The Fourth-Generation Lower Body Lift: Combining Techniques and Technologies for Improved Outcomes in High-Demand Female Patients.

[OBJECTIVE] The purpose of this study is to describe the outcomes and complications in patients with moderate to severe skin laxity who underwent a comprehensive lower body lift (LBL) using multilayer liposculpture, abdominal wall volumization, skin retraction technologies and buttocks augmentation with implants or flaps.

[METHODS] This retrospective case series included ASA 1 or 2 patients with abdominal dermatochalasis, gluteal ptosis, and variable lipodystrophy. Patients were selected with a maximum BMI of 28 kg/m. Surgical techniques combined multilayered liposculpture assisted by ultrasound (UAL), power-assisted liposculpture (PAL), and helium-based radiofrequency-assisted liposculpture (HeRFAL), along with circumferential abdominoplasty, pubic lift, and gluteal lift with implants using the YXZ technique or turnover flaps. Deltoid, rectus abdominis and external oblique were amplified with fat grafting.

[RESULTS] From 2021 to 2024, 32 female patients with an age range from 31 to 57 and an average BMI of 24.7 ± 2.7 Kg/m were treated. Surgery times ranged from 2 to 6 hours (mean 5.1 ± 1 h). The most frequent minor complications were seromas in 11 (37.9%) patients and minor dehiscences in 7 (25%) patients. Patient satisfaction was very high, and no patient requested excisional surgery for energy-treated areas.

[DISCUSSION] The study shows the feasibility and effectiveness of combining advanced techniques and technologies in LBL for patients with moderate to severe skin laxity. The integration of UAL, PAL, and HeRFAL technologies allowed for effective fat removal and tissue tightening, while RAFT and SPARTAN techniques enhanced abdominal wall. The YXZ technique provided tailored gluteal augmentation.

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