Body contouring after massive weight loss
Patients who have undergone bariatric procedures experience massive weight loss and have residual excess skin throughout their body. Patients who are overweight tend to have excessive skin AND fat. These patients who are interested in body contouring procedures are candidates for traditional lifting procedures (breast, face/neck, arms, abdomen), but are also potential candidates for liposuction surgery. Unlike these patients, post-bariatric men and women experience a rapid deflation of their body – fat is lost and the skin is left behind. Underlying this process is relatively poor skin quality after massive weight loss. The skin has lost its elastic properties and often has stretch marks and cellulite, which are classic signs of permanent skin damage. These patients are NOT candidates for liposuction since removing more fat from already damaged and deflated skin, makes the sagging skin appearance even worse. Excisional techniques are the treatments of choice.
Dr. Ha can help patients determine their appropriate treatment plan for body contouring during a consultation. These are significant procedures that can be lengthy and can have serious complications if the appropriate precautions are not observed. Typically, body contouring procedures are best performed 18 to 24 months after the bariatric surgery has been completed. This is to ensure that physiologic changes and weight loss have been stabilized. It is important that a patient’s bariatric surgeon and internist are closely involved to optimize his/her health status prior to undergoing these extensive procedures.
Descriptions of procedures like breast lift (mastopexy), face/neck lift, arm lift (brachioplasty), and thighlift can be found elsewhere on this website. The classic procedure for post-bariatric body contouring is the Circumferential Abdominoplasty, or often known as the Lower Body Lift, Trunk Lift, or Extended Abdominoplasty. This procedure involves a traditional tummy tuck for the anterior abdomen, but also excision of excess fat/skin in the hip area extending into the back (above the buttock area). From posteriorly, the scar pattern resembles a gentle “V” above the buttock area. The scar is still concealed within the panty or underwear line. This procedure helps remove the redundant skin that is found in the abdomen as well as many of the excess “rolls” found in the sides and back. Depending on the technique and anatomy, the lateral thigh/buttock area can be lifted at the same time, to create a more balanced contour.
In contrast, a Panniculectomy is a more functional operation that is designed to remove only the overhanging skin below the infra-abdominal fold. This sagging skin mass is know as a Pannus. Patients with this excessive skin may be experiencing frequent rashes, infections, or ulcerations in this fold, creating hygiene issues and odor. The pannus itself may become infected intermittently (panniculitis) requiring antibiotic therapy. These patients who have these symptoms and fail conservative treatments are potential candidates for panniculectomy. This procedure is NOT a tummy tuck because it does not address any bulging or sagging skin/fat above the umbilicus (belly button), no muscle tightening is performed, and significantly less abdominal skin/fat is removed.
These weight loss procedures are major surgeries, some with significant recoveries. Typical recovery for a circumferential abdominoplasty is about 4 weeks. Drains are placed and remain for up to 4 weeks. Because of the poorer quality of skin, scar widening, wound dehiscences (separation), and seromas (fluid collections) are common occurrences and their incidence is higher than in non-bariatric surgery patients. Fortunately, these are problems that resolve with conservative treatment. The scars from these procedures are long and potentially more conspicuous than in non-bariatric patients, but the trade-off for the incredible body contour and shape is more than worth it.
Dr. Ha believes that the highest priority is a patient’s safety. Body contouring is ultimately elective and all appropriate precautions should be observed prior to proceeding with surgery. Multiple procedures at the same setting are usually possible and patients can benefit from shared recovery times and cost. However when the duration of surgery begins exceeding 6 to 8 hours, the risk of complications increases – including blood clots, respiratory failure, infection, post-op nausea and vomiting, etc. Dr. Ha does not exceed these operative times and in many cases will employ a co-surgeon to help maximize the number of procedures within this time limit. A comprehensive medical work-up is always performed and the treatment plan can change depending on a patient’s health appropriateness. Dr. Ha insists on performing these procedures in certified facilities with board-certified anesthesiologists.