After Major Weight Loss
Pregnancy and extreme weight loss can both result in excess loose, sagging, or projecting lower abdominal wall tissues. A tummy tuck restores abdominal appearance, resulting in a smoother, flatter abdomen. Results may be enhanced by liposuction, breast lifts, or augmentation and thigh lifts.
Recommended Treatment For:
Contouring of the Arms (Arm Lift)
Contouring the Thighs and Buttocks (Thighs and Buttock Lift)
Chest Wall Contouring (Breast Lift, Male Breast Lift Or Reduction)
Facial Contouring (Facelift/Necklift)
Combination Procedures (Breast Lift, Tummy Tuck, Arm Lift)
Before Your Surgery
Bariatric surgery and the weight loss that follows, will result in many life changing issues. Your activity level will increase and your appearance and self esteem will significantly improve. However, the loose skin and skin folds that result from your weight loss can be of a significant concern. The sagging skin can cause issues with personal hygiene and with fitting clothing properly. Your appearance is dependent upon how your skin will react after your weight loss and its adherence to your new slimmer foundation. If your skin has an elastic property it will better conform to your new slimmer foundation. Another important factor is how much weight loss occurs in specific parts of your body. If you carried a significant amount of weight around your middle, then the skin in that area will have further to contract and will be most affected by your weight loss. The end result is that hanging skin can affect your self-confidence and become a constant reminder of your past obesity.
The most common area of concern is the overhanging apron of skin on the front of the abdomen, called a “pannus”. In addition to hygiene issues beneath the pannus (rashes and skin irritation) there is also a concern for the proper fitting of clothing. These symptoms and concerns tend to be worse in hot weather and may be a cause of chronic back problems. While the abdomen is definitely the area of greatest concern, excess skin on the upper arms and inner thighs are also problematic areas.
When is the right time to consider body contouring plastic surgery?
The timing of body contouring surgery is dependent on two main factors. First, is attaining a stable weight, which usually occurs 12 to 18 months after the weight loss procedure. We prefer the patient to be at a stable weight for at least 3 months before your body contouring surgery. The most common problem that we see is that many patients feel that body contouring prior to attaining their stable weight will enhance their activity and provide an unrealistic way to reach their true stable weight. Second, after attaining your stable weight, it is highly advisable that you are also in a healthy medical condition. The stress of these procedures dictates that all candidates be medically stable. Therefore, reaching a stable weight and being in good medical condition pave the way for a more successful body contouring outcome.
Contouring of the abdomen
Before committing to body contouring surgery you must ask yourself:
Are you willing to accept a scar in return for your improved body contour?
There is one simple rule of body contouring surgery: you can’t take away excess skin without having a scar and these scars can be long and they are permanent. The scars will tend to fade with time, but they will always be there. The way the scar looks is mostly determined by your body’s natural healing process and the location of the scars. Some people make thicker heavy scars, while others make thin scars. In most procedures, the scars are hidden in places that are covered by clothes, such as along the waistline. In some procedures, such as an arm lift (brachioplasty), the scars can be visible. Ask yourself, “Am I willing to trade the loose skin in this part of my body for a permanent scar?” If the answer is clearly yes, then you are likely to be satisfied with the operation.
Plastic surgery procedures commonly performed following weight loss include abdominoplasty/tummy tuck (panniculectomy) , liposuction, arm lift (brachioplasty), thighs and buttock lift, breast reshaping, male breast reduction or lift, facelift/necklift, and other special areas. It is possible that you could also choose to have a combination of procedures performed at the same time.
Abdominoplasty (Tummy Tuck/Panniculectomy)
This is the most common procedure performed after weight loss or strictly as a cosmetic procedure for contouring of the abdomen. I prefer to categorize this procedure as either a limited abdominoplasty, a standard tummy tuck or a circumferential abdominal wall contouring. The person undergoing abdominal wall contouring after excessive weight loss will require either the standardor the circumferential procedure. It is a two hour procedure, requires a general anesthetic and may also require an overnight stay in the hospital. The scar is usually placed low along the waistline and around the belly button. In those patients who have a lot of excess skin or have under gone previous abdominal wall surgeries, they may require an “up and down” scar. In some patients, the scar may completely circle the waist so as to ensure a contouring of not only the front, but also the back. The choice of procedure might be influenced by your current weight, medical condition, and financial issues. During the procedure, a tightening of the abdominal muscles is often done in order to give a better overall contoured result. Plastic drain tubes, about as thick as a pencil, are placed during the surgery to drain fluid from the surgical site. These stay in for about a week and need to be emptied at home twice a day. They are removed in the office when the amount of drainage is below a certain point. We advise patients to avoid heavy lifting (more than 10 pounds) for six weeks after the surgery. Patients who do light work can return in as little as two weeks, although many will allow four weeks. Risks of the procedure include bleeding, infection, and seroma (a harmless collection of fluid beneath the skin). Seromas are treated in the office by draining them with a small needle. More serious complications, such as blood clots that form in the legs, can also occur but are very rare.
Patients who have hernias from previous abdominal surgery can often have them fixed at the same time as the panniculectomy (abdominoplasty, or tummy tuck). Our office will work with your insurance company to ensure coverage for this procedure. The hernia repair can lengthen the procedure by about one-half hour, but will not prolong your over-night stay in the hospital.
