Body contouring after weight loss, according to studies, not just results in improved appearance but also serves as a long-term weight management solution for the “right” patients who understand the importance of healthy lifestyle.
A study which followed gastric banding surgery patients for 15 years has shown that those who opted for body contouring after weight loss had an average BMI of 24.6 versus 31 in those who did not based on a follow-up visit.
According to the Centers for Disease Control and Prevention websites, BMI is an individual’s weight in kilograms divided by the square of height in meters. The normal, healthy range is between 18.5 and 24.9; if lower or higher than this amount the person is considered underweight or overweight, respectively.
Meanwhile, a BMI of 30 and above is considered obese. A recent study has suggested that about a third of US adults are battling obesity, one of the highest in the world.
A Geneva-based study has also shown the same long-term benefits for massive weight loss patients who had received a different type of bariatric surgery.
Beverly Hills plastic surgeon Dr. Tarick Smiley, who had performed thousands of body contouring after weight loss, believes that a “palpable and visible” physical improvement can serve as a strong motivation to keep a steady, healthy weight, which is “only possible through proper diet and regular exercise.”
Aside from the long-term impact on weight, body contouring after weight loss can also improve the patient’s quality of life, said Dr. Smiley on one of his recent Snapchat posts.
The most commonly performed body contouring after massive weight loss are tummy tuck and breast surgery, he said.
A 2012 study published by journal Plastic and Reconstructive Surgery evaluated the quality of life of 33 patients who had body contouring after bariatric surgery. The respondents reported improvements in mental wellbeing, intimacy, physical functioning and appearance, and social network.
With the improvements in these key “quality of life” domains, Dr. Smiley believes that plastic surgery following massive weight loss should always be part of a long-term, sustainable weight management solution.
The improvements in physical function and appearance were the most common benefits his patients cited, he said.
Fat transfer in plastic surgery has many uses, including hand rejuvenation, breast reconstruction and augmentation, buttock enhancement, scar revision, and facial rejuvenation.
Fat transfer uses donor fats collected via liposuction, which are then sorted, washed, and purified to come up with the healthiest cells to be re-injected into the area that needs to be augmented or reshaped.
Dr. Tarick Smaili, one of the leading Beverly Hills plastic surgeons, explains the circumstances that may warrant fat transfer.
Facial soft tissue atrophy or shrinkage is caused by significant weight loss and aging. The submalar, or the area below the cheekbone, is particularly prone to this age-related problem.
While dermal fillers such as Restylane, Radiesse, and Juvederm are easier to use—because they are readily available materials with good safety track record—proponents of fat transfer in plastic surgery suggest that it provides more natural results and feel because the cells have the same cohesiveness as the surrounding tissue.
Despite the benefits of fat transfer, it is not ideal for lips and other non-static facial areas due to poor survival rate and highly variable results.
- Breast reconstruction and augmentation
In breast reconstruction, fat transfer is more commonly used to hide the breast implant edges and other contour irregularities. The idea is to provide additional soft tissue coverage to achieve a more natural result and “feel.”
Fat transfer is also helpful in cosmetic breast augmentation, although most patients can only expect a “conservative” cup size increase, i.e., about one cup per session/surgery. It is important to note that injecting volume that is beyond what the tissue and skin capacity can hold will lead to poor survival rate of grafts.
Instead of butt implants, some patients have the option to use their donor fats to reshape and augment their “behind.” However, most will need a minimum of 500 cc of “processed” fat per butt cheek for a visible improvement. Of course, tall or “large built” individuals will need at least 800-1,000 cc per side to compensate for their body frame.
Nowadays, buttock augmentation via fat transfer is more commonly referred to as Brazilian butt lift.
Despite the benefits of Brazilian butt lift, patients will face some limiting factors such as the amount of healthy donor fats, skin tautness in their buttocks, and body frame.
Just like the face, the hand is also susceptible to age-related soft tissue atrophy, making fat transfer a possible option. However, some doctors prefer dermal fillers because of their more predictable results.
Question: Could I have breast surgery and Brazilian butt lift at the same time?
Surgeon’s Answer: In many cases it is cost-effective to perform two or more plastic surgeries in one setting since the patient will only pay for one anesthesia and facility fee. However, it does not apply to breast surgery and Brazilian butt lift.
Breast surgery—such as augmentation, lift, or reduction—requires that you sleep on your back for at least six or eight weeks postop. The idea is to prevent pulling on the wound and causing harm to the recovering tissue, which could happen if you lie on your stomach or chest.
Recovery after a Brazilian butt lift, meanwhile, requires that you avoid any pressure on the buttocks, which could kill the fat grafts and lead to low survival rate of fats and asymmetric shape. The general rule of thumb is to avoid sleeping on your back for two to three weeks.
Prolonged sitting while the fat grafts have not yet formed their blood supply can also lead to poor results.
The best sleeping position following a Brazilian butt lift, which in essence is a buttock augmentation via fat grafting technique, is to lie on your stomach or side, ideally leaning more forward to avoid “accidents.”
