Back External Quilting Suture in Massive Weight Loss Patients: A New Technique to Enhance Body Contouring

Despite its first descriptions in the previous decade, the use of the hemostatic net has experienced a recent resurgence of enthusiasm in cervicofacial rhytidectomy. Sizeable studies demonstrate a reduction of postoperative hematoma and better skin retraction thanks to external quilting suture techniques. Recent evidence supports this technique's safety for skin and soft tissue vascularization. We describe an innovative extension of transcutaneous suture indications to postbariatric and body-contouring surgery. By extending the hemostatic net, described for cervical and thoracic surgery, to postbariatric and body-contouring surgery, we aim to propose a safe, reproducible, and innovative technique to enhance contour shaping of the lumbar region. We present a series of 8 massive weight loss patients undergoing liposuction followed by hemostatic net sutures to improve contouring while minimizing scarring. Stitches were performed with 1/0 braided sutures and removed after 2 days. The follow-up ranged from 6 to 20 months. The average lipoaspirated volume was 1431 mL (range, 450-2300 mL). No complications were reported, and no subsequent procedures were needed. Lower back contouring improvement was evaluated using pre- and postoperative photograph comparisons by the patient and the surgeon. Skin marks partially faded at 6 months and disappeared at 12 months. This study primarily emphasized the safety and feasibility of external quilting sutures as an adjunct in postbariatric contouring rather than demonstrating definitive superiority over existing methods. This technique offered an additional option in the plastic surgeon's arsenal to address massive weight-loss sequelae despite poor skin tone.