called VASER liposuction. VASER is a cutting-edge technology that breaks fat cells apart with ultrasound energy. It liquefies your fat so that it is easier to remove with suction.

Belt Lipectomy VASER liposculpture Fat Melting by Dr. Bernard Beldholm

Fat melting with VASER reduces tissue trauma during surgery. In traditional liposuction, your surgeon breaks the fat apart manually in an aggressive back and forth motion. VASER is much gentler in comparison.

Fat removal

Now that your fat is melted, Doctor Bernard removes the fat with machine-assisted suction. In traditional liposuction, a surgeon would need to remove solid masses of fat through a small cannula. VASER turns your fat cells into liquid. Therefore, gentle suction is all that is needed to remove it. There is less tissue damage with this method. VASER provides better results compared to regular liposuction, in Doctor Bernard’s experience.

Belt Lipectomy VASER liposculpture Fat Removal by Dr. Bernard Beldholm

3. Tightening loose skin on your lower back, buttocks and thighs

Next, Doctor Bernard removes the excess skin on your backside. Thanks to VASER, which creates small holes in your tissues, your tissue is pre-loosened for easier cutting. Skin removal should not be rushed. Doctor Bernard works on small areas at a time. He carefully removes just the right amount of skin and makes sure to cut nice, straight lines. The incision lines need to match up so that your scar will be a neat, straight line.

Belt Lipectomy Tightening of Loose Skin by Dr. Bernard Beldholm

4. Sealing the blood vessels

As he cuts away your excess skin, he seals up each blood vessel as he goes. It is time consuming to close up each individual blood vessel, but it is important for your safety. Doctor Bernard’s goal is to minimise your risk of bleeding after surgery. Sealing the blood vessels may also reduce bruising and post-op complications.

Belt Lipectomy Sealing the Blood Vessels

5. Closing the back incision

Now that your loose lower back skin is gone, the next step is closing the incision. As your skin is pulled together and stitched closed, it will tighten and lift your buttocks and outer thighs. The closure should be tight initially, but not so tight that it causes unsightly skin bunching.

Belt Lipectomy Closing the Back Incision by Dr. Bernard Beldholm

Doctor Bernard closes your incision in layers.

He also applies a medical-grade glue as he closes your incision. The glue comes in spray form. It keeps your tissues tightly sealed as they heal. Creating a tight seal with glue also reduces fluid buildup at the wound site. Tissue glue may also reduce bruising as you heal.

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Phase 3: Turning You Over

Now that your backside is complete, it’s time to remove loose skin on your front. In order to work on your tummy, you need to be turned over on the operating table.

Doctor Bernard and his staff turn you over with help from special equipment known as a Jackson table. The table allows you to be flipped over safely. Turning must be done very carefully. Even with the Jackson table, it takes a team of people to make sure everything goes smoothly. Your safety is top priority.

Once you are turned over, the operating room staff will prep and re-strap your body.

Phase 4: Extended Tummy Tuck with Liposuction

During this step, Doctor Bernard tightens the loose skin on your abdomen and sides. The technique for the front is similar to the back.

1. VASER liposuction of your abdomen and hips

Doctor Bernard repeats all three steps of VASER liposuction on your tummy and sides. He removes excess fat, shapes your curves and highlights your existing muscles.

2. Abdominal incision

Next, he makes a horizontal cut on your lower abdomen. The incision may extend up and around your hips, depending on how much loose skin you want to be removed. Doctor Bernard will discuss the incision and what kind of scar to expect at your consultation.

3. Creating the epigastric tunnel

Starting from the incision, Doctor Bernard cuts upward, stopping at your belly button. Older tummy tucks dissect all the way up to the ribs. All that cutting is not necessary today. Instead, he creates a tunnel the rest of the way up to your ribs. This is called an epigastric tunnel. This method makes your recovery easier since fewer nerves and blood vessels are damaged. It also preserves blood flow. The surgery is safer this way.

4. Abdominal muscle repair

The epigastric tunnel allows Doctor Bernard to view your ab muscles. He can then fix your separated abdominal muscles, which is a common problem after weight loss or pregnancy. He carefully stitches the ab muscles together at the midline. He also uses tissue glue for a nice, tight seal.

5. Belly button repositioning

If you have a large amount of loose skin, your belly button may need to be moved. Otherwise, it would be too low on your abdomen once your skin is pulled down to close the incision. If necessary, Doctor Bernard will move your belly button to a normal position so it’s not obvious that you had a tummy tuck.

