Massive weight loss, through surgical or non-surgical procedures, is a significant achievement and the foundation to a healthier, happier life. Following bariatric surgeries, patients feel and look better, yet excess hanging can still affect your comfort and self image. The loose and sagging skin exists in areas such as the arms, breasts, thighs, faces, abdomen, and buttocks. The elasticity of your skin will greatly influence the need for contouring after weight loss. With body contouring, we can improve the shape of the skin but we cannot improve the quality of the skin. Often times a staged approach, planned future surgeries, are required to minimize risk and maximize the final result.
Excess hanging skin can generate hygiene problems, decrease mobility, make daily tasks difficult and create discomfort, often in the form of rashes or sores and prevent many forms of exercise. This sagging skin can be removed through body contouring plastic surgery procedures that help weight loss patients achieve a new positive body image.
Patients who have recently experienced loss of a large amount of weight through procedures such as gastric banding or bypass surgery, stomach stapling, bariatric surgery, lap band surgery, or non surgical methods such as diet or exercise.
These candidates have maintained a stable weight for an extended period of time, approximately 12 to 18 months, and do not expect further weight loss, as a result of the previous surgical procedure. During this stabilization period, the skin will shrink as much as possible in preparation for the body contouring procedures.
Candidates should be in good health and maintain a nutritional diet during the year following weight loss surgery. Candidates should not smoke during the 6 weeks prior to surgery and are urged not to recover the habit following surgery as smoking will increase risk of complications and slow the healing process.
Candidates should also have reasonable expectations for the results of the body contouring procedures.
Body Contouring patients have a variety of procedures available to assist in the removal of excess skin and restore a shapelier contour. Generally, multiple procedures will be performed to address different areas of the body, and this may occur through a series of operations over an extended period of time. Whenever possible, we try to accomplish as much as is safely possible and perform most surgeries in less than 6-8 hours maximum. Pacific Center for Plastic Surgery considers itself a center for excellence in post bariatric, maximum weight loss, cosmetic and reconstructive surgery. This is important as our focus of interest, using a team approach (using a dedicated surgical assistant and at times both Dr. Nichter and Dr. Horowitz will operate together to minimize complications and operative times and to share their collective operative experience and judgment. Depending on the selected procedures, some may be performed at the same time in either an “upper body lift” (arms, breasts, face) or “lower body lift” (abdomen, thighs, buttocks). The specific procedures necessary are to be determined on a case-by-case basis; the patient will discuss the areas of concern with Dr. Nichter and Dr. Horowitz to develop an individualized and efficient surgical plan, allowing the primary areas of distress to be addressed first.
Procedures may require touch-up operations at a later time. Although, the body contouring procedures will remove large amounts of excess skin, patients should know that the skin will continue to sag over time due to normal aging. In general, most surgical procedures will leave long scars. These may fade to white or widen and stay red for lengthy periods of time. Scars can sometimes be improved with topical medication or lasers but will never be gone. This is usually considered a worthwhile trade-off by most patients to remove all of the hanging skin and fat. Specific procedures are listed below but there are many variations from the standard methods used for non weight loss patients. These different methods will vary depending upon the patient’s sex, previous surgeries, combinations of contouring procedures, the location and amount of loose skin and placement of incisions to get the best possible result.
Below is a list of body-contouring procedures; for more detailed information, follow the link to the procedure page.
Panniculectomy refers to simple excision, removal, of the roll, pannus, of redundant soft tissue in the lower abdomen which falls onto the thigh. Occasionally this procedure is covered by insurance if there is a documented recurrent or chronic infection and rash requiring medical treatment. It does not involve improvement to the mid or upper abdomen or tightening to the abdominal muscles, but can be done in conjunction with an Abdominoplasty which will accomplish these goals.
