Body contouring procedures for female MWL (massive weight loss) patients involve unique challenges due to the sizable redundant skin that leads not just to poor body proportions but also to skin breakdown, non-healing irritation, and limited mobility.
The redundant skin which develops after significant weight loss—i.e., 100 lbs. or more—generally affects the waistline, upper arms, thighs, buttocks, and breasts. For this reason, MWL patients may have to accept longer, more visible scars just to achieve a near normal body proportion.
The list below shows the most common body contouring procedures for female MWL patients, as explained by experts at the renowned California Surgical Institute.
* Extensive tummy tuck. Instead of the usual hip-to-hip incision, MWL patients will need a longer scar that extends to their lower back to address both the frontal abdomen and flanks.
Almost all MWL patients will also require some type of muscle repair; this is accomplished by suturing the pair of abdominal muscles into the midline. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says in his Snapchat video that he prefers permanent sutures to absorbable stitches due to their additional support, which counteracts the effects of inadvertent [mild to moderate] weight gain and even pregnancy.
* Lower body lift. In essence, it combines three surgeries—e.g., tummy tuck, outer thigh lift, and buttock lift—in one operation with its incision that covers the entire circumference of the lower torso. Due to its high invasiveness, not every MWL patient is a good candidate and may have to stage each procedure to minimize bleeding and surgical trauma.
* Some type of breast surgery. Women who lost a significant amount of weight typically end up with flaccid breasts whose upper pole lacks volume, further contributing to the unflattering shape. For this reason, they typically require breast lift, which may be combined with breast reduction should they want to “downsize,” or implants in the event that they want additional volume especially in the upper cleavage.
* Back lift. The skin in the back is susceptible to sagging in the event of significant weight loss. Basically, there are two ways to address this problem: a horizontal incision where the “bra band” lies across, or a bilateral scar below the armpit that travels down toward the flanks.
* Arm lift. MWL patients will typically need an armpit-to-elbow incision that is placed in a more posterior manner, as opposed to the “inside” of the arm. While the posterior scar is more visible, it allows the surgeons to remove more redundant skin and minimize the tension on the wound, leading to more favorable scarring.
Sleeve gastric surgery is believed to be one of the safest weight loss surgeries since it does not leave foreign object or implant in the body nor involve rerouting or changing stomach openings.
Due to the technique’s impressive safety profile, renowned Beverly Hills surgeon Dr. Tarick Smiley prefers this technique to other weight loss surgeries.
In his recent Snapchat video, Dr. Smiley says sleeve gastric surgery can reduce the size of the stomach by around 60 percent, making this an effective tool in controlling hunger without causing the same side effects of malabsorptive-type weight loss surgery.
Despite the benefits of sleeve gastric surgery, its long-term results will still primarily depend on the person’s commitment to lead a healthier lifestyle—i.e., proper diet (three small meals that are low in carb and high in protein everyday) and regular exercise. For this reason, the real challenge is identifying patients who can stick to their weight management program.
Studies have suggested that sleeve gastric surgery removes the part of the stomach that releases most of the hunger-producing hormone called ghrelin, leading to its high success rate. Medical evidence shows that patients lose 45-64 percent of their excess body weight just a year after surgery.
Because of the lower complication rate of “sleeves” compared with other weight loss surgeries, Dr. Smiley says it is suitable for individuals who have risk factors such as osteoporosis, anemia, and complex medical conditions.
Unlike malabsorptive weight loss surgeries (e.g., gastric bypass) in which the intestine is shortened, during a sleeve procedure the openings are left intact and the normal functions of digestion are mostly preserved. For this reason, there is a lower risk of malnutrition and its subsequent complications such as anemia and osteoporosis.
While the procedure is irreversible, the significantly reduced stomach may expand over time with poor diet, hence leading to gain weight. For this reason its success greatly lies in the patient’s determination to stick to healthy lifestyle long term; this is possible through support from his/her family, friends, and doctors.
Behavioral therapy may also help in preventing weight gain recurrence by changing how the patients’ think about themselves and to help them identify the environments and circumstances that are linked to their unhealthy eating and other poor lifestyle choices.
