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.
The incision pattern used in the inner thigh lift surgery is primarily determined by the location of excess skin. In general, massive weight loss patients should expect longer scars to remove more redundant skin.
Basically, there are two ways to accomplish the inner thigh lift surgery: short scar and standard medial thigh lift.
In short-scar inner thigh lift, the resulting scar lies precisely at the groin and thus well hidden by the patient’s underwear. However, it is only suitable for individuals with mild tissue laxity.
In massive weight loss patients, a wedge of excess skin is also removed where the thigh meets the pubic area, resulting in the appearance of groin scar. But another vertical scar that extends down to their legs, almost reaching their knees, is also required for additional contouring.
All efforts are made to ensure that the vertical scar remains on the inner aspect of the legs. For this reason proper wound closure in which there is no or very little tension on skin is particularly critical.
Without tension on the skin surface, the scars are less likely to migrate or thicken, according to California Surgical Institute website.
The wounds are closed in several deep layers so the skin surface will not receive excessive tension. Butterfly stitches, also called Steristrips, can further reduce the tension.
Butterfly stitches are narrow adhesive strips that hold the edges of a wound in an attempt to encourage the scar to remain linear and “unobtrusive.”
While inner thigh lift is commonly performed as a critical part of a full body lift after massive weight loss, it is rarely combined with tummy tuck due to the “opposing” tensions of these two procedures, which could lead to poor healing and less than optimal scar.
Tummy tuck elevates the mons pubis to some extent, while the inner thigh lift creates a “downward pull.” For this reason it is best to perform them separately to avoid healing problems.
Most patients are able to return to work after 2-3 weeks, although they may have to avoid rigorous activities for a few more weeks.
Mommy makeover revision surgery becomes necessary because of three basic reasons: inadvertent pregnancy, significant weight fluctuations, and botched results from the initial procedure.
A mommy makeover surgery is any combination of body contouring procedures that generally focus on improving the appearance of abdomen and breasts, areas that are highly susceptible to the effects of pregnancy.
Leading body contouring expert Dr. Tarick Smiley says all efforts are made to avoid the need for mommy makeover revision, adding that it always starts with proper patient selection—i.e., the patient must be near her ideal weight and is done having children.
Nevertheless, “inadvertent” pregnancy and drastic weight fluctuations do happen, which can change if not reverse the results of tummy tuck, breast augmentation, and breast lift, which are the three most common mommy makeover procedures performed by the celebrity plastic surgeon.
Oftentimes, mommy makeover revision is possible provided that the patient’s weight has been stable for at least six months and/or she has fully recovered from the “trauma” of childbirth (it takes about 6-12 months); however, a longer waiting period is deemed necessary if one chooses to breastfeed.
It is important to note that the hormones that trigger the body to produce milk have some effect on skin elasticity or shrinkage; hence, the patient must wait at least six months after weaning, says Dr. Smiley.
All efforts are made to avoid additional scars in mommy makeover revision, so the surgeon would simply use the previous incision sites. However, some patients may have to accept a longer scar to achieve the optimal breast shape or to preserve the natural curves and contours of their tummy.
For instance, a patient who previously had a mini tummy tuck (its scar is typically 4-6 inches in length) but later gained weight or became pregnant may need her scar extended from hip to hip, which is the standard technique, to achieve a flatter abdomen and a narrower waistline.
Also, a patient who had a modified form of breast lift (less scarring) may have to accept the scars from the standard technique (it uses an anchor-shaped incision for additional lifting effect) if she requires a more extensive revision.
In the event of botched mommy makeover surgery, Dr. Smiley says it is of critical importance to wait at least six months before a revision is attempted. The idea is to wait for the skin to relax and the implants (in the case of breast augmentation surgery) to settle.
Performing revisions too soon is like “hitting a moving target,” hence the results are harder to predict, he explains.
