Procedure guide
What a lower body lift involves, who it helps after weight loss, and what to expect.
Written by Orr Shauly, MD, plastic surgery resident. Updated .
For information and education only, not medical advice.
The short answer.
A lower body lift removes a circumferential belt of loose skin and fat from the abdomen, flanks, back and buttocks, and lifts the buttocks and outer thighs, leaving a scar that circles the body below the waist.1,2 It is most often performed after massive weight loss, once weight has been stable for at least 3 - 6 months.1,3 A systematic review of 42 studies and 1,748 patients found wound separation to be the most common complication, with high satisfaction and quality of life scores across studies.4
- 1,748 Patients
- in a systematic review
- Patients across 42 studies of circumferential lower trunk contouring, with high satisfaction reported in all of them.4
- 3 - 6 Months
- of stable weight first
- Minimum period of stable weight recommended before body contouring after weight loss.1,3
- 18%
- seroma after belt lipectomy
- Seroma rate after circumferential belt lipectomy in 222 patients, with risk rising as more skin is removed.5
- 94.2%
- would do it again
- Patients in a 55-patient series who said they would undergo a lower body lift again.6
What a lower body lift is.
After massive weight loss, the trunk often takes the shape of an inverted cone, with loose skin hanging from the abdomen, flanks, back, buttocks and outer thighs.1 A standard tummy tuck addresses only the front and does not correct this laxity around the sides and back.1
A lower body lift treats the lower trunk as one circumferential unit. It removes a belt of excess tissue, tightens the abdomen, lifts the buttocks and outer thighs and can raise a sagging mons pubis.1,2,7 Patients must accept a long scar in exchange for the improved contour.2,3
Belt lipectomy vs lower body lift.
| Procedure | Back Scar | Strengths |
|---|---|---|
| Belt Lipectomy2,4 | At the waistline | Better correction of hip and back rolls and more control of waist shape |
| Lower Body Lift2,4 | Lower, near the top of the buttocks | Stronger lift of the buttocks and outer thighs |
| Fleur-de-Lis Abdominoplasty1 | None, with an added vertical scar in front | Horizontal looseness of the abdomen without back or thigh sagging |
Tissue that would otherwise be discarded can be turned into flaps to add buttock volume. In 280 lower body lift patients, 85% had buttock augmentation at the same operation, mostly with their own tissue, without an increase in complications.1,8 Removing too much tissue at the back can flatten the buttocks, so surgeons preserve gluteal fat.2,9
Who is a candidate.
Candidates have loose skin around the lower trunk after weight loss and a stable weight. Textbooks recommend stable weight for at least 3 - 6 months, which is often 12 - 18 months after gastric bypass.1,3 The best candidates have a body mass index near 25 - 30, and risks rise above 35.1,3
- Nutrition: Nutritional deficiencies such as iron, protein and vitamin deficiencies are common after bariatric surgery and are corrected before surgery.1,3
- Nicotine: Any nicotine use raises the risk of wound breakdown, and patients stop at least a month before surgery.3,9
- Weight Loss Method: In 307 patients, complications did not differ between weight lost by surgery and by diet and exercise, but each unit of body mass index raised risk.10
- GLP-1 Medications: Weight on semaglutide plateaued after about a year in trials, but patients regained most of it after stopping, so timing needs care.11
In 59 patients, those with a body mass index above 40 had no more complications but gained less in body satisfaction, body image and social function.12
How a lower body lift is performed.
- Markings: The resection is marked with the patient standing and bending, using a pinch test to avoid removing too much.1,7
- Back: With the patient face down, the back and flank tissue is removed and the outer thighs are released with liposuction so they can be lifted.1,7
- Anchoring: The deep fat layer is sutured to the underlying fascia to hold the thighs up and create a new contour at the scar.1
- Front: With the patient on their back, an abdominoplasty is completed, including muscle repair and a new belly button opening.1,7
- Safety: Warming, careful padding during position changes, drains and blood clot prevention are used throughout.1,7
The final scar is placed low so most underwear and swimwear can hide it.1,7
Staging and recovery.
