Contouring of the Upper Extremity (Brachioplasty)
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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