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Plastic Surgery After Dramatic 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.

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.

How it is done

• 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.
• After making the incisions, the surgeon repositions and reshapes the breast tissue and surgically removes excess skin.
• 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).
• If needed, your surgeon can reduce the size of the areola by excising skin around the perimeter.
• 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.
• 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 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.

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.

 

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.

Selecting a Surgeon

Select a surgeon you can trust

It’s important to choose your surgeon based on:

• Education, training and certification
• Experience with plastic surgery after dramatic weight loss
• Your comfort level with him or her

Member Surgeons of the American Society for Aesthetic Plastic Surgery are experienced and qualified to perform your aesthetic procedure.

After finding a board-certified plastic surgeon in your area who is experienced in performing plastic surgery after dramatic weight loss, you will need to make an office appointment for your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit, which is sometimes deducted from the price of the procedure.

Your initial consultation appointment

During your initial consultation, you will have the opportunity to discuss what you want to achieve. Your surgeon will evaluate you as a candidate for plastic surgery after dramatic weight loss and clarify what procedures may benefit you most.

It is important to be completely honest during the consultation. Be fully prepared to answer these questions:

• Do you have any medical conditions or drug allergies? Are you being treated for any medical conditions?
• Have you had any previous surgeries?
• What are your current medications and vitamin and herbal supplements?
• What is your current use of alcohol, tobacco, and recreational drugs?
• What is your history with any noninvasive cosmetic procedures?
• What outcome do you expect from the surgery? What is your chief motivation in undergoing plastic surgery after dramatic weight loss?

Your surgeon may also:

• Ask you to look in a mirror and point out exactly what you would like to see improved.
• Take photos for your medical record, using computer imaging to show improvements you can expect.
• Evaluate your health status, including pre-existing health conditions or risk factors.
• Evaluate the elasticity of your skin.
• Discuss your options and recommend a course of treatment.
• Discuss likely outcomes, including risks or potential complications.
• Discuss the type of anesthesia that will be used.

Your treatment plan

Based on your goals, physical characteristics, and the surgeon’s years of training and experience, your surgeon will share recommendations and information with you, including:

• An approach to your surgery, including the combination of procedures.
• The outcomes that you can anticipate.
• Your financial investment in the procedure.
• Associated risks and complications.
• Options for anesthesia and surgery location.
• What is needed to prepare for the surgery.
• What you can expect to experience after surgery.
• Show before-and-after photos of cases similar to yours and answer any questions.

Questions to ask your aesthetic plastic surgeon

For a general list of questions to ask your surgeon about his or her background, to find out about plastic surgery safety and to plan your procedure. We developed these questions to help you:

• Make the most informed and intelligent decision about your procedure.
• Confirm that you have the right surgeon for your procedure.
• Make your initial consultation as rewarding as possible.
• Understand your options, potential outcomes and risks.

It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.

• Am I a good candidate for those procedures that interest me?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for the procedures I am undergoing?
• Will my scars be visible? Where will my scars be located?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my surgery?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?

Preparing for Your Procedure

How do I prepare for a plastic surgery after dramatic weight loss procedure?

Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery.

• You should be at a stable, dependable weight before you undergo body contouring. It is a good idea for your plastic surgeon to consult with your bariatric surgeon before surgery to determine if you have achieved your final weight plateau.
• Procedures are most commonly performed under general anesthesia, although local anesthesia with sedation may also be used in some cases. If your body surgery is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.
• If weight benchmarks or lifestyle changes are recommended, do your best to comply to get the best surgery results and minimize the chance of complications.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery and critical outcomes.
• Establish a no-fail support system for the full recovery period dictated by your surgeon. This is most critical to your recovery. If you have children less than five years of age, you must have someone to take care of them for at least two weeks. Lifting, driving, laundry and cleaning should not be attempted during your recovery from most of these procedures.
• Avoid taking aspirin, nonsteroidal anti-inflammatory medications (NSAIDs: Advil, Motrin, Aleve) and vitamins/homeopathic regimens that can increase bleeding.
• You should not smoke; your surgeon will tell you how far in advance of your surgery you should quit.
• Prepare your home for recovery. Your doctor can suggest many conveniences that may help you, depending on your procedure. For example, if your mobility is limited, it may be helpful to move objects from high shelves.
• Prepare meals that can be easily reheated.
• Set up your nightstand with everything you’ll need within easy reach, including the telephone, reading material and TV remote. Prepare your bed with the necessary pillows you might need for support.
• Get all of your chores out of the way before surgery so you may recuperate with as little worry as possible.
• If you dye your hair, be sure to do it before your surgery.

What can I expect on the day of plastic surgery after dramatic weight loss?

Your surgery may be performed in an accredited hospital, free-standing ambulatory facility or office-based surgical suite. Your surgeon will give you an estimate of how long your surgery will last based on the procedures you will undergo. Hospital stays may be necessary for some combined procedures.

• You will receive medications to keep you comfortable during the surgical procedure. Local anesthesia, combined with sedation, may be an option or you will receive general anesthesia. An anesthesiologist or nurse anesthetist will be present to administer sedatives or general anesthesia and assist in monitoring you during surgery.
• For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
• Your plastic surgeon will follow the surgical plan discussed with you before surgery. Once the operation has begun, he or she may decide to combine various techniques or to change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
• Your surgical dressings will depend on the procedures you undergo and may include surgical drains.
• After surgery, you will be taken into a recovery area where you will continue to be closely monitored.
• Before leaving for home, you (or someone looking after you) should feel comfortable emptying and resetting your drains.
• You may go home on the day of surgery or spend one or two nights in an aftercare center with a nurse or in the hospital, unless you and your plastic surgeon have made other plans for your immediate postoperative recovery. Under no circumstances will you be permitted to go home alone or stay home without another adult present. Follow your doctor’s recommendation in relation to this decision.