Most patients after massive weight loss need several operations, often three over a year or more, usually starting with the trunk, buttocks and outer thighs.1 At least 3 months of recovery is usually needed between stages.1,9
In 632 abdominal contouring patients, operations lasting longer than 6 hours had more seromas, infections and minor reoperations, which is one reason long combinations are split.9,13
| Time | What Usually Happens |
|---|---|
| Surgery Day1 | Walking with assistance begins, along with blood clot prevention |
| First 1 - 2 Days1 | Fluids and urine output are monitored closely |
| First Weeks1 | Drains are removed once output falls below about 30 ml a day, and caregivers help with showering and garments to prevent falls |
| At Least 3 Months1 | Recovery to full health before any further stage |
Risks and complications.
| Complication | Reported Rate | Context |
|---|---|---|
| Wound Separation1,7 | 22% - 30% | Often at the back closure, usually managed with wound care |
| Seroma1 | 13% - 37% | More common with a body mass index above 35, mostly in the lower back |
| Skin Necrosis1,7 | 6% - 10% | Usually from tension or prior scars, and treated with wound care |
| Infection1,7 | 1% - 7% | Untreated seromas can become infected |
| Hematoma1,7 | 1% - 5% | Large collections are drained in the operating room |
In a 55-patient series of lower body lifts with buttock augmentation, 40% had at least one complication, 10.9% had a major complication and 21.8% needed a blood transfusion.6 In 222 patients, seroma risk rose about 9% for each additional pound of skin removed.5
Blood clots in the legs or lungs are the complication with the greatest potential to be fatal, so risk scoring, compression devices and often blood thinners are used.7,9 Some looseness can return within the first year.9
Results and quality of life.
In a prospective multicenter study of 129 patients who had a lower body lift or abdominoplasty after massive weight loss, physical and mental quality of life scores improved at 6 and 12 months.14 A systematic review of 24 studies found that most post-bariatric patients who had body contouring improved in body image, physical function and psychosocial function.15
In a meta-analysis of 2,307 bariatric patients followed for about 5 years, those who had body contouring maintained greater weight loss, with body mass index about 3 points lower than those who did not.16
What we don't know yet.
- Evidence Quality: Most studies of circumferential contouring are low-level, and randomized trials are lacking.4
- GLP-1 Timing: The best timing for body contouring after medication-based weight loss is not yet known.11
- Weight Maintenance: Whether body contouring causes better weight maintenance or simply occurs in patients who keep weight off is not settled.16
Common questions.
What is the difference between a lower body lift and a tummy tuck?
A tummy tuck treats only the front of the abdomen. A lower body lift continues around the sides and back, so it also lifts the buttocks and outer thighs and removes back rolls.
Where is the scar after a lower body lift?
The scar circles the body below the waist. Surgeons place it low so most underwear and swimwear can cover it, although it is long and permanent.
How long after weight loss should I wait?
Weight should be stable for at least 3 - 6 months, which is often 12 - 18 months after gastric bypass. Weight on GLP-1 medications tends to plateau after about a year, but much of it can return if the medication is stopped.
Can a lower body lift lift my buttocks?
Yes. It raises the buttocks and outer thighs, and tissue that would otherwise be removed can sometimes be used to add buttock volume at the same operation.
Will I need more than one surgery?
Often. Many patients after massive weight loss need about three stages over a year or more, with at least 3 months between operations, to treat the trunk, chest, arms and thighs safely.
Is a lower body lift right for me?
Only an in-person evaluation can answer that. This guide is educational and cannot assess an individual case. A qualified plastic surgeon can review your weight history, health and goals with you.
Key terms.
- Lower Body Lift
- A circumferential procedure that removes loose skin around the lower trunk and lifts the buttocks and outer thighs.
- Belt Lipectomy
- A circumferential excision of loose skin and fat with the scar at the waistline.
- Massive Weight Loss
- Loss of more than half of excess body weight, often after bariatric surgery.
- Superficial Fascial System
- A network of fibrous tissue within the fat that surgeons suture to support a lift.
- Adherence Zones
- Areas where skin is firmly attached to deeper tissue, which may be released to allow lifting.
- Autoaugmentation
- Using a patient's own excess tissue as a flap to add volume, such as to the buttocks.
- Fleur-de-Lis Abdominoplasty
- A tummy tuck with an added vertical midline excision to remove horizontal looseness.
- Seroma
- A collection of clear fluid under the skin after surgery.
References.
