Following significant weight loss, many people find they still don’t have the fit and healthy body image they desire. Skin may be loose, sagging and, in many cases, body contours may appear irregular. In general, body contouring surgery following major weight loss reduces excess fat and skin that has developed in multiple areas of the body, resulting in a smoother, more attractive body tone. The areas of the body that are typically addressed include:
Abdominal area – Tummy tuck and/or abdominoplasty
Abdominoplasty, also known as tummy tuck, is a procedure to flatten and tighten the abdominal skin and muscle. There are many reasons a patient may be unhappy with the way their abdomen looks. It may be excess abdominal skin only, excess fat only, a combination of both excess skin and fat, and /or stretching of the abdominal muscles.
Pregnancy can affect the abdomen by stretching the muscles apart. Exercise will help to strengthen muscles and over time the space between the muscles may retract bringing the muscles closer together as they were before pregnancy. Because of this, we recommend waiting at least a year after pregnancy to work on abdominal exercises as well as allowing yourself time to return to ideal weight before considering Abdominoplasty. Although it is safe to become pregnant after an abdominoplasty, we recommend waiting for surgery until after you are done having children.
During a traditional abdominoplasty, excess skin and fat is removed and the muscles are tightened as needed. There is not one tummy tuck for all patients. Abdominoplasty must be tailored for each individual. A patient with a large amount of excess skin will likely need a full abdominoplasty, which involves an incision on the lower abdomen from hip to hip. A patient with excess skin only in the lower abdomen may need a mini abdominoplasty, which is a simpler procedure performed through a smaller incision above the pubic area. A patient who has good skin tone, no sagging skin, but has excess fat, would be a good candidate for liposuction. A patient with no excess skin and fat, but bulging of the abdomen from spreading apart of underlying muscles may need a tightening of the muscles (muscle plication) without skin removal.
Arm lift – Brachioplasty
An arm lift, or brachioplasty, is a surgical procedure that reshapes the under portion of the upper arm, from the underarm region to the elbow.
Fluctuations in weight, growing older and even heredity can cause your upper arms to have a drooping, sagging appearance. Exercise may strengthen and improve the underlying muscle tone of the upper arm, but it cannot address excess skin that has lost elasticity or underlying weakened tissues and localized fat deposits.
If the underside of your upper arms are sagging or appear loose and full due to excess skin and fat, an arm lift may be right for you. An arm lift is performed to:
- Reduce excess skin and fat between the underarm and the elbow
- Reshape your arm to result in smoother skin and contours
- Result a more toned and proportionate appearance
In order to achieve your improved image, there will be a scar on the inside of your upper arm.
- Breasts – Breast lift
- Buttocks, including groin and thighs – Lower body lifts, Medial thigh lifts
This procedure addresses loose and sagging skin of the abdomen, buttocks and thighs. Excess skin and fat are removed through incisions placed on the lower abdomen and upper buttock regions to tighten the skin and improve the contour of the buttock, abdomen, hips and thighs. Lower body lift requires general anesthetic, and at least a one night stay in the hospital. Drains are placed and compressive dressings are worn postop to decrease swelling and fluid collection. Walking soon after surgery is important to decrease the chance for blood clot formation.
The procedure is an extension of the high lateral tension tummy tuck concept developed by Ted Lockwood. Lockwood basically re-invented the tummy tuck by re-defining the nature of suspension of the deeper tissues of the abdomen and flank. The lower body lift extends the tummy tuck incision completely around the lower torso. This allows re-suspension of the lateral and anterior thighs along with the traditional tummy tuck improvements.
The operation is extensive and is known for wound healing complications. Some surgeons have arbitrarily divided the operation into smaller portions to help limit these complications. Furthermore, the concept has been expanded upon to include additional lifts such as those of the inner thigh (medial thigh lift). The traditional lower body lift targeted the upper thighs as well as the buttocks and abdomen. For the large volume weight loss patient, this operation is ideal to remove the redundant skin that frequently "hangs" around the lower torso.
These operations typically require 5–8 hours operating time when done together. The procedure requires time off from work. Close post-operative supervision is advised
Facelift - Face, neck and/or jowls
Our face is our most visible feature. Facial aging, heredity, stress, environmental conditions or dramatic weight loss causes a loss of skin elasticity and firmness, sagging tissue and wrinkles. We can feel great but appear tired or sad. In general, a facelift corrects sagging facial skin and muscles, removes excess fat and restores firmness to create a more youthful, rested and vibrant appearance. A facelift is a highly individualized procedure. A traditional facelift restores the midface, jowls and neck, allowing excess skin to be removed. Additional procedures that may further enhance the outcome may include: facial implants or soft tissue augmentation to recontour the facial structure, and resurfacing techniques to improve the tone and texture of facial skin. Insurance typically does not cover a procedure like this.
A thigh lift (thighplasty) reduces excess skin and fat in the thigh and knee area, resulting in redefined, slim and taut thighs. Both men and women who have saggy, flabby and/or dimpled loose tissue and skin on their thighs may be candidates for this body contouring procedure. Many people who have lost weight due to bariatric surgery may also benefit from thigh lifts to get rid of the excess fat and flab in this area. The thigh lift is usually performed on the inner surface of the thighs but can include the outer thigh area and buttock if indicated. Thigh lift surgery can also be performed in conjunction with other procedures such as a body lift or liposuction.
Panniculus is a medical term describing a dense layer of fatty tissue growth, consisting of subcutaneous fat in the lower abdominal area. It can be a result of obesity and can be mistaken for a tumor or hernia. Abdominal panniculus can be removed during abdominal panniculectomy, a type of abdominoplasty. A panniculus can also be the result of loose tissues after pregnancy or massive weight loss.