Panniculectomy with liposuction can produce dramatic contouring effects by removing the apron of skin and tissue that hangs from the abdomen, and suctioning the excess fat. This “combo” approach is often reserved for massive weight loss patients with large redundant skin and “stubborn” fat rolls, which do not lend themselves to diet and exercise.
(Note: Tummy tuck and panniculectomy are almost the same, except that the latter entails a larger skin removal, which MWL patients require to achieve near normal appearance.)
Before and After Photos
In a recent Snapchat video post, leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated panniculectomy with liposuction performed in a female patient with large rolls of skin in her anterior abdomen and fat rolls along her flanks and lower back.
Dr. Smiley first performed liposuction in which the fatty areas were injected with tumescent fluids, which caused the fat cells to expand and thus easier to be removed with a cannula (hollowed stainless steel tube attached to a vacuum pump).
Afterwards, Dr. Smiley created a curved flank-to-flank incision pattern to remove the hanging apron of skin and fat. He positioned the scar lower than the standard approach (i.e., a few centimeters below the pubic hairline) because the patient also needed a pubis lift.
Dr. Smiley said that following massive weight loss, the mons pubis tends to sag and/or appear noticeably full, which could prevent MWL patients to wear tight leggings out of embarrassment.
After removing the apron-like skin, which was about 2 ½ inches thick, Dr. Smiley slightly lifted the mons pubis so it would not detract from the flatter, smoother abdomen.
Afterwards, the celebrity plastic surgeon closed the incisions in a way that the resulting curved scar was positioned underneath the patient’s underwear. With meticulous suturing technique (no tension on the skin) and proper postop care, the scar is expected to fade into a thin white line after about a year.
With more than one-third of the US adult population considered obese, over the recent years there has been an upsurge on the number of bariatric or weight loss surgery. While this a life-saving procedure, some patients remain dissatisfied with their appearance due to their large redundant skin and hanging fats that no longer respond to further diet and exercise.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says thigh lift is one of the most common requests of massive weight loss (MWL) patients, citing a survey showing that about 4,800 patients underwent the procedure last year alone.
This is an incision pattern used in outer thigh lift surgery.
According to a 2016 survey released by the American Society of Plastic Surgeons, about 55,200 MWL patients had some type of body contouring surgery.
Dr. Smiley says that post-MWL thigh lift is often just a component of a series of body contouring surgery due to the natural distribution of redundant skin that also affects the abdomen, buttocks, breasts, and upper arms. Oftentimes, the patients also develop a varying degree of sagging neck and jowl, he adds.
Meanwhile, he explains some surprising thigh lift facts:
- All efforts are made to hide the scar within the natural skin fold—e.g., groin and gluteal fold.
While a good surgeon will make every effort to create incision patterns in which the resulting scar runs within the natural skin fold, the scar length will still depend on the extent and location of loose skin. Hence, inner thigh lift for MWL patients entails a vertical scar on the inside of their leg that may even reach their knee.
- Outer thigh lift is often a component of lower body lift.
As a stand-alone procedure, outer thigh lift uses an oblique incision between the top of the leg and hip, resulting in a V-shaped scar pattern. But due to the natural diffusion of excess skin, occasionally the incision is extended across the circumference of the torso, leading to a belt-like scar.
With a lower body lift, the outer thigh, hips, anterior abdomen, and buttocks are simultaneously lifted and their contours improved.
- Most patients described their recovery after medial thigh lift “tough.”
Due to gravity and persistent swelling, the medial thigh lift incisions are susceptible to wound breakdown. In fact, it is not uncommon to have small separations in the incision, which mostly do not require a surgical closure although they can result in additional healing time.
In general, it takes three weeks for most patients to be able to return to work and another 3-4 weeks before they can gradually start doing more rigorous activities.
- Medial thigh lift is best performed separately from tummy tuck.
Tummy tuck often elevates the sagging mons pubis, while the inner thigh lift pulls down the skin to improve the contour of the leg. Due to the opposing tension, it is often ideal to perform them separately.