Liposuction is a technique that uses hollow suction tubes to remove fat. The tubes are narrow and can be placed through small incisions that are not very obvious. Liposuction is rarely used as a sole procedure in patients who have lost a large amount of weight because it does nothing to tighten skin. In fact, removing fat from under inelastic loose skin only makes the loose skin worse. This technique may, however, be used along with lifting procedures to get a better overall contour.
Contouring of the Arms
Arm Lift (Brachioplasty)
This procedure is one of the most requested after excessive weight loss. It must be stressed during the consultation that contouring can be attained, but the trade off is the presence of a scar. The scar, in mild cases, can be hidden beneath the armpit, but in more severe cases it will run along the inner upper arm to the elbow. The scar can be situated so that it can’t be seen from the side or back, but will be noticeable with the arm up. Many patients who would never show their arms before the brachioplasty are quite comfortable wearing sleeveless clothes after this operation. The operation averages two hours, and the recovery involves about one to two weeks out of work for light jobs and four weeks for jobs that require lifting. This popular procedure can be combined with other operations such as breast lift or abdominoplasty. Drains are used, and risks specific to this operation include patchy numbness on the upper and lower arm. The numbness does not interfere with function, may disappear over time, and is rarely bothersome to patients.
Contouring the Thighs and Buttocks
Thighs and Buttock Lift
The combination of these two procedures is usually referred to as a lower body lift. These procedures are customized to address each patient’s needs.Actual scar placement is dictated by the laxity of the skin and a desire to hide the scar beneath clothing. Scars for the outer thigh lift can also be used for the abdominoplasty procedure and the same scar can be extended around the back as a buttock lift. The inner thigh can be treated by lifting the skin and placing the incisions along the groin crease. In severe cases, a long vertical scar may be required along the inner thigh. The lower body lift procedure requires more time and has a longer recovery than the abdominoplasty. Drains are used and the risks are similar to the tummy tuck procedure.
Chest Wall Contouring
In general, a breast lift raises and firms the breasts by removing excess skin and tightening the surrounding breast to reshape and support the new breast contour. With an excessive weight gain the breast skin stretches and the areola becomes enlarged. With the subsequent weight loss, the breast can lose its elasticity resulting in a significant sagging of the breast mound. The nipple areola may also become enlarged. The goal of the breast lift is to improve the shape of a female breast that:
Sags or is pendulous, but is proportionate with the body frame
Has lost firmness and skin elasticity
Has a flatter elongated shape
Has a nipple and areola that point downward
Has stretched skin and an enlarged areola after weight loss or after pregnancy
The breast lift is done on an outpatient basis and may be done under a general anesthetic or with a mild sedation. The operative time is one and a half hours. An incision is made around the areola and may also extend down from the areola to beneath the breast. In general the greater the sagging of the breast, the longer the incision will be. The nipple is not detached in an attempt to avoid any loss in sensation to the breast (see fig 1 ). The skin envelope is redraped around the newly formed breast mound to give a more rounded and perky appearance (see fig 2). All patients are discharged home on the same day of surgery with a support bra in place. This procedure is often performed in conjunction with other body contouring procedures including tummy tuck or the upper arm lift.
Recovery: Most patients rate the pain level as a 5 on a scale of 1 to 10. All patients are given detailed, written postoperative instructions and prescriptions for antibiotics and pain control. Light activity is tolerated well in the first week. Most patients are never so incapacitated that they can not take care of their own basic needs. We see you in one week after your procedure. At that time all your dressings and your sutures are carefully removed. Your postoperative recovery and activity levels are again discussed and an anticipated date for your return to work is discussed. Light employment is tolerated after two weeks, with heavy lifting and regular activity in 3 to 5 weeks. You are also given detailed instructions for care of your suture lines so as to help prevent excessive scarring. Your final consultation usually occurs 5 months after your procedure.
Male Breast Lift or Reduction
Obesity in men often leads to breast enlargement, a condition referred to as Gynecomastia. This is treated with a combination of liposuction and skin removal. The pattern of scars varies with the amount of correction needed, but they are often well concealed by chest hair. Risks of the procedure are bleeding and infection. The recovery time is about one week.
Loose skin on the neck and face can be corrected with a variety of face and necklift procedures. The common feature of these procedures is that the scar is hidden along the front of the ear and in the hair. This procedure may be done as same day surgery or with an overnight stay. Bruising and swelling is worst during the first two weeks. Risks include bleeding and, rarely, injury to facial nerves. For a more detailed description of this procedure refer to our Facelift Procedure under cosmetic surgery.
Combination Procedures (Breast Lift, Tummy Tuck, Arm Lift)
Some patients want to have as much done as possible in a single surgery. Your surgeon will advise you about what combinations of procedures are reasonable to do at one time. For example, breast reshaping and tummy tuck is a common procedure offered to many patients. Some patients may be candidates for multiple procedures that will provide a “total body reshaping.” Only patients who are close to their goal weight, are in very good shape and have no underlying medical problems should consider such big operations. Most importantly, your surgeon should have experience with these types of procedures and plan to do the surgery in a hospital setting. Remember, more surgery means bigger results, but also a bigger recovery and possibly more risk. For that reason, several procedures may be staged so as to offer a safer and more recovery-friendly environment.
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