Plastic Surgery After Massive Weight Loss

Also known as post-bariatric surgery or body contouring after massive weight loss

Plastic surgery after dramatic weight loss reduces excess skin and fat left behind after major weight loss. Its goal is to restore attractive proportions by removing the sagging skin around the face, neck, upper arms, breasts, abdomen, buttocks and thighs that creates a misshapen contour. Although these procedures leave scars, most patients find them to be an acceptable tradeoff for an improved appearance.
 
When to Consider Plastic Surgery after Dramatic Weight Loss

• If you have experienced dramatic weight loss from bariatric surgery or diet and exercise.
• If you have sagging skin in multiple areas, including the face and neck, breasts, arms, abdomen, back and thighs.
• If your weight has stabilized following bariatric surgery or diet and exercise. This may be 18 months or more after your weight loss.

Considerations
Pros

• Gets rid of loose skin so you can fit into your clothes better.
• Gets rid of overhanging skin that might be causing painful chafing, rashes and infections.
• Improves your self-esteem

Cons

• Surgery results may not meet your expectations.
• You will have permanent scarring (though your surgeon will try to hide scars in body creases and unobtrusive areas).
• Your surgery results may be affected by weight gain, aging and lifestyle choices.
• ​
  

These are the top three pros and cons to weigh when considering plastic surgery after dramatic weight loss. If you want to focus on those unique to you, please consult with your aesthetic plastic surgeon.

Are you a good candidate for plastic surgery after dramatic weight loss?
There may come a time after dramatic weight loss when your weight is stable, but you are distressed by sagging and overhanging skin. If you are considering plastic surgery to improve your body contour, these characteristics make you a good candidate:

• Your weight has been stable for at least six months with no further weight loss expected. For optimal results, body contouring should not be done for approximately two years after the start of any dramatic weight-loss program. This time allows your skin to shrink as much as possible and your nutrition to be stabilized and optimized, factors that will aid in your recovery.
• You are in overall good health without chronic medical conditions, such as diabetes or heart disease. People in poor health are not good candidates for body-contouring procedures. Get clearance for plastic surgery from your primary care physician or from doctors treating you for medical conditions.
• You have a healthy diet; problems such as protein deficiencies can interfere with healing.
• You do not smoke; smoking slows down the healing process and increases the risk of serious complications during and after surgery. If you smoke, you must quit at least six weeks before surgery.
• You have mental stamina; surgical contouring procedures require patience and endurance.
• You have realistic expectations; surgery will lead to marked improvements in your shape, but it is impossible to restore the skin or body to what it would have been without the weight gain or to what it was in your teens or twenties. Even after body-contouring surgery, skin continues to sag over time as part of normal aging.

 
Detailed Procedural Info
How is a plastic surgery after dramatic weight loss procedure performed?
Your first step is to tell your plastic surgeon what you wish to achieve. Your surgeon will then suggest the procedures that will help you reach your goals and give you a realistic picture of what those procedures can do for you. Sometimes multiple procedures can be performed at the same time, while, other times, a staggered approach may be recommended. Because each procedure can impact the outcome of the next, careful surgical planning is required. Of the body contouring procedures, panniculectomy and lower body lift are the procedures most closely associated with dramatic weight loss.

Panniculectomy

What it does
The pannus is the name for overhanging skin of the lower abdomen that typically occurs after major weight loss and/or pregnancy. A panniculectomy removes the hanging pannus, or apron of skin, from the lower abdomen below the belly button (excess skin and fat above the belly button are not removed). It is often performed on patients who are still significantly overweight, but have troublesome skin irritation from hanging skin. Some potential candidates have fat extending over their hips, around their backs or as low as their knees, which presents health hazards. After surgery, you will have fewer skin problems, but little improvement in your belly contour.

