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.
Butt lift surgery (should not to be confused with Brazilian butt lift, which in essence is buttock augmentation via fat transfer) is typically performed in massive weight loss patients who often complain about the redundant skin.
Most buttock lift risks can be avoided or at least reduced with proper patient selection. The goal is to reserve this elective surgery only to people who have achieved their optimal health and weight.
Lab screening and lengthy consultation between the surgeon and his patient will help determine if the latter is healthy enough to handle surgery, according to the California Surgical Institute website.
Patient cooperation is another key factor to minimize butt lift risks. For instance, infection, increased bleeding, and poor healing are closely linked to smoking, aspirin and other drugs and supplements with blood thinning properties, and obesity—risk factors that can be eliminated by the patients’ themselves.
A good rule of thumb is to discontinue smoking and aspirin products at least three weeks before and after surgery.
Wound healing problem is one of the main issues during recovery. It is important to note that the incisions—whether made within the junction of the butt cheek and posterior thigh, or near the waistline if the surgery is combined with a lower body lift—are under a great deal of stress due to movement while walking, sitting, etc.
To reduce risk of wound healing problems, great surgeons know the importance of proper suturing techniques in which there is no or very little tension on the skin. For this reason, layers of sutures in which the deep tissue receives most of the tension are critical to promote good healing and scarring.
Nonetheless, patients should also do their part in reducing healing problems by avoiding over-exertion for a minimum of three weeks postop. For this reason, individuals whose work requires heavy lifting or any type of rigorous activity are advised to take a longer time off than people with desk job.
Unacceptable scarring (i.e., keloids or thick scars) is another risk, although this can be avoided with meticulous wound closure, wound care, and proactive scar treatments like silicone tapes and gel and sunscreen. Nonetheless, genetics remains one of the strongest predictors of how well a person will scar.
A circumferential body lift, also known as lower body lift, removes the redundant skin and fat around the frontal abdomen, hips, and back, resulting in a belt-shaped scar that is generally concealed by the patient’s underwear, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Circumferential body lift is almost always performed after massive weight loss and basically combines three major surgeries, namely, tummy tuck, outer thigh lift, and buttock lift. For this reason, it is only reserved for healthy patients with no healing problems.
While most patients having some type of body lift already know the basic preparations—e.g., 8-10 hour fasting prior to the operation, eating healthy, reaching the ideal weight, avoiding tobacco products and drugs with blood thinning properties (aspirin and ibuprofen)—they may not be aware of some seemingly trivial details explained below.
Due to the invasive nature of circumferential body lift, the amount of bleeding might be an issue. For this reason, some patients may need blood transfusion during surgery; however, in the ideal scenario they can donate blood at least four weeks ahead of time and have it stored in case they need it.
- Some natural remedies can affect healing
Some natural remedies and herbal supplements not just affect healing or increase bleeding, but may also may interact with anesthesia and painkillers. Furthermore, their effects are still widely unknown and so a good rule of thumb is to avoid them altogether at least 2-3 weeks before surgery and about a week afterward.
- Caregivers are life-savers
In the first few weeks postop, the patient should only focus on her recovery. Everything else—e.g., childcare, house chores, and office work—are put on the sidelines.
A good rule of thumb is to line up two or more caregivers, who can help the patient get around during recovery.
Loose soft clothes (button down shirt and loose-fitting pants) that are easy to put on and take off are important during recovery especially when the patient is made to wear compression garments and surgical drains.
- Ask for the surgeon’s shopping list
Most surgeons will provide a shopping list that typically includes painkillers, compression garments, scar creams, and even healthy snacks and drinks to help their patients plan their recovery well ahead of their surgery.
Body contouring plastic surgery is a broad term used to describe any techniques employed by surgeons to improve areas of the body that have redundant skin and sagging appearance, which commonly occur after massive weight loss and pregnancy. Meanwhile, the aging process can also contribute to tissue laxity.
