Plastic Surgery for Massive Weight Loss

This is an important section of the website to which I wanted to dedicate an entire section. There are so many patients seeking this procedure that plastic surgery for massive weight loss has quickly become a sub-specialty in its own right. There is a lot of information here specific to these patients and their procedures that should be discussed. I am sympathetic to the fact that many patients with excess folds of skin after massive weight loss still consider themselves fat. I very much understand the needs and concerns of these patients; you are well on your way to resuming normal size and normal life, but hindered by the outcome of many lost pounds. I am pleased to be able to help you with this.

Many patients nowadays have undergone bariatric surgery, that is, bypass or stapling of the stomach. It has become a very safe and predictable operation well tolerated by patients of virtually any large size. The result of this is a large population of individuals with significant sized rolls of excess loose skin all over their bodies. The essentials of your anatomy that we are dealing with here are loss of skin elasticity, poor skin quality (stretch marks) and excess skin because the underlying fatty support framework has been deflated. Furthermore, the skin cannot totally contract back down enough because it has lost its elastic qualities. The underlying muscles and bones are fine. There is laxity in the ligaments that course from the muscles to the skin that support these areas. The relationship between the amount of excess skin, skin elasticity, vectors of laxity, and excess fat is what determines the surgical intervention. I will coordinate the features of your anatomy with your expectations, formulate a plan with you, and guide you through this.

After bariatric surgery it is best to wait until your weight has stabilized. Plastic surgery for treatment of the excess skin can be done in STAGES, less often it may all be done at one time, depending on the anatomy, your medical condition, and your expectations. The surgery involves making incisions in concealed areas, such in the underwear lines, however it is often best to coordinate placement of these incisions with the vectors of greatest laxity, this is how you get the best pull and the best result. To determine your vectors of laxity, use the “pinch test”; pinch up your excess tissue and pull as much as you can to get the maximum result. Where you pinch up the skin is at or near where we should place your incision. Working through the incision I then create a space to loosen any retaining ligaments, tighten underlying muscles as indicated, pull the edges together at just the right tension, trim the excess, and close up the incisions. Some residual fat may need liposuction in certain areas. Deep stitches are secured to the ligaments and bone so there is less of a tendency for the skin to fall down. The length of the incision depends on the amount of excess skin removed and it is not unusual to remove 5-10 inches in length! In general please remember that "THE LONGER THE SCAR, THE BETTER THE RESULT" Implants are often used in association with breast lift. The healed incisions are usually pencil thin and are located relative to your areas of excess skin and the greatest laxity. Incisions may have a tendency to heal slightly wide and dark but this gets better over time. The surgery is mostly comfortable because it is essentially a surface surgery and I do not cut through things that hurt like muscles, tendon, and bone. Surgery involves a general anesthetic, performed where I do surgery, which is in a hospital setting with an MD anesthesiologist, and an overnight stay in the hospital. The surgery is safe and predictable. There is some pain and swelling after surgery but this is not severe or prolonged. The stitches are all dissolvable, with return to activity and some work in as little as 10-14 days, and to some physical exercise in the third week. Surgeries to revise and “touch up” previous procedures are very common and the usual. The surgical procedure and results in body lift depend on your anatomy, the number of areas involved, the amount of excess skin, and vectors of laxity. Collectively, these all determine where the incisions need be made, how long are the incisions, how much tissue will be removed, and can this surgery be done in one or do you need multiple stages.

The categories of surgery for massive weight loss that I offer my patients may be thought of in terms of the following spectrum of possible procedures:

• Body Lift. See the section on Body Lift as this is the main concern to patients in weight loss surgery. This is the usual approach to the trunk and torso. It may be combined with one or more of the following surgeries.
• Outer Thigh Lift. This is where the abdomen and buttocks are mostly okay and just a lift to the outer thighs is needed. Here the incision is some length along the belt area and over the outer thighs.
• Inner Thigh Lift. Same as above as applies to inner thigh. Here the incision is just in the groin crease area but also may extend down the inner thigh to the knee like a “T”.
• Tummy Tuck (Abdominoplasty). This may be done alone or in stages combined with body lift. See the separate section for this.
• Buttock lift. This can be done alone or as part of the staging, and involves an incision in the belt area just in the back and part way around the sides.
• Breast Lift with Implants. Many patients will desire this procedure.
• Arm Lift. This virtually always involves the incision from the elbow to beyond the armpit and slightly onto the chest wall.
• Chest wall lift. This is making incisions along the bra line from the breast around the back to remove these rolls of skin when present.
• Facelift. This is often done at some stage.

I have great expertise in body lifting procedures and have performed many of these operations over the years, and with very natural results. I spend a great deal of time discussing your anatomy, listening to your expectations, and interpreting for you what your anatomy and tissues will allow me to do in a safe and predictable way. In addition, I consider your body as a whole and I build a system into all body contouring surgeries that, initially, allows you to recover much quicker and, secondly, it serves to preserve your surgical results. This system includes a special diet, special attention to blood clotting, vitamins, supplements, special garments, skin products, physical training and knowing what to avoid. Together, all of this allows me to create results that are consistently very beautiful, quick to heal, exceptionally natural, and with minimal incisions. I am delighted to surgically provide you with such a profound yet natural body image change, and one that has consistently so pleased my patients and changed their lives.

Please also review the article on Body Contouring in my Articles Section of the website.

For before and after images of this procedure click here

Please call or contact the office for any further information or to schedule an appointment.