Aftercare and Recovery

Your doctor will discuss how long it will be before you can return to your normal level of activity and work following liposuction. After surgery, you and your caregiver will receive detailed instructions about your postoperative care, including information about:

• Drains, if they have been placed
• Normal symptoms you will experience
• Any potential signs of complications

Immediately after plastic surgery after dramatic weight loss

For thorough details, read separate sections on abdominoplasty, breast lift, breast reduction,breast augmentation, gynecomastia, liposuction, and lower body lift.

• Generally, you can expect to be bandaged, wearing compression garments, and you may have some surgical drains.
• When the anesthesia wears off, you may have some pain. If the pain is extreme or lasts long, contact your physician. You will also have some swelling after the surgery. In some cases, this swelling will remain for weeks or even months. Contact your physician to find out if your pain and swelling is normal or a sign of a problem.

Recovery time frame

Your recovery will depend on the specific procedures you undergo. When procedures are performed together, the benefit is a single recovery time. The first week will be the worst, and you will still feel like you are recovering for approximately two to three weeks.

• You may experience discomfort, swelling and numbness. You may be up and walking within hours of surgery, but you will require recuperation for several weeks or longer, depending on how much surgery you undergo.
• The recovery period is significant and can be intense the first few days. You can speak with your surgeon about using a pain pump as well as medications to control pain and discomfort so that you can move about and sleep as needed.
• You will likely go back for follow-up evaluation with your surgeon within five days. During this visit, your doctor can remove the drainage tubes. Swelling should subside within five weeks and the results are apparent within three months.
• By the end of the first week, you should be walking around the house frequently, but you will still be unable to drive. You may be comfortable enough to drive a car in two or three weeks or when all of your sutures and drains are removed.
• Swelling and numbness may take months to resolve. Fading and flattening of scars take three months to two years.
• You will probably need to wait six weeks after surgery before attempting any strenuous activities.

Recovering from plastic surgery after dramatic weight loss

Follow all postoperative instructions. This will include information about wearing compression garments and the level of activity that is safe for you. Your doctor will alert you to the signs of problems to watch for, such as signs of infection. It is important to realize that the amount of time it takes for recovery varies based on what your surgery entails. Here is an idea of some basic precautions and instructions to help your recovery go as smoothly as possible. However, it is vital that you get instructions from your plastic surgeon.

• Arrange for someone to help you get around the house and help with your medication for at least the first 24 hours after surgery.
• Make sure you continue to have help at home—this cannot be stressed enough. You’ll be tempted to try to help around the house quickly, but you won’t feel like yourself for one or two weeks and you still shouldn’t do anything strenuous, including lifting, for four to six weeks. If you have small children, you must put someone else totally in charge of their care for two weeks.
• Ask your surgeon how to sleep, including use of pillows, to minimize the tension on your incisions, reduce pain and facilitate a thinner scar.
• Call your surgeon immediately if you notice an increase in swelling, pain, redness, drainage or bleeding in the surgical area or if you develop fever, dizziness, nausea, or vomiting. Other red flags include shortness of breath, chest pains and unusual heartbeat.
• Your surgeon will likely supply you with a surgical bra to wear early in your recovery after breast reduction or breast lift. This will help minimize swelling. Most swelling should subside within a few weeks, although swelling may persist for up to four months after breast reduction.
• You will need to wear an abdominal binder after abdominal surgery. You may shower once the dressing, sponges and gauze pads are removed. This usually occurs within 72 hours. After showering, pat your incisions dry and replace your abdominal binder.
• Avoid heavy lifting, contact sports and jogging for up to six weeks.

How Long Will the Results Last?

Barring pregnancy or significant weight gain, your results should be permanent, though plastic surgery cannot stop you from normal aging. However, if you underwent a breast lift in conjunction with your plastic surgery after massive weight loss and have received breast implants, these are not permanent, and it is likely there will come a time when you will have to replace them.

Maintain a relationship with your aesthetic plastic surgeon

For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you have any questions about your healing and results. Do not hesitate to contact your surgeon when you have any questions or concerns.

Associated Costs

The cost of plastic surgery following dramatic weight loss varies from doctor to doctor and from one geographic area to another. The biggest factor will be the number and kind of procedures you undergo.

Because these procedures are elective, insurance does not cover most of them. If you are undergoing panniculectomy, breast reduction or any procedure in which your excess skin causes functional problems, you should contact your insurance company to see what they might cover. For example, if your pannus interferes with daily living, this surgery may be covered by insurance. Many surgeons offer patient financing plans to make the procedures more affordable.

Choose your surgeon based on quality, training and experience—not cost.

Limitations and Risks

Fortunately, serious risks are rare and the satisfaction rate with these procedures is high. The overall complication rate is small if the operation is performed by an experienced plastic surgeon operating in an accredited facility.

All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures

Risks and potential complications of surgery should be discussed during your consultation. Being under heavy stress or having nutritional deficiencies might lead to slow healing.

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your post-bariatric surgery.

 

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