Removing and reducing are two different surgeries
Body surgery is broadly divided into two branches. Surgery that removes volume from the inside, and surgery that reduces the surface area on the outside.
Liposuction is the former. It removes fat beneath the skin to reduce volume. The skin is left as it is and only the inside is addressed.
A body lift is the latter. The stretched skin itself is cut away and the remaining skin is pulled together. In clothing terms, it is the difference between removing the lining and taking in the outer fabric and sewing it back up.
Because the two have different purposes, choosing the one that does not match the situation leaves the result short of expectations. If fat alone is removed when the skin is already stretched, the leftover skin simply becomes visible.
Why skin does not shrink on its own
Young, elastic skin does shrink to a certain degree. The collagen and elastin in the dermis create a force that tries to return to the original shape.
But this force has limits. If the degree of stretching was large or that state was maintained for a long time, the fibers are already damaged and cannot return.
Age is involved too. When collagen has decreased, the capacity to recover is lower. This is why the same amount of weight loss gives different results in your twenties and in your fifties.
If there are stretch marks, it is a sign that the dermis has already torn. In those areas, it is hard to expect any shrinking force.
Childbirth and repeated weight gain and loss act in the same direction.
Which areas is it done on
Abdominoplasty is the most widely known. It is considered when abdominal skin sags forward after childbirth or major weight loss and folds over below the navel. The process sometimes includes tightening separated abdominal muscles and repositioning the navel while the skin is excised.
Arm lift addresses the loose skin on the inner arm. The target is the part that hangs down when you raise your arm. It is chosen when removing fat alone will not tidy up the state.
Thigh lift mainly deals with the inner thigh. Because it is an area that rubs and folds when walking, discomfort often comes with it.
The same principle applies to the breasts. Surgery that lifts sagging breasts is breast lift.
| Area | What is addressed |
|---|---|
| Abdomen | Stretched abdominal skin and separated rectus abdominis muscles |
| Arm | Skin sagging along the inner upper arm |
| Thigh | Loose skin on the inner thigh |
Scarring as the price
The greatest characteristic and burden of a body lift is the scar. Because it is surgery that cuts skin away, a line remains in proportion to what was removed.
Choosing a place where it can be hidden is the core of the design. For the abdomen the incision is placed low where underwear covers it, for the arm on the inner surface, and for the thigh along the natural crease.
Still, the scar cannot be eliminated. As covered in how scars form, areas under tension tend to widen, and a body lift is surgery that pulls tissue together, so tension is present.
That is why checking the position and length of the scar in advance during the consultation matters. Deciding which to accept, the sagging skin or the scar, is the heart of the decision.
It takes time for a scar to settle. The red, raised appearance of the early stage is not the final look.
How TheLINE separates liposuction from lifting
TheLINE Plastic Surgery Clinic checks the condition of the skin first during the consultation. Even in the same area, the surgery is completely different depending on whether the problem is fat or skin.
The way we check is simple. We grasp the loose part by hand and pull it upward. If the skin follows well and returns to some degree when released, there is room to approach it with liposuction. If what is grasped is mostly skin and it stays loose when released, the state is closer to needing a lift.
There are cases where both are done together. Fat is addressed first, then the remaining skin is excised. However, doing it all at once can strain the blood supply, so the plan is sometimes divided.
Dr. Jaeho Cho, a board-certified general surgeon, and Dr. Yoosuk Chung, a board-certified plastic surgeon, assess the case together, and SVF isolated in the in-house laboratory is applied to the excised area to support the recovery process.
How much is cut away
The amount excised is not decided by eye. The tension must not be excessive when the remaining skin is pulled together.
Cutting away too much makes the suture line taut. In that state the risk of the wound opening rises, and even if it heals, the scar remains wide. Surrounding skin can also be pulled, throwing off the shape of other areas.
Conversely, cutting away too little leaves sagging behind. That is a situation where the desired line does not appear even after surgery.
So the process includes pulling and checking during the surgery to set the extent. Rather than following the pre-drawn line exactly, adjustments are made while checking the condition of the tissue.
Posture also has an effect. The degree to which the skin is pulled differs between lying down and standing, so this is checked together at the design stage.
The recovery process
A body lift takes longer to recover from than liposuction. Because skin is excised and sutured, the wound needs time to heal.
Posture is restricted early on. After an abdominoplasty, you are advised to keep the upper body raised and the waist bent. This is to keep tension off the suture line.
A drain is sometimes placed. It prevents fluid from collecting where tissue was excised and is removed after a few days.
A compression garment is worn just as with liposuction. It reduces swelling and helps the tissue settle.
Return to daily life differs by area and extent. Desk-based work resumes relatively quickly, but movements that use the arms broadly or bend the waist are resumed after some time. Exercise starts later still.
Limits you should know
A scar will definitely remain. If you cannot accept this point, it is better to look for another method.
The two sides will not become perfectly identical. The body was not symmetrical to begin with, and differences also arise during recovery.
If weight increases significantly again, the result changes. This is why surgery is recommended after weight loss is complete and the weight has stabilized. If weight loss is still in progress, the timing is adjusted.
Smoking is particularly unfavorable for recovery. It is known to reduce blood flow, interfering with healing at the suture line and raising the risk of the wound opening.
Side effects such as bleeding, infection, hematoma, wound dehiscence and reduced sensation may occur. Unexpected inflammation or bleeding may occur, and the degree varies from person to person, so caution is required.
Frequently Asked Questions
Can it not be done with liposuction?
If stretched skin is the main problem, removing only fat leaves the sagging fully visible. If it does not spring back when you grasp and pull it and then let go, the state is closer to needing a lift.
How much of a scar remains?
A line remains in proportion to the length that was cut away. We position it so that underwear or a natural crease covers it, but it cannot be eliminated, so the position and length are checked in advance at the consultation.
I am in the middle of losing weight, can I have surgery now?
After the weight has stabilized is recommended. If weight loss continues, additional skin will be left over and the result may change.
Can liposuction and a lift be done together?
They are sometimes performed together, but doing everything at once can strain the blood supply, so depending on the extent the plan may be divided.
How does TheLINE decide?
TheLINE Plastic Surgery Clinic grasps and pulls the loose area to check how well the skin recovers. The surgery differs depending on whether the problem is fat or skin.