Obese patients who have sleeve gastric surgery and other weight loss surgeries are less likely to die from cancer, diabetes, heart diseases, and other obesity-related medical conditions than those who forego the procedure, as suggested by several studies.
Thigh lift after weight loss in general deals with more redundant skin and excess fat. And while it can deliver a significant amount of improvement, it is important to note that massive weight loss patients may not achieve the same tight appearance seen in individuals with good skin elasticity.
Depending on the location of excess skin, thigh lift may involve incisions along the inner thigh and/or near the hipbone that may be extended into the buttocks area for additional contouring.
To help determine the most ideal scar location, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says he advises his patients to bring along their favorite bathing suit during consultation. While all efforts are used to “hide” the incisions beneath the bikini area, individuals who need extensive correction may have to accept more visible and longer scars.
The surgeon’s experience will play a crucial role in the success of thigh lift after weight loss. There is a fine line between removing too much skin and fat and excising too little, says Dr. Smiley. The goal is to preserve the full range of motion of the legs but at the same time create a more toned and defined appearance.
Aside from removing just the right amount of skin and fat, Dr. Smiley says proper wound closure is also critical to achieve good results. One of his goals is to reduce the tension on the skin, which is done by suturing the deeper levels of the tissue tighter than the layers near the surface.
With no or very little tension on the skin, it results in thinner scars that blend with the surrounding skin.
While some MWL patients may have other surgeries at the same time as their thigh lift, most doctors recommend staging each procedure to minimize the surgical trauma, bleeding, and other risk of complications. This is particularly true for individuals who are asking for tummy tuck as well.
The hip-to-hip incision used in tummy tuck elevates the sagging pubis mons; however, the opposing tension between this procedure and the thigh lift could lead to wound breakdown and poor healing, warns Dr. Smiley.
For most patients, thigh lift recovery is about three weeks, meaning all strenuous activities must be avoided at this stage to prevent wound healing problems.
Exercise after plastic surgery — When is the ideal time to resume one’s normal routine, including sports and other physical activities?
It is important not to rush one’s recovery. It is critical to avoid high level of stress, vigorous exercises, and other activities that can lead to increased heart rate and spike up one’s blood pressure in the first few weeks after surgery to avoid persistent swelling, bleeding, and other factors that are linked to poor/prolonged healing.
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Some patients can resume all their normal activities after three weeks, while others are instructed to avoid vigorous exercise for up to two months. According to California Surgical Institute website, there are several factors that determine the ideal time to resume one’s normal routine.
Minimally invasive surgeries such as liposuction and minor scar revision typically have short downtime and less physical restriction.
Meanwhile, a more involved surgery such as tummy tuck with muscle repair, breast reduction/reconstruction, and full facelift may entail up to 6-8 weeks of complete cessation from strenuous activities.
Despite some “physical restriction” during the healing stage, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says light exercise plays a crucial role in the healing process. He often instructs his patients to take 2-5 short walks throughout the day to promote good circulation, which in turn leads to a myriad of benefits such as well-controlled swelling and reduced risk of blood clots and constipation (and other side effects of narcotic pain meds).
Light exercises, he says, can also prevent or at least minimize lethargy, which is caused by narcotics and other postop medications and the natural healing process. Depending on the type of surgery and the patients’ level of physical fitness prior to surgery, some can regain their normal energy levels at six weeks, while others may have to wait up to two months, he adds.
Rhinoplasty, or nose job in layman’s term, requires a stricter and prolonged physical restriction. The idea is to give the bone and cartilage grafts sufficient time to heal without any disturbance, thus contact sports such as hockey, basketball, and football are best avoided for up to six months.
Because the postop instructions differ from surgeon to surgeon, Dr. Smiley says the patient must stick to his doctor’s specific recommendations to achieve optimal results from plastic surgery and to minimize risk of complications.
Body contouring surgery is a broad term for plastic surgery procedure that eliminates the excess skin and/or fat, which does not respond to further weight loss, diet, and exercise. Tummy tuck, liposuction, arm lift, and buttock lift are the most common examples, says Dr. Tarick Smaili who is the medical director of the prestigious California Surgical Institute.