He carefully cuts around your belly button to free it. He attaches a small plastic marker to your belly button with a 2/0 silk stitch. The plastic piece allows him to feel where your belly button is located once your skin is pulled down later. Feeling for the hard plastic bit, he can then create a new hole for your belly button.

6. Removing loose skin on your tummy and sides

Doctor Bernard trims off the loose skin on your abdomen and sides. He carefully measures how much skin to remove before making any cuts. He may position the operating table on a slight tilt of about 15 degrees.

Dr Beldholm places a few allis forceps (surgical clamp) at your lower tummy incision. Next, he will pull your upper tummy skin downward so it overlaps your lower belly. He can feel the allis forceps underneath, so he knows exactly where to mark and cut the excess skin. Again, he seals each blood vessel as he goes to reduce bleeding.

7. Belly button repositioning

If necessary, your belly button will be moved. The goal is to move your belly button to a natural position. This prevents your navel from sitting too low on your abdomen now that your belly skin has been pulled downward.

He feels for the plastic bit he attached to your belly button earlier in the surgery. He makes a new hole for your belly button and pulls your original belly button through this hole.

Let’s talk about belly button aesthetics. It may be small, but it makes a big difference to your cosmetic results. An oval or irregular belly button looks more natural than a round shape. A rounded belly button can also cause your skin to bunch and eventually close up. Doctor Bernard finds that creating an oval belly button usually prevents that from happening.

Doctor Bernard has another trick to make your belly button look natural. He removes a small cylinder of fat beneath your belly button with VASER liposuction. This gives your belly button a natural dip, similar to the look of a swimsuit model.

He then shapes your belly button and adds a small hood.

8. Closing the incision

Your surgery is almost done. Doctor Bernard closes your abdomen in layers. He uses deep permanent sutures and V-Loc 90 barbed sutures, which are absorbable. He will start at your scarpa’s fascia and work upward to your skin surface.

In addition to sutures, he applies ARTISS tissue glue. The glue creates a tight seal, reduces fluid buildup and reinforces your stitches. For the first few months of recovery, your abdomen needs that extra support for proper healing.

He also places four dissolving sutures around your new belly button. The stitches are pulled taut and downward. This helps to bury your belly button scar so you won’t see it. The results look very natural.

9. Skin tightening and mons lift

It’s time to close the abdominal incision. As Doctor Bernard sutures the incision closed, it tightens your abdomen and lifts a saggy mons area.

The mons pubis is a common trouble spot. It is located a few inches below your belly button. This fatty pad of tissue covers your pubic bone. You may have a pronounced or sagging mons after pregnancy or weight loss. If you have a belt lipectomy, it has a mons lifting effect.

10. Wound dressings

Wound dressings protect your incision as it heals. Bandages keep germs out and cushion your skin so it doesn’t get irritated. Basic sterile bandages are fine, but Doctor Bernard prefers something a bit better.

He loves the PICO negative pressure dressings. This high-tech wound dressing is battery-operated. It creates constant, gentle pressure on the wound to promote healing. The manufacturer says it improves blood circulation at the wound site and minimises swelling. Doctor Bernard has seen the results firsthand and has been using the PICO bandages for years. His tummy tuck pricing includes the PICO dressings for no extra charge.

PICO’s advanced inner layer is made of super-absorbent material with AIRLOCKTM technology. It helps to keep bacteria out and keeps your wound dry. Studies from the manufacturer show it prevents up to 99.9% of bacteria from reaching the wound. After your surgery, you’ll wear the soft, comfortable PICO bandage for seven days. Doctor Bernard will then remove it for you.

11. Compression garments

The final step of surgery is placing a compression garment on your tummy. Compression garments reduce swelling, which is a normal response to surgery. They also reduce tension on your skin as it heals. Compression garments may also lower the risk of seroma, or fluid buildup, after surgery.

Doctor Bernard provides you with a high-quality compression garment, so you won’t have to go out and buy one. You will wake up in the recovery room already wearing the garment.

Your belt lipectomy is now complete.

Bernard Beldholm Logo


30 Belmore Rd
Lorn NSW 2320


This website contains adult content. You must be 18 years or over to read. All surgery carries risks. You should seek a second opinion before proceeding. Results vary from patient to patient. See our disclaimer.
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