Thigh lift after massive weight loss is typically beyond cosmetic improvement. A good number of patients also seek the procedure to find relief from non-healing skin irritation and tissue breakdown caused by the redundant skin rubbing each other every time they walk and move around.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that thigh lift after massive weight loss is commonly combined with tummy tuck and buttock lift. By simply extending the hip-to-hip incision of tummy tuck around the entire waistline, surgeons can reshape the outer thigh, anterior abdomen, and buttocks all at the same time.
Despite the contouring effects of the aforementioned technique (which is referred to as 360 degree lower body lift), patients with healing problems and other “risk factors” may have to stage their surgery to minimize risk of complications.
This is the typical incision pattern used in outer thigh lift surgery.
As a stand-alone procedure, the incision pattern used in thigh lift will depend on the location and the extent of redundant skin. For instance, the outer thigh requires an incision starting from the hip down to the groin and so the resulting scar lies precisely at the “panty line.”
Meanwhile, the inner or medial thigh lift requires incisions starting from the groin down to the knee and so the resulting scar is on the inner aspect of the thigh.
This is the actual scar resulting from a medial or inner thigh lift surgery.
Compared to other body contouring procedures, recovery from thigh lift is generally “tougher” because of the increased swelling due to gravity and the full weight of the legs. Hence, the first two weeks are the most critical period, requiring the patient to be extra cautious when moving.
The patient must move carefully and slowly to avoid pulling on the incisions. It is important to note that wound dehiscence (reopening) requires longer time to heal.
After two weeks, most patients can slowly increase their activity without causing an elevated heart rate. Over-exertion must be avoided for an additional 4-5 weeks to prevent more swelling and healing problems.
Most patients are advised to take 3-4 weeks off so they can focus on their recovery. Furthermore, protein supplements along with superb diet (more fresh fruits and vegetables and whole grains, while avoiding too much fats and sodium) can help patients improve their healing.
Oftentimes, thigh lift after massive weight loss is followed by other body contouring surgeries such as tummy tuck, arm lift, or back lift.
Male body contouring surgery can range from liposuction, breast reduction, to tummy tuck and other types of body lift following massive weight loss. While the goal is to achieve a more masculine physique, which possesses fundamental traits as suggested by several studies, the results will still depend on the patient’s “starting” anatomy.
Renowned Beverly Hills plastic surgeon Dr. Tarick Smiley, who regularly posts educational videos on Snapchat tackling the issue of male body contouring surgery, has provided a list of the most popular procedures and the corresponding ways to achieve gender-appropriate results.
- Liposuction —i.e., body contouring surgery in which the unwanted fat beneath the skin is removed with a hollowed tube
Unlike women who generally seek liposuction to appear more slender, men are more interested in looking more toned. Hence, male patients require less fat reduction.
Male liposuction typically entails a small amount of fat removal just to “reveal” the underlying muscle (like the appearance of six pack abs).
About 27,760 male breast reductions were performed in 2016, according to a survey released by the American Board of Plastic Surgery.
Gynecomastia, a condition in which the male breasts appear overdeveloped, affects up to 60 percent of men although in the vast majority of cases it disappears after puberty (or when the hormonal levels stabilize) or after cessation from drugs causing the woman-like breasts.
But for men whose enlarged breasts that persist longer than two years and even after the elimination of “possible contributing factors” (e.g., obesity, hormonal imbalance, drug, and medical condition), surgery might be a good option provided they are healthy.
All male tummy tuck patients have lost a significant amount of weight, leading to the redundant skin that may not just affect the abdomen, but also the flanks and back. Therefore, they typically require longer incisions, which of course lead to longer scars.
Tummy tuck not just removes the apron-like skin; if needed, the surgery may also involve muscle repair in which the pair of muscle extending from the breastbone to the pubic region is tightened in the midline.
