After achieving major weight loss, bariatric patients are often left with loose, excess skin that embarrasses them and makes their weight loss achievement less obvious.
Depending on the problem areas, there are a variety of body contouring procedures that may be recommended to help further improve the body’s shape after losing a significant amount of weight.
Q: What is body contouring?
A: Body contouring refers to a broad field of plastic surgery procedures that address areas of excess fat and/or skin. Body contouring procedures can be performed in normal-weight patients, patients who have lost significant weight through diet and exercise, and patients who have lost weight after bariatric surgery.
Q: Is achieving ideal body weight required before body contouring?
A: It is important for weight loss patients to achieve weight stability prior to proceeding with any body contouring procedures. Ideally, patients should be weight stable for a minimum of 12 months. This is important because weight fluctuations, both gain or loss, can affect the aesthetics of body contouring procedures. This can lead to poorer outcomes, and increase the incidence of need for secondary procedures.
Q: How does one prepare for body contouring surgery?
A: Many post-bariatric patients prior to weight loss had weight-associated medical conditions. Prior to any procedures, these patients should have general medical clearance. If a patient is a smoker, thy should go through a smoking cessation program. In order to reduce the risk of significant wound healing complications related to alteration in tissue perfusion by nicotine, all patients should be nicotine free for a minimum of six weeks prior to and after an elective surgical procedure. Bariatric patients are at risk for nutritional deficiencies that can affect healing and thus put them at risk for wound healing complications. They should all undergo nutritional assessment, and any deficiencies should be addressed.
Q: What are the risks of body contouring surgery?
A: The risks of body contouring procedures are similar to any other major surgery. The most common complications are related to wound healing, including wound infection, wound breakdown, and seroma formation. Massive weight loss patients often have other medical conditions, related to their previous obesity, including sleep apnea, hypertension, and diabetes that can increase the risk of surgery.
Skin quality is altered in patients who were previously obese and have subsequently lost significant weight. This can lead to increased incidence of poor wound healing, scar-related issues including scar migration, and skin laxity leading to aesthetic-related issues, which can all lead to an increased need for revision procedures.
Q: What are the body contouring steps?
A: Massive weight loss patients often require multiple surgical procedures to address excess skin and fat throughout their entire body. From the healing and safety standpoint, it is not feasible to perform all of these procedures in one operation.
Typically, panniculectomy (removal of excess skin and fat from the abdomen) or lower body lift procedures are performed as the first stage. Breast reduction/lift procedures can be combined with either Brachioplasty (arm) or medial thigh lift. The remaining procedure can be performed as a third stage. If there is significant facial laxity, a facelift can be performed, often, as the final stage. Typically, the time period between stages is three to six months to allow for recovery and healing.
Q: How long does it take to get back to normal after body contouring?
A: Typically, body contouring procedures require at least three months for the overall cosmetic results to be fully apparent. This allows enough time for all residual swelling to resolve and for the soft tissue to soften. Scars typically require 12 months to go through the remodelling process, and, because body contouring procedures require significant incisions, they often are apparent during this time period.
Q: How long do the results of body contouring last?
A: The major factor that affects the longevity of results in post-bariatric body contouring is weight fluctuations. This is the main reason that these procedures are delayed until patients are weight stable for a minimum of 12 months. If patients are able to maintain their weight, long-lasting results can be achieved. The main issues in this patient population are related to scar migration and soft tissue laxity leading to contour deformities. These are the result of the altered skin/soft tissue characteristics related to the previous obesity.
Q: How much does body contouring cost? Does insurance cover it?
A: Not all insurances cover body contouring procedures. More insurance companies are specifically excluding body contouring from coverage. The most commonly covered procedure is abdominal panniculectomy.
Q: What makes body contouring at AIG hospitals special?
A: At AIG Hospitals, our academic surgeons approach body contouring with a patient-first attitude. Our surgeons are considered leaders in their field. Some of their research activities focus on patient safety, outcomes analysis, and developing state-of-the-art surgery, thus allowing us to incorporate the latest techniques into creating a safe surgical environment in which we can maximize our patients’ experience and outcomes.
1. Tummy Tuck (Abdominoplasty): Tummy Tuck (Abdominoplasty) is one of the most popular plastic surgery procedures in general, let alone as an after-massive-weight-loss supplement. A tummy tuck removes excess fat and skin and can restore weakened or separated muscles. Some people who have had weight loss surgery may also need a panniculectomy if they have significant hanging fat and flab (pannus) following weight loss. The pannus may cause skin irritation and infection. Unlike a tummy tuck, a panniculectomy only removes excess skin and fat; it doesn’t tighten the muscles. Ask your surgeon which procedure is best for you.
2. Lower Body Lift: Lower Body Lift (belt lipectomy) tightens and sculpts the buttocks, back of the thighs, outer thighs, inner thighs, hips and abdomen. (The scar is hidden in the bikini line.)
3. Thigh Lift (Thighplasty): Thigh Lift (Thighplasty) after massive weight loss shapes the thighs by reducing excess skin and, sometimes, fat. The result is a more contoured upper leg. There are several types of thigh lifts, each of which is tailored to a specific trouble spot(s). Recovery time varies based on the nature of the thigh lift.
4. Arm Lifts (Brachioplasties): Arm Lifts (Brachioplasties) have increased in popularity in recent years. For people who have lost massive amounts of weight, hanging flab in the arms can prevent them from revealing their trimmer figure in short sleeves or tanks. An arm lift removes the excess hanging skin from the underarm and reshapes the under part of the upper arm, from the armpit area to the elbow.
5. Breast Lift (Mastopexy): Breast Lift (Mastopexy) — with or without breast implants — is a popular post-weight loss procedure. With a dramatic change in weight, the breasts — which are composed largely of fatty tissue — can begin to sag and flatten. A breast lift can return them to a perkier state.