The problem can arise if you have breast surgery and Brazilian butt lift in one surgical setting. It may be difficult, if not impossible, to find a comfortable sleeping position that will not compromise your results.
Take note sleeping in your stomach during the initial stage of breast augmentation recovery is particularly detrimental because of the increased risk of implant shifting and sagging. Also, pressure on the area can lead to late-onset bleeding, persistent swelling, and pain, which can jeopardize the results.
You may argue that you can lie on your side and remain still during sleep, so combining these two procedures is acceptable. However, take note that most Brazilian butt lifts involve transferring fat to the hips or lateral side of the buttocks to achieve a more attractive silhouette, and placing pressure on this area can lead to less than optimal results.
The general rule of thumb is to stage the surgeries. For instance, you may want to have a buttock augmentation or Brazilian butt lift first and then wait for at least three months for your breast surgery.
Also, make sure that both surgeries are performed only by certified plastic surgeons who specialize in body contouring procedures.
The use of pain pumps has become a common practice in plastic surgery recovery such as tummy tuck and breast surgery. These are balloon-like devices attached to a catheter to deliver pain medications directly to the incision site, making it possible for patients to be less reliant to oral pain drugs that are associated with more side effects such as constipation, stomach upset, and nausea.
Because the drugs do not circulate throughout the body, pain pumps are said to result in fewer or more tolerable side effects.
Oftentimes, the contents of pain pumps last for three to four days when postop discomfort is at its peak. After this period, most patients no longer need strong pain medications such as narcotics that could lead to constipation if used over a long period of time.
Studies have suggested that most patients find these pain pumps simple to use and not cumbersome.
Beverly Hills plastic surgeon Dr. Tarick Smaili says pain pumps are particularly helpful in managing discomfort after breast surgical enhancement, such as mastopexy, augmentation, reduction, and post-mastectomy reconstruction, citing studies have shown that their use lead to shorter hospital stay.
Most pain pumps contain bupivacaine, an agent when used continuously during the initial healing phase could prevent long-term chronic pain syndrome, as suggested by medical reports.
Pain pumps also have low systemic toxicity and reduced incidence of complications because they work directly on the surgical site, explains Dr. Smaili.
This pain control system is also popularly used after tummy tuck in which a hip-to-hip incision is often used to contour the mid section. Compared to other plastic surgeries, the procedure leads to more postop discomfort, which mostly come from muscle repair or tightening.
During tummy tuck surgery, the abdominal muscle is tightened and reshaped using internal sutures. Because of the resulting discomfort, within the first few days patients are generally advised to sleep, sit, and walk in a way that they are slightly flexed at the waist.
While pain pumps do not completely eliminate the postop pain, they decrease the amount of discomfort to a significant degree that they become a common part of pain management treatment during plastic surgery recovery.
The renowned Beverly Hills plastic surgeon says that in the future, scientists could find ways to design pain pumps that can directly deliver numbing medications to all the nerves in the surgical site, making the healing process virtually painless.
Massive weight loss patients often deal with deformity caused by the redundant skin and fibrous fat, which does not respond to further diet and exercise. Aside from cosmetic problems, they also face mobility issue, breakdown of tissue, non-healing skin irritation, foul odor, and poor hygiene.
Because the mid and lower body area has the most redundant skin that causes mobility problems, most MWL patients first choose extensive tummy tuck in which the hanging abdominal skin is removed and tightened, and/or lower body lift where in the buttocks, flanks, and thigh are improved all at the same time.
Nevertheless, an upper body lift surgery remains important to help them achieve a more balanced appearance. Surgeries such as breast lift, breast reduction, arm lift, and back lift fall under this category.
By combining the lower and upper body lift procedures, the surgery is now called a total body lift.
While in some cases it is cost-effective to perform multiple procedures in one surgical setting, conventional wisdom suggests that in elective plastic surgeries the length of time in the operating table—particularly if they require the use of general anesthesia—is ideally under six hours to reduce the risk of complications and minimize the surgical trauma.
Another advantage of staging the surgeries is that it is easier to achieve a more predictable result because the skin is given enough time to redrape to the new contour.
Explanations of the most common types of upper body lift for MWL patients:
* Breast surgery
For women, the redundant skin and tissue laxity cause severe drooping of their breasts and/or deflated upper cleavage. Surgical enhancements such as breast lift and breast reduction can help them achieve a near normal appearance.
Some male patients can also benefit from breast surgery, particularly those with a condition called gynecomastia or “woman-like” breast that is caused by excess tissue and skin. Oftentimes, the procedure involves skin-excision techniques partnered with liposuction to remove the excess fat that no longer responds to further weight loss.
* Arm lift or brachioplasty
For MWL patients, their arm lift uses a significantly longer incision than those required by individuals with minimal skin laxity caused by aging. Oftentimes, the skin excision extends from their elbow to the chest wall for additional contouring.
* Back lift
A procedure more common in women than men, it involves an incision that is positioned underneath the bra strap to hide the scars. For additional contouring, liposuction may be also necessary.