How it is done

• The surgeon makes a horizontal incision at the pubic area, where the excess skin and fat can be carefully removed.
• The remaining skin is pulled closed and secured.
• Sometimes a drain is inserted that requires home care for a while.
• Tape is applied to all of the incisions to aid in healing and to prevent tearing.
• If you have any abdominal hernias or torn abdominal wall areas, the surgeon can often repair them simultaneously.

Liposuction, lower body lift and tummy tuck are procedures related to panniculectomy.

Lower body lift
also known as belt lipectomy

What it does
This procedure reshapes the abdomen, waist, hips, thighs and buttocks through an incision made around the circumference of the body. It is designed for those who have loose skin in the buttocks, back of the thighs, hips, side of the thighs, front of the thighs, inner thighs, abdomen and relatively thin layers of fat below the skin in these areas.

How it is done

• Incisions pass from the back around the hips to the front of the thighs.
• The surgeon removes loose skin as well as underlying fat tissue from below the incision to allow suspension of the remaining tissues to stretch and smooth the lower body, especially the buttocks and thighs.
• The surgery begins in the back, but you are repositioned during the surgery to address the hips, outer thighs and front of the thighs.
• This surgery can be combined with abdominal skin tightening if needed.
• If a previous abdominoplasty has been performed, or is not needed, the lower body lift can be extended to tighten the inner thighs.

Liposuction, abdominoplasty and panniculectomy are procedures related to lower body lift.
Breast reduction, breast augmentation and gynecomastia (male breast reduction) are other procedures associated with plastic surgery following dramatic weight loss. The following procedures are frequently incorporated in plastic surgery for dramatic weight loss, but are also undergone by people who have never been obese:

Tummy Tuck
also known as abdominoplasty

What it does
Abdominoplasty removes loose, excess skin and fat and tightens slack fascia, removing stretch marks and excess skin in the lower abdomen below the belly button.

How it is done

• Your surgeon will remove most of the skin and fat between the belly button and pubic hair in a horizontal oval or elliptical shape.
• The fascia overlying the abdominal muscles is tightened with permanent sutures.
• The skin around the belly button is repositioned.
• The belly button is brought out through a small incision and sutured it in its normal position.
• The incision is closed with sutures, which typically run from hip to hip.
• Your scar will be along the natural crease within the bikini line. The length and visibility of the scar varies.

Liposuction
Also known as lipoplasty

What it does
Liposuction can improve the contour of your flanks, hips, chest, thighs, neck, upper arms and knees. It is frequently used in conjunction with other plastic surgery procedures following dramatic weight loss. See liposuction for more information.

How it is done

• Your surgeon will make very small incisions in the area where fat will be removed.
• A thin, hollow rod (cannula) is inserted through the incision to create tunnels through the fat.
• Suction forces the fat into the cannula and out a high-vacuum hose.
• After fat removal, the surgeon will apply dressings and most likely put you into a compression garment.

Breast lift
Also known as mastopexy

What it does
A breast lift treats sagging and uneven breasts, decreased breast volume, drooping nipples, and stretched areolas, returning a youthful shape and lift to your breasts. Women who desire larger, smaller, or more rounded breasts may want to consider a breast augmentation or breast reduction along with the breast lift. See breast lift for more information.

How it is done

1. Your surgeon will make incisions. Mastopexy incisions vary, depending on the amount of excess skin, the position of your nipples, your preference and your surgeon’s suggestions.
2. After making the incisions, the surgeon repositions and reshapes the breast tissue and surgically removes excess skin.
3. Your nipple and areola will be positioned to a more youthful height. (Nipples and areolas usually remain attached to underlying mounds of tissue, which may allow for the preservation of sensation and the ability to breastfeed).
4. If needed, your surgeon can reduce the size of the areola by excising skin around the perimeter.
5. Your surgeon will then tighten the remaining skin while closing the incisions, layering the sutures deep within the breast tissue to support the newly-shaped breasts.
6. Skin adhesives and/or surgical tape may be used to help close and support the skin.

