Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Body Contouring


Medical Codes

ICD-9-CM:
86.83 - Size Reduction Plastic Operation; Liposuction; Reduction of Adipose Tissue: Abdominal Wall (Pendulous), Arm (Batwing), Buttock, Thighs (Trochanteric Lipomatosis

Related Terms

  • Abdominoplasty
  • Belt Lipectomy
  • Body Sculpting
  • Brachioplasty
  • Flankoplasty
  • Gynecomastia Reduction
  • Lipoplasty
  • Liposuction
  • Thigh Lift
  • Thighoplasty
  • Tummy Tuck
  • Upper Arm Lift

Overview

Body contouring is the removal of excess fat and/or skin from the body to achieve a more natural or cosmetically desirable shape. Most body contouring is elective surgery done for cosmetic reasons. However, after massive weight loss of greater than 100 lbs. (45 kg), body-contouring surgery may be performed for hygienic or health reasons. Body contouring includes a number of different procedures, but as treated here excludes facial plastic surgery and breast reconstruction.

Abdominoplasty (also called a tummy tuck) is a procedure in which fat and skin are removed from the middle and lower abdomen and the abdominal muscles (rectus abdominis) are tightened, giving the individual a firmer abdomen. This procedure is often done on women whose abdominal muscles and skin have been stretched and lost elasticity due to multiple pregnancies. It is also done for purely cosmetic reasons to counteract the effects of aging. Occasionally, abdominoplasty is a medical necessity for individuals who have lost huge amounts of weight, usually as a result of bariatric surgery (gastric bypass or stomach stapling). In these individuals, the skin at peak weight became stretched to the point at which it will never be elastic enough to fit the new, smaller contour of the body after weight loss. Sometimes 25 pounds (11 kg) or more of skin will hang from the abdomen. This skin creates both psychological and physical problems. The creases of skin frequently develop rashes (suppurative intertrigo) and become infected. In addition, the abnormal body contour creates both practical problems in dressing and psychological problems related to appearance.

Flankoplasty and thigh lift or thighoplasty are similar procedures to remove excess fat and skin from sides of the abdomen and the thighs. These procedures are rarely done alone, but commonly are done in conjunction with abdominoplasty.

Belt lipectomy is a surgical procedure often used to remove excess skin from the waist resulting from large weight losses. Especially in older individuals, once weight loss has been achieved, the skin around the waist develops extra folds like a deflated balloon. Belt lipectomy addresses this problem around the entire circumference of the body, removing the excess skin and lifting and tightening the muscles to produce a flatter abdomen, a better-defined waist, elevated buttocks, and tighter thighs. This gives the individual a more conventional body shape.

Brachioplasty removes excess skin from the inner portion of the upper arm. This procedure is done either after weight loss or to counteract the sagging effects of aging (ptosis).

Liposuction, or lipoplasty, is a body-contouring technique that is used either alone on small patches of fat or in conjunction with one of the other surgeries mentioned above to help shape and smooth the body. There are several different ways to perform liposuction, including suction-assisted liposuction (SAL), ultrasound-assisted lipoplasty (UAL), fluid injection lipoplasty, and tumescent liposuction. Each technique has advantages and disadvantages. The choice of technique depends on the doctor's preference, the location from which the fat is to be removed, the age and health of the individual, and the individual's cosmetic expectations. Liposuction is designed to be a tool to shape the body and is not a weight loss procedure. It removes fat but does not remove cellulite (reticular dermis).

Body contouring can be performed in a doctor's office, a freestanding surgical center, or a hospital. The choice of location depends on the extent of the surgery, the type of anesthesia used, and the age and health of the individual. Cosmetic body contouring is considered elective surgery and is almost never covered by health insurance; body contouring that is necessary because of major weight loss is sometimes covered.

Source: Medical Disability Advisor



Reason for Procedure

Most body-contouring procedures are performed because individuals wish to look thinner, fitter, or younger or are dissatisfied with the shape of a particular part of their anatomy. A few procedures are performed after the massive weight loss (100 lbs. or more) that often follows bariatric surgery.