Abdominoplasty This procedure frees up all of the extra or redundant abdominal skin and fat by removing the excess skin around the abdomen and may be used to tighten the abdominal muscles. Liposuction often is used to lessen areas of the fat layer for an improved result. The procedure involves a side to side incision at the level of the pubic hair line. More sophisticated surgical approaches for Massive weight loss may include additional incisions such as a Fleur de lis, an additional incision in the midline up and down to remove excess skin from side to side (in addition to up and down tightening); a reverse lift leaving scars under the breasts, or a Pubic Lift for redundancy in the pubic region and other modifications that are customized to your particular needs. Because of the complexity and number of surgical options, it is key to choose your surgeon wisely. Make sure that he has experience in this type of surgery, is Board Certified by the American Board of Plastic Surgery. This is why so many of our patients choose Pacific Center for Plastic Surgery.
Belt lipectomy/Circumferential body lift: usually continues around from the Abdominoplasty to include the back; may be done in one stage as a second operation. In the moderate to larger patients, it is important to anticipate the movement of the skin that is left behind after the procedure. This allows the surgeon to anticipate the location of the scars and subsequently place them in a less conspicuous location, for example, the scars may be placed where they can be hidden by the underwear line. This procedure has the potential to lift and contour the buttocks and posterior thigh.
Breasts: Women have several options for beast procedures following weight loss.
Breast lift (Mastopexy): A breast lift will remove excess skin near the breasts and reduce the appearance of sagging breasts.
Breast Augmentation: Some women choose to combine a breast augmentation with the breast lift. This procedure enhances the breast shape and contour through implants. It is commonly required after massive weight loss even if you do not want a larger breast, as a lift alone does not restore the upper, superior pole, of your breast.
Breast Reduction: Some women choose to combine a breast reduction with the breast lift, if the breast size remains larger than desired. After weight loss, much of the breast tissue lies below the fold and removing a portion of skin in this area can help to shape your breasts into more of a desirable breast mound.
Gynecomastia: After weight loss, many males experience excess sagging breast tissue; this may be treated by liposuction alone or in combination with skin excision.
Arm Lift (Brachioplasty): This procedure removes excess skin and fat from the arms to reduce the “bat wing” effect, typically from the armpit down to the elbow, resulting in a shapelier arm. The scar is minimized by having it on the underside of your arm towards your body and is often hairline in appearance.
Facelift: This procedure involves the re-draping and removal of skin around the face and neck. Since more skin is removed than a typical facelift, the incisions are carefully placed in front and behind the ear and at times following the hairline. Some of the newer techniques that are utilized by Dr. Nichter and Dr. Horowitz use hidden and short scar techniques in conjunction with other facial aesthetic surgery.
Buttocks and Thigh Lift: These lifts remove excess skin and tighten the skin and soft tissues near the buttocks and upper thighs. This is often performed in conjunction with the Abdominoplasty. The incision is made below the belt area in the body lift and during the thigh lift; the incisions are placed on the inner thigh extending toward the knee.
Liposuction: This procedure may be used to assist in the removal of isolated fat areas after excess skin has been removed. It may be used alone in areas such as the back rolls, outer thigh, inner thighs, or in conjunction with all of the other contouring procedures to enhance the results
Upper body lift: can include direct excision of rolls of skin from the upper back or sides of the chest. These operations are individualized for each situation.
In general, the techniques used in body contouring surgery have grown and improved over the last several years in response to the large number of patients who have had massive weight loss. It is one of the fastest growing areas of our practice at Pacific Center for Plastic Surgery. Updated and innovative methods that adjust treatment according to body type are creating improved results and enhancing the shape of patients’ bodies. With massive weight loss in a short period of time, skin does not retain its shape, leaving the patient with excess, baggy skin. Also, patients lose different amounts of body fat before the weight loss plateaus, leaving them either thin, moderate or still heavy often times in an asymmetric manner. A carefully planned, individualized approach is often the difference between an acceptable result and a great result and is dependent on your surgeon’s experience.
Effectively mapping incisions before surgery as well as using a combination of new and current shaping techniques leads to the most successful surgeries for moderate to larger body shapes.
Some of our happiest patients are those who have undergone Plastic Surgery after significant weight loss and this reflects other Centers for Excellence. For example, the vast majority of patients who participated in a recent study at the University of Pittsburgh are extremely pleased with the end result. It was reported that 39 of the 40 patients in this study rated the outcome of their surgery very good or excellent. We hope you are able to take advantage of your potential new shape through post bariatric plastic surgery as well.