Weight loss procedures such as lap band and gastric bypass help patients lose a considerable amount of weight. Despite the health benefits of massive weight loss, some patients get discouraged because of severe skin laxity that can result from the weight loss. A post bariatric body lift (or plastic surgery after weight loss) can be the solution.
Every patient’s body is different. The most common areas that the body shows severe skin laxity and sagging are the abdomen, inner thighs, arms, back and breasts. The procedures must be tailored for the individual needs of the patient.
A preoperative healthy BMI is important for weight loss body contour surgery. Morbid obesity patients have increased surgery risks. Deep vein thrombosis (DVT), pulmonary embolus (PE), sleep apnea, infection and delayed wound healing are all related to morbidly obese patients, so weight loss and medical consultation and clearance are essential prior to surgery.
The severe skin sagging may result in vertical elongation of the breast. Weight loss might also effect the breast volume giving the breast a flattened appearance. Mastopexy (or breast lift) procedures lift and tighten the breast by excising excess skin and reshaping the breast tissue. The nipple position is also elevated with this procedure.
Because of severe stretching, the skin can not support the deep breast tissue and it is difficult to maintain any superior breast tissue, making the breast shape hollow superiorly after surgery. Because of the difficulty with maintaining superior volume, some patients choose to augment the breast with a silicone or saline implant. The implant should blend with the breast width but it doesn’t need to be large.
Post-bariatric surgery patients are very conscious of their weight and large implants can make patients look heavy. The augmentation can be done simultaneously with a mastopexy but it can also be delayed.
The abdomen is perhaps the most commonly treated area after weight loss procedure. Patients seek treatment for the removal of a heavy, hanging abdominal roll called a panniculus. If the panniculus is large and extends to the back then the procedure would remove the excess skin circumferentially. The abdominal muscles might need to be tightened.
Inner Thigh and Arms
The inner thigh and arms can also be contoured by skin excision. Both of these areas are difficult to treat because of the lack of deep fascia, which allows for placement of deep sutures in a strong layer and takes the tension off of the skin. Because the deep fascia is absent in these areas, the skin might heal with more tension, and the scars can be very visible post-operatively. Staged procedures with liposuction to reduce bulk followed by skin excision can reduce some of the swelling and tightness in these areas.