Due to the natural diffusion of redundant skin and tissue laxity that commonly follows drastic weight loss, most tummy tuck patients also need arm lift, buttock lift, and lower body lift for a more proportionate result.
While body contouring can help patients achieve a more masculine physique—which is generally defined as an inverted triangle torso as it tapers from the shoulders to the waist—it is important to note that their underlying anatomies will still have a large effect on the final results.
Therefore, the right candidates for male body contouring surgery must be able to explain their “realistic” goals in details to their surgeons.
Most people battling obesity for many years think that weight loss [bariatric] surgery is the only solution to their problem. However, they may not realize that lifestyle changes, full commitment and grit, guidance from experts, and community support will also play a critical role in their lifelong journey towards being healthy.
Plastic surgery, such as circumferential body lift surgery and tummy tuck, is also a critical part of their weight loss journey. After massive weight loss, redundant skin and tissue laxity affect the thighs, upper arms, abdomen, hips, back, buttocks, and breasts.
Surveys have suggested that body contouring after massive weight loss is one of the fastest growing fields in plastic surgery due to the growing number of patients seeking bariatric surgeries. Furthermore, researchers have found that it can substantially improve the patients’ quality of life and body image.
And with improved body image, patients will have a stronger motivation to stick to healthier lifestyle and ultimately preserve the results of body contouring surgeries.
“The excess skin not just prevents MWL patients from fitting better in their clothes. It can also result in skin irritation, pain, foul odor, and discomfort,” said leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
One of the most powerful plastic surgery techniques for MWL patients is circumferential body lift, which basically combines tummy tuck, outer thigh lift, and buttock lift. Hence, the resulting scar can stretch across the lower abdomen, hips, and upper buttocks.
Incisions are made to remove crescent-shaped segments of skin and some excess fat from the buttocks, outer thigh, and abdominal areas. If needed, the pair of abdominal muscle, which extends below the breastbone and to the area just above the pubic region, is tightened with internal sutures at the same time.
The remaining skin is then tightened and redraped to the new contour. Afterwards, dressings are applied and drains are put in place to prevent seroma or fluid buildup. To further control swelling and promote healing, firm elastic bandages or compression garments are used to support the area.
Since circumferential body lift surgery is basically a multiple surgeries operation, it entails a “tough” recovery. Meanwhile, most patients are back on their feet 2-3 weeks after surgery, although they should still avoid strenuous activities and heavy lifting for another 3-4 weeks to prevent healing problems.
The axillary lift is a type of body lift commonly performed in massive weight loss patients. This procedure deals with the redundant skin and fat along the armpit, which not only causes unsightly bulges but also poor odor, skin rashes, and non-healing irritation.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated the axillary lift on his Snapcat account. He performed the surgery in a female patient who had lost a lot of weight and so she was left with redundant skin.
The celebrity surgeon created a wedge-shaped incision covering the armpit and the lateral chest, thus allowing him to remove a large amount of skin and fat. The wound was then closed in a way that the resulting scar would lie parallel to the transverse armpit fold.
Dr. Smiley says it is of critical importance to remove just the right amount of redundant skin to allow for proper wound closure and to prevent limited activities of the arm.
“We should strike the perfect balance between creating a tighter, smoother armpit area and avoiding too much tension, which happens after an over-aggressive skin resection,” says Dr. Smiley.
Hence, he highlights the importance of the surgeon’s experience and “eye for details” when performing any type of body contouring surgery after weight loss.
The resulting scar from the axillary lift could migrate or appear conspicuous if there is too much tension on skin. For this reason, Dr. Smiley always closes the wound in several rows so the tension on the superficial layer is mitigated, which also allows for good healing.
To further promote favorable scars, he recommends silicone sheets and gels as they hydrate the skin. Wound that heals in a moist environment is known to fade better.
Occasionally, the axillary lift is combined with other body contouring surgeries such as brachioplasty (arm lift), arm liposuction, and even breast surgery, says Dr. Smiley.