Source: Medical Disability Advisor



How Procedure is Performed

All body-contouring surgery begins with a consultation with a physician, usually a plastic surgeon, but sometimes a dermatologist (if the contemplated procedure is liposuction), in which the individual articulates his or her vision of the desired results of the surgery. The physician performs a complete physical examination to determine if the individual is an acceptable candidate for the desired procedure. The physician also discusses the risks and the most likely outcomes of the procedures, often drawing on the individual's body to show where incisions will be made. A great deal of time is spent in patient education, so that the individual can make a realistic assessment of the risks, potential complications, and expected outcomes of the surgery. Before the surgery, the individual will be required to stop smoking and possibly to discontinue some medications.

Body-contouring surgery may be performed under local anesthesia, often with supplemental sedation, or under general anesthesia, depending on the site and extent of the surgery and the preference of the doctor and the individual. Surgeries can last anywhere from less than 1 hour for a single, simple liposuction to 5 hours for an abdominoplasty. Individuals may return home after a few hours or remain in the hospital overnight, again depending on the extent of the surgery and the complications that may arise. Body-contouring surgery after significant weight loss (more than 100 lbs.) may need to be performed in stages and can involve multiple procedures, including a complete lower body lift with abdominoplasty, upper arm lift, breast lift, and thigh lift.

Liposuction is one of the most commonly performed body-contouring procedures. After the individual is sedated and/or anesthetized, the physician makes a small incision at the spot where the liposuction is to be performed. First, sterile saline is infused to separate the tissue layers and to reduce traumatic bleeding. In suction-assisted liposuction, a thin hollow tube (canula) is inserted into the incision and moved back and forth to loosen fat while the fat is suctioned away. In ultrasound-assisted liposuction, the canula contains a device that produces ultrasound waves that help destroy the fat cells and liquefy the fat so that it can then be removed with suction. In both fluid injection and tumescent liposuction, a solution is injected into the fatty area to help remove the fat. These techniques often take longer (up to 5 hours) than other types of liposuction but have the advantage of being done with local anesthetic injected along with the fluid at the fatty site. Liposuction can be performed on more than one area during a single surgery session and is often done in conjunction with other body-contouring surgeries to help remove excess fat and create a more natural body shape.

Abdominoplasty proceeds in the same way as liposuction to the point of incision. Normally a horizontal incision is made that extends between the pelvic bones just above the pubic region. Depending on the amount of skin to be removed, a second incision may be made above the navel. The surgeon then loosens the skin from the underlying muscle and tightens the abdominal wall by pulling the stretched abdominal muscles together with sutures. Sometimes liposuction is used to remove excess fat and sculpt the abdomen. If necessary, a new hole is made to relocate the navel. Excess skin is then removed, a temporary drain is inserted, and the skin incision is closed. Following surgery, dressings are applied to the surgical wounds, and the area may be wrapped in a compression garment or elastic bandage to support the abdomen and minimize swelling (edema).

Other body-contouring procedures follow the general outline of abdominoplasty, with muscles being lifted and tightened and excess fat and skin removed. There are many variations in technique for all these procedures. The choice of technique is based on the body shape of the individual and the preferences of the surgeon.

Source: Medical Disability Advisor



Prognosis

Immediately following body-contouring surgery, the area where the surgery was performed will have soreness, bruising, and swelling (edema) for several weeks. There may also be some bleeding. Individuals are usually required to wear special compressive garments that aid in healing and prevent blood from pooling. With larger surgeries, such as abdominoplasty, the surgical drain will be removed in about a week. Within a few weeks, stitches will be removed, but it may take several months before the swelling subsides completely. In addition, the area where the surgery was performed may feel either numb or tingly (paresthesia). The scars will remain prominent for many months but will eventually fade, although they never disappear completely.

