Obesity is a significant risk factor for many chronic diseases and can lead to an early death. Additionally, obesity places tremendous pressure on joints, increasing the risk of degenerative diseases of the knees, hips, and feet. While lifestyle changes with a sensible diet and exercise are the best approach to help patients lose weight in a safe and maintainable manner, for some, bariatric surgery can be an effective method to help them lose considerable weight loss journey.
As a plastic surgeon, I have the opportunity to see patients who have lost an incredible amount of weight and have made significant lifestyle changes. However, they are often unhappy because they are now prisoners in their own hanging skin fortresses. This excess skin can be removed through plastic surgery procedures, which can provide patients with a “get out of jail card” from their skin excess.
Unfortunately, many bariatric surgeons attempt to provide body contouring procedures themselves for financial reasons. This can lead to less than desirable outcomes and even unnecessary deaths because they lack the training and principles of body contouring procedures that can only be learned in a plastic and reconstructive surgical residency.
Another obstacle to post-bariatric surgical body contouring is the issue of who will pay for the procedure. Any procedure that can be compensated by insurance must have a surgical code with a relative value scale attached to it. However, the American Medical Association, which sets up the coding, has never evaluated plastic surgery procedures in the context of massive weight loss. Therefore, even if an insurance company would “cover the procedure,” it would not reflect the time and effort required by the surgeon to provide patients with this care. Many complex and challenging techniques are not taken into consideration with insurance reimbursement.
Some patients believe that this is unfair. However, I remind them that patients who did not have the motivation to lose weight in the first place are the ones who get surgical weight loss procedures. If their body contouring procedures are covered by someone else, what is the incentive for the patient to maintain their new lifestyle? If they have had to save their money for several expensive operations, that in summation equal the cost of an expensive car, then the patient is less likely to give up on their lifestyle to maintain their costly investment in themselves. I also tell my patients that an expensive new car devalues over time very quickly, but an active interest in their new body can last a long and meaningful time. People always act differently if they have some skin in the game (pun intended).
What are the procedures to make me look and feel better?
Typically, surgical rejuvenation procedures for the arms, breasts, abdomen, flanks, buttocks, and legs are separated into three distinct surgeries. Each surgery takes approximately 6.5 to 7 hours to perform due to the complexity of the procedure and the amount of work required to remove and reshape the skin. Despite the significant time commitment, the results are often well worth it.
Circumferential lower body lift with gluteal augmentation
Typically, the first procedure I undertake is the circumferential lower body lift, which includes gluteal augmentation using vascularized flaps from the flank region. This procedure is pivotal to achieving the desired aesthetic outcome for the body, and it allows me to make better judgments for subsequent procedures involving the breasts and legs. It comprises three distinct operations performed simultaneously: a tummy tuck, flank-plasty with lateral thigh repositioning, and gluteal augmentation using skin from the muffin top to enhance the buttocks.
Despite the lengthy surgical time and complexity of the procedures, most patients are discharged on the same day and recover better at home than in the hospital. The incisions are closed deeply, so sutures do not need to be removed. Patients typically have four drains for about a week, and we use a pain pump with a long-acting local anesthetic to alleviate pain. Everyone receives blood thinners for five days to prevent blood clots. I inform patients that they can expect to start feeling better in about two weeks, after which recovery progresses rapidly. This procedure is truly transformative, and the overwhelming majority of patients are extremely satisfied with the results.
Upper body lift (bilateral brachioplasties with lateral chest wall reshaping and breast rejuvenation)
The next step typically involves a combined upper arm and lateral chest wall contouring procedure, also known as an extended brachioplasty. This is often paired with a breast lift, with or without an implant. The brachioplasty is a one-stage procedure with minimal complications, and patients are usually very pleased with the results despite the long scar that extends from the elbow to the armpit and down the posterior lateral chest. However, the breast lift is usually a two-stage procedure because post-weight loss breast tissue is complex and often includes unsupported, hanging tissue that cannot be corrected in a single operation. If the remaining breast tissue is very thin, an implant may be needed during the second stage to help create shape and volume.
Medial thigh lift
The final stage of the body rejuvenation process typically involves a lateral thigh lift. First, we perform an aggressive liposuction in the area of the medial thigh, followed by resection of any loose tissue left after the liposuction. The incision for this procedure runs from the knee to the groin crease on the inner aspect of the leg. This enables us to transversely tighten the skin in this distribution, resulting in a smoother and firmer leg. Recovery from this operation is not as challenging, and patients can usually resume normal activities within a week. By removing excess hanging skin, patients can feel more comfortable wearing shorts, dresses, and pants.
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 Frequently Asked Questions
What is body contouring?
Body contouring is a set of surgical procedures designed to remove excess skin and reshape the body after significant weight loss.
Who is a good candidate for body contouring?
Good candidates for body contouring are people who have lost a significant amount of weight and have excess skin that cannot be addressed through diet and exercise.
How long does the body contouring process take?
The process can take several months, as each procedure is typically performed separately and requires time for recovery in between.
Are the results of body contouring permanent?
The results can be permanent, but maintaining a healthy lifestyle through diet and exercise is essential to ensure long-lasting results.
What are the risks associated with body contouring?
As with any surgery, there are risks involved with body contouring, including bleeding, infection, scarring, and other complications.
What is the recovery process like for body contouring?
The recovery process can vary depending on the type of procedure performed, but it typically involves several weeks of limited activity and wearing compression garments to minimize swelling.
How much does body contouring cost?
The cost of body contouring can vary widely depending on the specific procedures performed, the surgeon’s fees, and other factors. It is important to consult with a board-certified plastic surgeon to get an accurate estimate of costs.
Can body contouring be combined with other procedures?
Yes, body contouring can be combined with other procedures such as breast augmentation or reduction, or facial procedures to address other areas of concern.
Conclusion
Body contouring procedures can be a vital part of a weight loss journey for many individuals who have lost a significant amount of weight. These procedures can address excess skin and fat in various areas of the body, including the arms, breasts, abdomen, flanks, buttocks, and legs, resulting in a smoother, firmer, and more toned appearance. The three-stage process typically involves a circumferential lower body lift with gluteal augmentation, an extended brachioplasty, and a lateral thigh lift. Despite the length of the procedures, the recovery process is generally manageable, and patients can resume normal activities in a relatively short period of time. Body contouring procedures can be life-changing, providing patients with a newfound confidence and sense of accomplishment as they complete their weight loss journey.
Overall, body contouring procedures play a crucial role in completing the weight loss journey for many patients. After undergoing significant weight loss, excess skin and tissue can be a major obstacle to feeling comfortable and confident in one’s own body. Body contouring procedures, such as those described above, provide a way to address these concerns and achieve a smoother, more contoured appearance.
It’s important to note that these procedures are not just cosmetic in nature – they can also have significant physical and emotional benefits. By removing excess skin and tissue, patients may experience improved mobility and decreased discomfort or irritation. Additionally, the boost in self-confidence that often accompanies a more contoured appearance can have a positive impact on overall quality of life. While these procedures do require a significant investment of time and resources, for many patients, the results are well worth it. If you have undergone significant weight loss and are struggling with excess skin and tissue, speaking with a qualified plastic surgeon can provide valuable information and guidance on the best options for achieving your desired outcome.