Body contouring after massive weight loss almost always entails skin removal. Good examples include arm lift, tummy tuck, lower body lift, and thigh lift. The vast majority of MWL female patients also warrant some type of breast enhancement—e.g., breast reduction and/or breast lift.
Tummy tuck is arguably the most powerful tool in body contouring for MWL patients, according to the Inland Empire Plastic Surgery Institute. It removes the excess skin and fat between the navel and the pubic “hairline,” before redraping the skin in the upper abdomen to close the hip-to-hip incision.
All efforts are made to place the hip-to-hip scar very low so it remains concealed by the patient’s underwear. But for massive weight loss patients, the scar might be extended to their flanks or even around their entire torso, a technique referred to as lower body lift or circumferential lift.
A lower body lift basically combines tummy tuck, outer thigh lift, and buttock lift.
Meanwhile, body contouring plastic surgery also encompasses procedures to reverse the effects of pregnancy. Common examples include tummy tuck, breast augmentation, breast lift, and abdominal liposuction, which can help patients regain their pre-pregnancy body.
Whether liposuction is performed in MWL patients or individuals who have always managed a healthy weight but nonetheless have “stubborn” fat, skin elasticity—how much shrinkage it can allow—will determine the ideal amount of removed fat. Furthermore, it is important to preserve a thin layer of fat beneath the skin to avoid surface irregularities.
Implants are also used in body contouring plastic surgery. Their main objective is to increase volume of the “target” area, which could be the female breast, male chest, calf, and bicep.
Male patients who seek body implant surgery typically want to emphasize bulk; hence, a good number of them are body-builders. (Note: Some men do not have the muscle type that allows them to develop their calf, chest, or bicep muscle with weight lifting and other rigorous exercise routine, making them good candidates for implants.)
Women, meanwhile, generally seek body implants to improve their proportions. As a result they typically seek breast and buttock implants—two synthetic prostheses that can deliver a more feminine silhouette.
Body lift after extreme weight loss entails advance planning to produce optimal results and prevent or at least minimize risk of complications. The goal is to achieve one’s optimum health and weight before any body contouring surgery is attempted, as suggested by celebrity Los Angeles plastic surgeon Dr. Tarick Smiley.
Dr. Smiley explains the most favorable “schedule” for body lift after extreme weight loss.
* Your weight has been stable for at least six months, although it would be better if you’re able to manage it for about a year or two—a strong proof that you can stick to a healthy lifestyle, which is the key to maintain the surgery’s results.
Aside from being near your ideal weight, it is also critical that no further [significant] weight loss is expected. The idea is to let your skin shrink to the best of its ability before attempting any body contouring surgery.
* Wait until you have achieved your optimal health. It is important to note that massive weight loss patients often have some type of malnutrition (anemia, muscle loss, and dehydration) because of their lower calorie diet. For this reason, even if you have already achieved your ideal weight you may still have to postpone your surgery until your body has adapt to your “new lifestyle.”
* Cooler weather, i.e., December through March, is generally perceived to be an ideal time to undergo most type of plastic surgery as it allows for bulkier clothing—e.g., thick trousers and sweaters—to hide obvious or sudden changes in your body. This is particularly true for anyone getting lower body lift, breast reduction, and tummy tuck.
Furthermore, cooler weather typically coincides with long holidays, allowing the patient to enjoy more time off.
* You are emotionally and psychologically prepared. Expect some postop blues, lethargy, excitement, feeling of doubt, resolution—pretty much mixed emotions—during the initial healing stage. Take note that having supportive family and friends can make the recovery less nerve-racking.
* You have time to recuperate. Rushing one’s recovery can have a detrimental effect on your healing. A good rule of thumb is to take at least a three-week off, avoid strenuous activities for about a month, and to expect lethargy to a varying degree for 6-8 weeks.
To avoid too much stress, you may ask to work part time or telecommute until you regain your preoperative energy level.