Upper arm lift
Also known as brachioplasty

What it does
With aging or dramatic weight loss, the upper arms can become loose and flabby. An arm lift removes excess skin and fat deposits, giving upper arms a more pleasing and youthful contour. Incision length and pattern depends on the amount and location of excess skin to be removed, as well as the best judgment of your plastic surgeon. Expanded information on this subject is in the arm lift section.

​How it is done

• Incisions are generally placed on the inside of the arm or on the back of the arm, and may extend from the underarm (axilla) to just above the elbow.
• If fat is to be reduced during your arm lift, it will be excised or treated with liposuction.
• If you have a small amount of extra skin, you may be a candidate for a mini brachioplasty, with an incision that is limited to the underarm area.

Thigh lift
Also known as thighplasty

What it does
This surgical procedure removes extra skin and fat to give you tightened, toned and better-proportioned thighs. Thigh lifts can also be performed in combination with liposuction of the thigh and lower body lift.

How it is done
There are several types of thigh lifts. Your plastic surgeon will suggest appropriate options for you based on how much excess fat and skin you have, your skin quality, the areas to be treated and your preferences.

• An inner (medial) thigh lift, which is the most popular, involves incisions in the groin fold. It is best for people with a moderate amount of skin and fat in this area. In this procedure, your surgeon lifts up the thigh skin and tissue to tighten this area.
• A vertical thighplasty, involving a vertical incision starting at the groin crease and extending to the inner knee, is appropriate if you have more significant fat and loose skin. This scar is visible when the inner thighs are exposed. During a vertical thigh lift, your surgeon removes a wedge of skin from the inner thigh.
• An outer thigh lift requires an incision extending from the groin around the hip. A newer procedure called the spiral thighplasty targets the front, back, inner and outer thigh. The incision is below the buttock fold and continues over the groin crease at the junction of the thigh and pubic area.

Additional Info

What are my options?
After dramatic weight-loss, the goal of plastic surgery is to tighten loose and sagging skin. Your options include lower body lift, tummy tuck, facelift, liposuction, breast lift, breast reduction or gynecomastia, thigh lift, arm lift and panniculectomy. You will need help from a plastic surgeon to determine which of these options are suitable for you. In many cases, it is wise to stage procedures at intervals. It is most important for your surgeon to create a plan, deciding what should be done first to give you the most surgical advantages.

What will my plastic surgery after dramatic weight loss incisions and scars be like?
Every effort will be made to make scars as small and inconspicuous as possible. Plastic surgeons are adept at hiding incisions in body creases whenever possible. Although incision lines are permanent, in most cases they will fade and significantly improve over time. Because some of these surgeries can share the same incisions, your plastic surgeon will be very careful to plan the order of surgeries.

Term Definitions

Panniculectomy: The incision extends from hip to hip and can be hidden in the bikini area.

Lower body lift: The incision extends around the circumference of your body in a bikini-line pattern, designed to be hidden in your underwear.

Abdominoplasty: The incisions stretch from hip to hip just above the pubic area. This will leave a scar that falls along the natural crease within the bikini line. Its length and visibility varies.

Breast lift: Incisions vary because there are different types of breast lifts, each with different scarring patterns. Your surgeon can conceal some incision lines in natural breast contours, but others will be visible on the breast surface.

Arm lift: Incisions are generally placed on the inside of the arm or the back of the arm and may extend from the underarm (axilla) to just above the elbow. If you have a small amount of extra skin, you may be a candidate for a mini-brachioplasty with an incision that is limited to the underarm area.

Thigh lift: Incisions for an inner thigh lift are in the groin fold. For a vertical thighplasty, a vertical incision starts at the groin crease and extends to the inner knee. An outer thigh lift requires an incision extending from the groin around the hip. For a spiral thighplasty the incision is below the buttock fold and continues over the groin crease at the junction of the thigh and pubic area.

Liposuction: Incisions are very small..