Individuals who have lost 100 lbs. or more after bariatric surgery achieve the best outcomes when their weight has been stable for at least 1 year and they expect no further weight loss, they have stopped smoking, and they have no significant comorbidities (“Body-Contouring”). Individuals with the highest success rates for body-contouring procedures involving liposuction are those within 30% of their ideal body weight, those who are nonsmokers, and younger individuals who have good muscle tone and elastic skin (“Important Facts”). If an individual gains weight after liposuction, the fat usually will not be distributed in the old problem areas but in other parts of the body; therefore, continued lifestyle measures are recommended (diet and exercise).

How satisfied individuals are with their body-contouring surgery depends mainly on the number of complications they experience and how realistic their expectations were prior to surgery. Although most individuals are happy with their new look, some find the results less dramatic than they had hoped, or simply different from what they expected. This complication can be diminished by pre-surgery patient education.

Source: Medical Disability Advisor



Specialists

  • Dermatologist
  • Plastic Surgeon
  • Psychologist

Source: Medical Disability Advisor



Rehabilitation

Individuals are encouraged to get out of bed and walk the day after the surgery, even after surgeries such as abdominoplasty, which may make it difficult for individuals to stand fully upright. Walking and light exercise are encouraged, but lifting and strenuous stretching are forbidden until the incisions are completely healed. The long-term success of any body-contouring surgery depends on maintenance of weight and fitness, so individuals are encouraged to develop a lifelong program of regular exercise and nutritional awareness.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

All the standard surgical complications may occur with body-contouring surgery, including infection, toxic reaction to anesthesia, puncture wounds to internal organs, fluid and electrolyte imbalance, and the development of blood clots, commonly in the leg veins (deep vein thrombosis). Complications especially related to body-contouring surgery include fat escape into the bloodstream (fat emboli) during liposuction, burns from ultrasound-assisted liposuction, pooling of blood serum at the site of the procedure (seroma), nerve compression, skin death (necrosis), poor wound healing, and separation or parting of the sutures (wound dehiscence). Other complications include asymmetrical appearance after the surgery, changes in skin pigmentation, altered skin sensation from sensory nerve damage during the procedure, scarring, and persistent lower extremity swelling (edema). A significant emotional complication is disappointment with the results and the time it takes for them to become apparent.

Source: Medical Disability Advisor



Factors Influencing Duration

Duration of disability depends on the type of surgery, the extent of the surgery, the age and health of the individual, the willingness of the individual to follow postoperative instructions (e.g., light exercise, no smoking), and any complications that arise.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals undergoing liposuction may return to sedentary work within 1 to 2 weeks of the procedure. Full recovery takes several weeks, and until recovery is complete, reassignment to jobs that do not require lifting or stretching is necessary.

For more extensive surgeries, individuals can usually return to sedentary work within 2 to 4 weeks (“Body-Contouring”). Restrictions on heavy lifting, stretching, and vigorous physical activity may last several months. The individual may need additional time off for follow-up physician visits throughout the recovery period.

Source: Medical Disability Advisor



References

Cited

"2009 Report of the 2008 Statistics." American Society of Plastic Surgeons. 2009. 3 Nov. 2009 <http://www.plasticsurgery.org/Media/stats/2008-US-cosmetic-reconstructive-plastic-surgery-minimally-invasive-statistics.pdf>.

"Body-Contouring Surgery After Significant Weight Loss." Cleveland Clinic Foundation. 2009. 3 Nov. 2009 <http://my.clevelandclinic.org/services/cosmetic_surgery/hic_body-contouring_surgery_after_significant_weight_loss.aspx>.

"Important Facts About the Safety and Risks of Liposuction." American Society of Plastic Surgeons. 2009. 3 Nov. 2009 <http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Cosmetic_Procedures/Liposuction_for_Women.htm>.

"Procedural Steps—Breast Reconstruction." American Society of Plastic Surgeons. 2009. 3 Nov. 2009 <http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Reconstructive_Procedures/Breast_Reconstruction.html>.

Source: Medical Disability Advisor