Reverse abdominoplasty or tummy tuck is only suitable for a small subset of patients. For the vast majority of patients though, the standard technique or hip-to-hip incision within the lower abdomen remains the best approach since it can remove the excess skin in both the upper and lower abdomen.
Reverse abdominoplasty primarily targets skin laxity in the upper abdomen, thus it only favors women whose lower abdomen appears relatively tight, according to experts at Inland Empire Plastic Surgery Institute.
The technique typically uses one long incision within the breast fold. While most of the scar aspect is hidden within the natural breast fold, it might become visible in the sternum area (medial chest), especially in small-breasted patients. Nevertheless, most scars fade about 6-12 months that they blend with the skin.
The procedure can be incorporated with “auto” breast augmentation in which the patient’s own [excess] tissue from the upper abdomen is used to add volume in the breast; hence she can avoid implants and the risks that come with them such as leak/rupture, scar capsule hardening (capsular contracture), and possible replacement in the future.
However, it is important to note that “auto” breast augmentation via reverse abdominoplasty is a highly complex procedure. To achieve more natural results, it is often combined with fat transfer in which excess fats are liposuctioned from different parts of the body such as the flanks, thigh, hips, etc., then later used to reshape the breasts.
For the right candidates, reverse abdominoplasty can produce impressive results from the cosmetic point of view. However, proper wound closure is critical to prevent poor scarring or scars migrating inferiorly that they become visible on the upper abdomen.
Once the excess skin the upper abdomen is removed, the remaining tissue is attached to the rib fascia, which is noted for its additional strength and thus preventing scar migration and sagging recurrence.
Aside from women who prefer auto breast augmentation, the technique may also suit previous abdominoplasty patients who develop sagging, which for some reason only affects their upper abdomen and not its lower aspect. Aging, weight fluctuations, and sun exposure are the most common factors that contribute to abdominal laxity.
While there are different types of plastic surgery after weight loss, they all share one goal: To address contour deformity due to poor skin tone and “redundancy,” soft tissue laxity, and highly fibrous fats.
All body contouring surgeries for massive weight loss (MWL) patients will require direct excision, thereby the appearance of scar is an inevitable tradeoff if they want to achieve a near normal appearance and/or find relief from pain, irritation, and skin breakdown caused by the large folds of skin.
Below is the list of the most common types of plastic surgery after weight loss, according to California Surgical Institute website.
* Tummy tuck. While the standard technique uses a hip-to-hip incision, MWL patients typically require a longer flank-to-flank incision for further contouring. Despite the resulting scar, studies have suggested that it can result in high patient satisfaction due to notable improvements in the quality of life and body functions, as the redundant skin in the abdomen is the most problematic—i.e., it causes irritation and foul odor.
* Thigh lift. Depending on the location of redundant skin, it may involve incisions within the groin and gluteal crease, on the inner thigh that could be extended into the knee area, in the hips, or a combination of these incision patterns.
* Buttock lift. Most MWL patients require a horizontal incision on the upper butt cheeks.
* Lower body lift. This accomplishes the goals of tummy tuck, outer thigh lift, and buttock lift under one operation as it uses a belt-like incision.
* Arm lift. For MWL patients, it typically uses a long incision on the inner arm or somewhat more posteriorly (starting from the armpit to the elbow), depending on the location of redundant skin.
* Breast enhancement. Female patients may require breast lift and/or reduction, while males may need gynecomastia surgery to correct their woman-like breast caused by the excess skin and/or fat.
* Liposuction. As a stand-alone procedure, it does not provide optimal results for MWL patients who really require an excision-based body contouring surgery because this is the only way to remove the large folds of skin.
Liposuction for MWL patients is often needed for debulking, or removing large amount of excess “fibrous” fat, which does not respond to further weight loss. Most surgeons perform the procedure at least six months prior to an excision-based surgery.
While “simultaneous” liposuction is sometimes acceptable, MWL patients generally require a stage approach to minimize the amount of surgical trauma and to reduce the risk associated with fluid imbalance and bleeding.