- 1.Chang J, Khosla RK, Hunstad J. Body contouring in massive-weight-loss patients. In: Janis JE, editor. Essentials of aesthetic surgery. New York: Thieme; 2018. p. 869-86.
- 2.Beidas OE, Rubin JP. Lower body lift and thighplasty. In: Chung KC, editor. Grabb and Smith's plastic surgery. 8th ed. Philadelphia: Wolters Kluwer; 2020. p. 643-50.
- 3.Beidas OE, Gusenoff JA, Manders EK. Principles of plastic surgery after massive weight loss. In: Chung KC, editor. Grabb and Smith's plastic surgery. 8th ed. Philadelphia: Wolters Kluwer; 2020. p. 627-31.
- 4.Carloni R, De Runz A, Chaput B, Herlin C, Girard P, Watier E, et al. Circumferential Contouring of the Lower Trunk: Indications, Operative Techniques, and Outcomes-A Systematic Review. Aesthetic Plast Surg. 2016;40(5):652-68. PubMed
- 5.Shermak MA, Rotellini-Coltvet LA, Chang D. Seroma development following body contouring surgery for massive weight loss: patient risk factors and treatment strategies. Plast Reconstr Surg. 2008;122(1):280-8. PubMed
- 6.de Runz A, Brix M, Gisquet H, Pujo J, Minetti C, Colson T, et al. Satisfaction and complications after lower body lift with autologous gluteal augmentation by island fat flap: 55 case series over 3 years. J Plast Reconstr Aesthet Surg. 2015;68(3):410-8. PubMed
- 7.Zomerlei TA, Janis JE. Liposuction, abdominoplasty, and belt lipectomy. In: Chung KC, editor. Grabb and Smith's plastic surgery. 8th ed. Philadelphia: Wolters Kluwer; 2020. p. 632-42.
- 8.Schmitt T, Jabbour S, Makhoul R, Noel W, Reguesse AS, Levan P. Lower Body Lift in the Massive Weight Loss Patient: A New Classification and Algorithm for Gluteal Augmentation. Plast Reconstr Surg. 2018;141(3):625-36. PubMed
- 9.Brower JP, Sullivan RR. Body contouring after massive weight loss. In: Woo AS, Bhatt RA, editors. Plastic surgery case review: oral board study guide. 2nd ed. New York: Thieme; 2021. p. 175-8.
- 10.Chetta MD, Aliu O, Tran BA, Abdulghani M, Kidwell KM, Momoh AO. Complications in body contouring stratified according to weight loss method. Plast Surg (Oakv). 2016;24(2):103-6. PubMed
- 11.Garbaccio NC, Smith JE, Posso A, Schonebaum DI, Foster L, Cordero JJ, et al. Plastic Surgery in the Ozempidemic: Considerations for the Timing of Body Contouring Surgery in Patients with Semaglutide-Associated Weight Loss. Aesthetic Plast Surg. 2025;49(21):6078-88. PubMed
- 12.Elfanagely O, Othman S, Mellia JA, Messa CA, Fischer JP. Quality of Life and Complications in the Morbidly Obese Patient following Post-Bariatric Body Contouring. Aesthetic Plast Surg. 2021;45(3):1105-12. PubMed
- 13.Vasilakis V, Lisiecki JL, Kortesis BG, Bharti G, Hunstad JP. The Effect of Obesity, Bariatric Surgery, and Operative Time on Abdominal Body Contouring Outcomes. Aesthet Surg J. 2021;41(8):NP1044-NP1052. PubMed
- 14.Berkane Y, Saget F, Lupon E, Mocquard C, Pluvy I, Watier E, et al. Abdominoplasty and Lower Body Lift Surgery Improves the Quality of Life after Massive Weight Loss: A Prospective Multicenter Study. Plast Reconstr Surg. 2024;153(6):1101e-1110e. PubMed
- 15.Jiang Z, Zhang G, Huang J, Shen C, Cai Z, Yin X, et al. A systematic review of body contouring surgery in post-bariatric patients to determine its prevalence, effects on quality of life, desire, and barriers. Obes Rev. 2021;22(5):e13201. PubMed
- 16.ElAbd R, Samargandi OA, AlGhanim K, Alhamad S, Almazeedi S, Williams J, et al. Body Contouring Surgery Improves Weight Loss after Bariatric Surgery: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg. 2021;45(3):1064-75. PubMed