The excess skin and fat from extreme weight loss often creates a circumferential hanging effect at many levels of the body. While many think of the body lift as only one contouring procedure, they are only thinking of the lower body lift or circumferential body lift procedure. There is another body lift procedure for the upper body, not surprisingly called the upper body lift.
Like the lower body lift, the upper body lift is a combination of three body contouring procedures. A frontal breast procedure (for both women and men), a side chest wall lift, and an upper back lift. In some cases, the cut out of loose skin may extend into the arms as well. This combined operation leaves long scars around the upper body but are usually a worthwhile trade-off for the dramatic improvement in the shape of the upper body. The resultant scars across the back and on the side of the chest are horizontal, much like the lower body lift. The change is in what occurs across the chest/breast area. Usually I like to keep it in the lower chest/breast crease and make it horizontal also. It can certainly be combined with a breast lift or a gynecomastia reduction if needed. But the one thing you don't want to do is cross the midline/lower sternal area with a scar if you can avoid it. The risk of scar widening is very likely in this area, not to mention being very noticeable particularly in women. Therefore an upper body lift is not always completely circumferential as a lower body lift would be.
Upper body lifts are not as common as lower body lifts because it takes a very extreme amount of weight loss to create enough skin to justify the operation. Usually the patients must have lost 150 to 200 lbs after their bariatric surgery. The upper body lift has its greatest effect in the problematic area of the side of the chest wall and upper back. As a result, it would not be uncommon to just do a partial upper body lift stopping short of the chest/breast area and not crossing the exact middle of the back. Upper body lifts have the same riska and postoperative issues as lower body lifts including poor scarring, small areas of wound separation, and fluid build-up after the drains are removed.
Dr Barry Eppley is a board-certified plastic surgeon in private practice in Indianapolis, Indiana at Clarian Health Systems. (http://www.eppleyplasticsurgery.com ) He writes a daily blog on plastic surgery, spa therapies, and medical skin care at http://www.exploreplasticsurgery.com