To achieve optimal results, body contouring surgery is generally reserved for normal weight patients who understand the importance of healthy lifestyle.
Meanwhile, anyone who expects significant weight changes will have to wait until he reaches his or her ideal body mass index.
The list below explains the most popular body contouring surgeries.
Also referred to as abdominoplasty, the procedure typically results in a hip-to-hip scar to remove the apron-like skin and excess fat. But for additional contouring, some patients, particularly women, will have their abdominal muscle reshaped and tightened as well by internal sutures.
Internal sutures are important to maintain the planned shape and minimize the impact of “inadvertent” weight gain or pregnancy.
While the procedure removes the excess fat, it is only the superficial fat beneath the skin. For this reason, it is not a treatment for obesity, which is caused by excess visceral fats that are stored around “important” internal organs such as the intestines, liver, and pancreas.
The visceral fats are more metabolically active than superficial fats, thus in the event of weight loss they are the first to go. Some superficial fats, meanwhile, are more “stubborn” that they are difficult, if not impossible, to eliminate through regular exercise and proper diet alone.
In essence, a lower body lift encompasses three procedures performed in one surgical setup: buttock lift, outer thigh lift, and tummy tuck. With combo procedures, patients may enjoy potential savings and one recovery time.
The vast majority of lower body lift is performed in massive weight loss patients due to the severity of their redundant skin and sagging tissue.
While it comes in different scar variations, a good surgeon will make every effort to place them within the armpit and/or on the inner arm to hide the scars. For additional contouring, some patients may need liposuction as well.
While the standard technique results in a horizontal scar across where the bra band lies, some patients who have lateral fat rolls might be more suitable for the vertical incision technique in which the scar starts below the armpit down to the hip.
The type of anesthesia for plastic surgery differs from patient to patient, although general anesthesia is the most commonly used modality as it put a person to a “deep” sleep to prevent anxiety or even the slightest amount of pain.
General anesthesia is particularly ideal during multiple surgeries, which are common in mommy makeover procedures and plastic surgery after weight loss, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smaili.
Aside from general anesthesia, there are other three types of anesthetics such as:
- Local anesthesia. As its name indicates, it can numb a localized area without causing the patient to lose consciousness, as opposed to general anesthesia.
Less invasive form of plastic surgery such as mini lift, mini tummy tuck, and liposuction may use local anesthesia combined with sedation for an additional comfort. With this approach, a patient will not experience nausea, extreme fatigue, lethargy, vomiting and other common side effects of general anesthesia.
General anesthesia, despite being the most preferred choice in plastic surgery, results in longer recovery compared with local anesthesia.
- Intravenous sedation. Also referred to as “twilight,” it is commonly used in conjunction with local anesthesia. Aside from preventing pain and anxiety, it also causes the patients to feel very sleepy.
- Regional anesthesia. By injecting it into larger nerves, a wider surface area feels numb. Should the surgeon use this modality, oftentimes it is combined with sedation for an additional comfort.
If the surgery will involve board-certified anesthesiologists, it could lead to higher fees, as opposed to non-certified anesthesiologists or nurse anesthetists. However, a prudent patient should not skimp on this aspect.
First and foremost, a board-certified anesthesiologist is a physician who has gone through medical school and has completed his internship and residency training program before obtaining his certification from the American Board of Anesthesiology.
Board certification is only obtained when an anesthesiologist has met the strict requirements and has passed the rigorous oral and written exams of ABA.
Nurse anesthetist, meanwhile, is a nurse with extra training in anesthesiology. Oftentimes, they work under the supervision of a board-certified anesthesiologist.
Simply put, board-certified anesthesiologists have a higher level of training, which is an important safety issue any patient should be made aware of.
To further make surgery safer, a prudent patient must also verify his plastic surgeon’s board certification/s and/or plastic surgery affiliates. The general rule of thumb is to select a doctor who is a member of the American Board of Plastic Surgery.