Contouring surgery after massive weight loss

Surgical body contouring following massive weight loss removes excess sagging fat and skin while improving the shape of the underlying supporting tissue. The result is a more normal and firmer appearance with smoother contours.

Dramatic weight loss has many benefits. But after weight reduction surgery, or any substantial amount of weight loss, the skin and tissues often lack the elasticity to conform to the reduced body size.

Before

After

Body contouring surgery procedures may include:

• Facelift: for correction of sagging of the mid-face, jowls, and neck
• Breast lift: for correction of sagging, flattened breasts
• Upper body lift: for removing the excess skin from the upper body (chest)
• Circumferential Tummy tuck: for removing the apron of excess skin hanging over the abdomen and lower back
• Lower body lifts: for correction of sagging of the abdomen, buttocks, groin and outer thighs
• Medial thigh lift: sagging of the inner, outer and mid thigh
• Arm lift: sagging of the upper arms

Most patients require a sequential scheduling of the above procedures so as to contour the deflated body. These procedures are individually major surgeries and must be undertaken after detailed investigations and planning. Furthermore, these surgeries result in long and at times prominent scars even if they are placed in well hidden locations.

How are these surgeries performed?

Body contouring surgeries after massive weight loss are performed in an operation theater under regional or general anaesthesia. The incisons are planned such that they are located in well hidden locations. However, in Indian (Asian) skin some sites such as the inner arms and inner thighs are further notorious in producing unpleasant scars.

Circumferential Tummy-tuck – The incision is placed along the lower abdominal crease and extends across the flanks to the lower back (junction of buttocks and lower back). Thus it entails acircumferential incision around the body to remove the “belt” of excess skin and fat.

Armlift (Brachiaplasty) – The incision extends from the armpit to the elbow along the inner aspect of the upper arm. Some variations to further hide the scar are:

• Placing the incision along the junction of the inner and back of the arm
• Mini-armlift – incision is along the lower border of hair bearing skin in the armpit with a small extension into the upper arm.

Thigh lift – The incision is placed along the inner aspect of the thigh extending from the groin to the knee. In some cases this may extend along the groin crease to tighten the outer aspect of thighs. In selected cases, an inner thigh lift may suffice when the laxity is purely on the inner and front aspects of the thigh. Here the incision is placed along the groin crease at the junction of the upper thigh and abdomen; extends across the inner aspect of the upper thigh to the crease beneath the buttocks.

Upper body lift– The incision is planned in a horizontal manner around the torso between the lower chest and upper abdomen. This may require shifting the nipple areolar complex (in males) to a higher, more normal location as a free graft. In selected cases, a vertical incision along the sides of the chest extending from the armpit region to a point at the junction between chest and abdomen may be a better option.

Excess skin and fat is removed using these incisions. The skin edges are closed meticulously in layers so as to place minimum tension on skin and thereby improve the scar quality.

Recovery

During your recovery from body contouring surgery, dressings or bandages will be applied to your incisions following the procedure. These dressings may continue for approximately 10-14 days. Small, thin tubes may be temporarily placed under the skin to drain any excess blood or fluid that may collect.

You will be given specific instructions that may include how to care for the surgical site(s), medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your cosmetic surgeon.

You may be instructed to avoid bending, straining or lifting for several days to weeks.

Where tightening of the abdomen or thighs is involved, your cosmetic surgeon may also instruct you to avoid standing fully upright and stressing any internal sutures as they heal, and to sleep with pillows elevating your knees.

To minimize the risk of DVT (blood clots in the legs) you will need to be up and walking as soon as possible, and drinking plenty of fluid. This dreaded complication is further minimized by the use of specialized anti-DVT calf pumps during and immediately after surgery.

Possible risks

Body contouring surgeries after massive weight loss are major surgical procedures and have some potential problems associated with them. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications.

Some of the possible risks include:

• Bleeding Infection
• Fluid accumulation
• Poor wound healing
• Skin loss
• Blood clots, deep vein thrombosis (DVT) and pulmonary embolism
• Excessive or widened scars
• Numbness or other changes in skin sensation
• Anesthesia risks
• Unfavorable scarring
• Residual skin laxity or contour irregular

Consultation

During consultation be prepared to discuss:

• Your surgical goals
• Medical conditions, drug allergies, and medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use
• Previous surgeries

Your aesthetic surgeon will also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Take clinical photographs
• Discuss your options
• Recommend a course of treatment – you may discuss about which body part isyour priority concern so that the sequence of different surgeries (stages) may be planned accordingly.
• Discuss likely outcomes of surgery and any risks or potential complications

It’s very important to understand all aspects of your procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your body contouring surgeon surgeon.

Preparing for body contouring surgery after MWL

In preparing for surgery, you may be instructed as follows:

• Get lab testing or a medical evaluation. These investigations are extensive to further enhance the safety profile of the surgery.
• Take certain medications or adjust your current medications prescribed by your body contouring surgeon.
• Stop smoking
• Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding