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Post Weight Loss Surgery

Losing a significant amount of weight by any method (bariatric surgery, stomach stapling, lap band, dietary changes plus exercise and hard work!) is an incredible accomplishment. If you have completed your weight loss journey, Congratulations! If you are still actively losing your excess weight, please take this opportunity to become fully educated about options for body contouring once your weight loss is complete and you have achieved a stable, “steady state” new weight.

Following significant weight loss, most individuals have loose, hanging or empty skin or redundant folds in many areas of the body. Often, patients state that they feel energized and youthful on the inside, but are “hidden” within an empty, large frame they formerly filled out. Massive weight loss patients choose to have body contouring Plastic Surgery to uncover their fit and healthy bodies underneath!

Post-weight loss surgery can involve sculpting and lifting the breasts, contouring of the chest, arms, abdomen, trunk and back, and lifting the buttocks, inner and outer thighs. Body contouring after weight loss creates a more pleasing appearance to the body, contributing to improved body image, confidence and self-esteem.

Who is a Good Candidate for Post-Weight Loss Surgery?

Good candidates for post-weight loss body contouring include individuals who are healthy, physically fit, and at a Stable Weight following Major Weight Loss. For ultimate safety and to ensure the best aesthetic results, it is recommended that anyone considering post-weight loss body contouring to wait At Least a Full Year after their weight is stable before having Plastic Surgery.

Poor candidates for surgery include patients with chronic nutritional deficiencies or absorption problems such as “dumping syndrome” or frequent diarrhea. Even people who are still relatively overweight can be malnourished and be at risk for poor wound healing, wound infections and overall postoperative fatigue or depression. Smokers, people with multiple medical problems, and patients who are psychologically unstable are not considered good candidates for surgery.

Having realistic expectations is imperative for post-weight loss surgery. Body contouring after significant weight loss will strikingly improve body shape, but it cannot be done without creating multiple scars and without experiencing significant “down time”. It is impossible to restore the body to a condition exactly like it was prior to the weight gain.

Many weight loss patients still attend peer support groups and are in contact with Nutritionists, Therapists or other professional counselors. We encourage our patients to notify their professional “support systems” that they are considering surgery, as they will face both physical and psychological stressors around the time of body contouring surgery.

All individuals with a history of anxiety or depression are warned that having Plastic Surgery can prompt a “flare up” of their symptoms, and that continuing their antidepressant medication and/or psychological counseling is particularly important around the time of post-weight loss surgery.

Please visit our Preparing for Surgery section to learn more about intelligent planning for body contouring surgery and the concept of recruiting supportive individuals to be your “postoperative recovery team”. We are proud of our weight loss patients who have achieved such an important, life-changing milestone, and we strive to help them achieve their aesthetic goals in the smartest and safest way possible.

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What Are the Options for Body Contouring after Massive Weight Loss?

Body contouring after massive weight loss can include lifting and sculpting the breasts or chest, the torso, thighs, buttocks and arms. The principle of body contouring surgery after weight loss is not just removing excess skin, but reshaping, “redraping” and sculpting the remaining tissue with an aesthetic eye and surgical experience to create the most attractive contour possible.

In general, only one or occasionally two areas of the body are addressed at each surgery. “Staging” procedures in sequence enables complete healing and full physical and emotional recovery before considering the next procedure. Waiting 6-12 months between surgeries is usually recommended for absolute safety. Please see our Preparing for Surgery section to learn about becoming an optimal surgical candidate, and our Postoperative Instructions section to become fully educated about potential risks and complications of post-weight loss surgery.

Breast or Chest Surgery after Weight Loss

Possible procedures to rejuvenate the breasts in women following significant weight loss include Breast Reduction, Breast Lift (Mastopexy), Breast Augmentation and occasionally Combined Mastopexy and Augmentation.

Men often seek Male Breast Reduction (Gynecomastia) surgery to improve the contour of their chest. Please visit each of these sections to learn more about each procedure.

Vertical Abdominoplasty

A special technique of abdominoplasty (“tummy tuck”) is usually indicated following significant weight loss. A Vertical Abdominoplasty removes excess hanging skin in the lower abdominal region, creating scars in both the horizontal and vertical dimensions and decreasing waist diameter circumferentially by “corseting” the muscles of the anterior abdominal wall back together in the midline. Visit our section on Abdominoplasty for more information about this procedure.

Lower Body Lift

Also known as a “Belt Lipectomy” or “Circumferential Abdominoplasty”, a lower body lift procedure makes incisions all the way around the torso in a belt-like distribution. Redundant skin and fat is removed below the incision to contour the abdomen, hips, outer thighs, back of the thighs and the buttocks. The inner thighs are not addressed by a lower body lift; a separate inner thigh lift is usually done in a separate procedure.

In the front, as for a regular abdominoplasty, the muscles of the abdominal wall are tightened back together in the midline, reconstituting the musculature and ergonomics of the abdominal “core”. A generous portion of skin and underlying tissues are removed, creating the effect an Outer Thigh Lift in addition to a Buttock Lift. A lower body lift is usually performed alone due to the length of surgery (4-6 hours) and the extensive nature of this procedure, and a 1-2 nights’ hospital stay is advised.

Medial Thigh Lift

A “Medial” (Inner) Thigh Lift removes excess skin and fat from the upper, inner thighs, creating smoother, lifted inner thigh skin and better-proportioned contours of the thighs. The incision can be either transverse (as for the TUG flap used in breast reconstruction), or can be oriented vertically, extending from the groin down the inner thigh to the knee. The direction of the incision depends on the amount of excess skin and fat and the associated need to redrape tissue circumferentially around the thigh in addition versus only lifting the inner thigh in an upward direction. At least an overnight stay after a medial thigh lift is recommended.

A medial thigh lift usually lifts just the inner thighs, whereas a lower body lift also addresses the outer and “posterior” (back part) of the thighs. From a wound healing and blood supply perspective, it is not safe to perform a medial thigh lift and a lower body lift at the same time. If both a lower body lift and a medial thigh lift are planned, at least 6-12 months are needed between these procedures to allow healing from one region before the next is addressed.

Arm Lift (Brachioplasty)

Massive weight loss, aging, and occasionally heredity can create sagging upper arms. An arm lift, also called Brachioplasty or “Bat Wing Surgery” is a technique that lifts and tightens the arms by removing extra skin and fat from the upper and inner part of the arms. Brachioplasty reshapes the arms, resulting in a smoother and more proportional contour and enabling underlying muscle definition to be more visible.

During an arm lift, an incision is made in the armpit, extending downwards in the inner (“medial”) aspect of the arm toward the elbow. Depending on the amount of excess skin to be removed, the scar may extend all the way to the elbow, or may be slightly shorter. Scar length is dictated by the amount of skin and fat to be removed.

The forearm is not addressed by a brachioplasty. Occasionally, Liposuction is also added to an arm lift if additional de-bulking of the upper arm is needed. Performed alone, a brachioplasty can be done as an outpatient procedure. If combined with another procedure, an overnight stay is usually recommended.

Special compression sleeves are worn for 6 weeks postoperatively to encourage smooth skin redraping to promote postoperative comfort and limit swelling. Following arm lift surgery, many patients feel more comfortable exercising and wearing short-sleeved shirts.

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What Really Happens During Post-Weight Loss Surgery?

Please see our Preparing for Surgery section to learn about what happens in the operating room on the day of surgery. Surgery can take three or more hours to complete, and at least an overnight stay is usually recommended.

Individual factors and personal preferences will determine the specific technique selected for your body contouring procedure. Please see the appropriate specific sections to learn more about what happens in the operating room for each procedure you are considering.

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Is Liposuction Part of Post-Weight Loss Body Contouring Procedures?

Liposuction is occasionally added to post-weight loss body contouring procedures to help contour persistent areas of stubborn fat deposition, but only after an optimal weight has been achieved and has been stable for at least a full year. Liposuction alone will not address excess skin or stretch marks, and will not help to tighten skin tone.

Post-weight loss surgery can be combined with liposuction if appropriate, but is not an alternative to weight loss and should be postponed if additional weight loss is planned for the best possible results. Your surgeon will examine you to determine whether liposuction is an appropriate addition to your procedure. Please see our Liposuction section for more information.

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What is the Recovery After Post-Weight Loss Surgery?

Some moderate discomfort and swelling is expected for a few days following post-weight loss contouring surgery. You will be given oral pain medication as needed for a week or two postoperatively. Short walks and deep breathing exercises are encouraged immediately after surgery to promote circulation in the legs and lungs. You will likely wake up wearing a soft postoperative compression garment that is recommended to be worn “23 hours a day” for at least 6 weeks postoperatively. Please see our Postoperative Instructions section for additional information about recovery from body contouring surgery.

Drains are nearly always inserted after post-weight loss surgery, as more fluid is generated after massive weight loss surgery than in average weight individuals. For any procedure, numbness, bruising and overall tiredness is common for 3-6 weeks after surgery. It can take 3 months up to a year for All surgical swelling to subside and for the very final results of body contouring surgery to be evident.

Any type of post-weight loss body contouring procedure is a major operation and has significant downtime and recovery. At least 6 weeks off exercise and heavy activities that raise the heart rate or blood pressure (including carrying children and pets) is recommended. You will need to enlist help with some activities during the immediate postoperative period. Please see our Preparing for Surgery section to learn more about preparing for your body contouring surgery.

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Will my Post-Weight Loss Surgery be Covered by Insurance?

Most body contouring procedures are generally considered to be cosmetic and are not covered by insurance. Our Patient Coordinator Mary will speak with you in detail after your consultation about estimated fees.

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What Are Potential Risks and Complications of Post-Weight Loss Surgery?

When you are considering any type of surgery, you should be fully educated about potential risks and complications. Please see our Preparing for Surgery section to learn about risks and potential complications related to surgery in general and Postoperative Instructions for additional information pertaining to post-weight loss body contouring.

Specifically for massive weight loss patients, the risk of complications such as wound healing problems, wound infection and seroma formation is significantly higher than average. For this reason, it is best to Wait to pursue any body contouring surgery after significant weight loss until your weight has been stable for at least one year, you have been medically cleared by your Primary Care Physician, and your overall health is at its absolute prime.

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Please click here to see before and after post-weight loss surgery results!

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As women Plastic Surgeons, we intimately understand how an individual’s feelings about their bodies can influence their self-image and self-esteem. At your post-weight loss surgery consultation, your surgeon will spend a great deal of time with you to get to know you personally and take a complete medical history. We will explore your reasons for seeking surgery, examine you, and if you are an appropriate candidate for surgery, your options will be described in detail.

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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA