Introduction: What are my options for Post Bariatric surgery body contouring?
You've been on your weight loss journey for a long time and you are determination has paid off. You went through bariatric surgery, continued to stick with your diet plan, and now you're rightfully proud of your weight loss. Then you look in the mirror and see a bunch of excesses, sagging skin.
You probably knew that would happen, but seeing it on your body is a letdown. So now you are thinking, "What are my options for Post Bariatric Surgery Body Contouring?" No worries, there is 360 Care Plan for you.
Impact of Bariatric Surgery
Bariatric surgery refers to a variety of weight loss procedures conducted on the stomach and intestines to help individuals with severe obesity lose weight. Common surgeries include gastric sleeves, gastric bypass, and laparoscopic banding. After surgery, patients experience rapid weight loss, with an average loss of 60-80% of their excess body weight over 12-18 months (1). This fast weight reduction occurs because the procedures limit how much patients can eat and/or prevent the body from absorbing calories and nutrients from food.
However, such drastic slimming unfortunately stretches the skin beyond its ability to “snap back” for many patients. The skin often lacks the elasticity to shrink along with the body after significant fat reduction. This leaves loose, overhanging skin that hangs off the body in areas like the arms, thighs, stomach, back, and buttocks (2). While weight loss positively impacts health conditions related to obesity, the residual skin flaps can negatively affect body image and self-esteem. Moving around can also grow uncomfortable as the tissue pulls, chafes, and gets in the way of activity.
Why do you need post-bariatric cosmetic surgery?
After extended and extreme periods of weight gain/loss, many people will experience excess or sagging skin. The elastic fibers in the skin can become damaged in this process, causing the skin to lose elasticity, and preventing it from bouncing back.
While it's important to get rid of the excess skin so you can look and feel wonderful, it should also be removed for health reasons. Large skin folds can be uncomfortable and make any activity difficult. Excess skin also tends to develop ulcers and rashes in the folds, which can lead to an infection.
What is surgical body contouring?
Body contouring surgery refers to procedures designed to eliminate the excess skin left behind after major weight loss. As the term “body contouring” suggests, the goal is to reshape and contour—or sculpt—the body into more aesthetically pleasing proportions and contours after bariatric surgery removes the bulky fat. Common body contouring operations include:
- Abdominoplasty (tummy tuck): Removes loose, overhanging skin and fat from the abdomen. The remaining tissue is tightened for a trimmer profile.
- Brachioplasty (arm lift): Reduces loose upper arm skin by excising and tightening.
- Thighplasty: Reshapes the thighs by excising loose skin/fat and suturing the remaining tissue into a lift.
- Breast lift (mastopexy): Elevates drooping breasts by removing excess skin and tightening supportive breast tissue.
Lower body lift: Tightens loose abdominal skin as well as skin on the buttocks and thighs in one circumferential procedure.
What are the most popular body contouring options?
The team at Healthy Life Bariatrics offers many body contouring procedures, including:
Post-bariatric belt lipectomy (body lift)
For many patients, the first step is a body lift that targets their abdomen and lower back. Your surgeon makes an incision around your abdomen and back at about the height where you'd wear a belt.
During the surgery, excess skin is removed, including the apron of skin hanging from your abdomen, and liposuction is done to remove fat if needed. Then your muscles are tightened and your skin is repositioned and sutured into place.
Although a belt lipectomy is usually confined to your lower abdomen and back, you may be able to have a buttock lift and outer thigh lift during the same procedure. Combining the procedures helps you keep that area of your body in proportion.
A breast lift and arm lift
After taking care of your abdominal area, most patients – men and women – want to improve the contour of their breasts and upper arms. Breasts contain a significant amount of fat, so after bariatric surgery and subsequent weight loss, they often sag and have a deflated appearance.
A post-bariatric surgery breast lift is different from a typical breast lift due to the amount of excess skin that's removed and the extra attention that's paid to using your existing skin and breast tissue to preserve blood supply and create the shape you envision.
After excess skin and fat are removed, your underlying breast tissue is lifted, shaped into your new contour, and the nipple and areola are repositioned. If needed, your surgeon can reduce the size of the areola to match your new breast shape.
An arm lift to remove excess fat and skin hanging from your upper arms may be performed at the same time as your breast lift. The excess tissue in your arm often extends into your armpit and chest, so it makes sense to take care of this area while you're getting your breasts or chest lifted.
Like all surgical body contouring procedures, during an arm lift, fat is removed with liposuction, excess skin is removed, then the skin is pulled tight and sutured together.
The only difference with an arm lift is that the scar may be visible. With other contouring procedures, the incisions are placed in areas where they're either not visible or can easily be covered by minimal clothing.
Why Might I Need Body Contouring Surgery?
Patients are often left with up to 30 pounds of excess skin after losing large amounts of weight (3). This surplus tissue leads to skin irritation, poor mobility, interference with exercise, and low satisfaction with body image—all negatively impacting quality of life. Unfortunately, diet and exercise cannot tighten such damaged skin. Body contouring surgery refines and sculpts the frame to help patients feel more comfortable physically and emotionally as they transition into their new slimmed figures.
What are the Risks of Body Contouring Surgery?
Body lifting procedures remain complex surgeries requiring anesthesia and extensive incisions, so medical risks apply. Complication chances depend heavily on the extent of procedures, with more lifts compounding the risks. Potential adverse events include (4):
- Bleeding (hematoma formation): Fluid accumulation under skin flaps. Usually resolves itself, but may require drainage.
- Infection: Inflammation from bacteria entering surgical sites. Treated with antibiotics.
- Poor wound healing: Incisions heal poorly, creating wider, more visible scars.
- Blood clots: Clots can form in veins after surgery, risking serious complications if they travel internally. Blood thinners used preventively.
- Skin loss (skin necrosis): Portions of a skin flap losing circulation resulting in tissue death. Debridement surgery may follow.
- Asymmetry: Uneven results noticeable between sides of body. Often involves revision surgery.
Carefully selecting a board-certified cosmetic or plastic surgeon with expertise in body contouring minimizes the risks of complications. Still, patients should understand the complexities before undergoing elective surgery.
How Do I Prepare for Body Contouring Surgery?
The American Society of Plastic Surgeons (ASPS) offers tips on optimally preparing for body contouring (5):
- Reach a stable baseline weight before surgery for best contours.
- Manage any underlying health conditions (like heart disease) before elective surgery.
- Quit tobacco smoking at least 6 weeks before surgery for proper wound healing.
- Plan for 4-6 weeks off for recovery help and moderate activity restrictions.
The plastic surgeon will conduct physical exams and lab tests to ensure patients enter surgery in optimal health. Discussing goals, motivations and expectations openly is encouraged.
What Happens During Body Contouring Surgery?
The specifics of surgery vary considerably depending on the combination of body lifts elected. But generally, contouring procedures involve (6):
- General anesthesia: Going fully unconscious for safe, pain-free surgery.
- Incisions: Strategic cuts made to excise underlying tissue laxity. Incisions placed inconspicuously when possible (pubic line, bra line, etc.)
- Excision: Removing excess fat, skin, and other tissues via incisions, leaving what the surgeon judges as optimal contours. What tissue remains gets tightened, trimmed, and smoothed.
- Closing incisions: Once excess tissue is excised to lift and contour, incisions are closed with layered sutures, surgical tape, and/or skin glue. Drains are often left to evacuate fluid buildup.
Sequential procedures spaced weeks apart allow adequate healing between stages while efficiently contouring head to toe over 6-12 months.
What Happens After Body Contouring Surgery?
The post-surgical period brings significant discomfort, pain, and immobility. Medications manage pain, but moderate soreness persists for several weeks. Swelling is also pronounced. Strenuous activity restricted for ~6 weeks. Typical recovery guidelines include (7):
- Get ample rest and avoid exercise other than short, mild walks.
- Take medications exactly as prescribed by a cosmetic or plastic surgeon.
- Wear recommended compression garments to minimize swelling, and improve contour.
- Carefully clean incisions, and change dressings as directed to prevent infection.
- Attend all scheduled follow-ups so the team can monitor healing, fluid buildup, and skin health.
With diligent self-care under guidance from the care team, most return to work within 2-4 weeks. By 6 months, patients enjoy a revitalized body definition from their transformation.
Conclusion: What are my options for post bariatric body contouring?
Body contouring surgically sculpts lean, proportional contours where diet and exercise come up short after radical weight loss. When performed by a qualified, board-certified plastic surgeon, body lifts safely refine results following bariatric surgery. Those struggling with residual skin should consult experts in post-bariatric contouring to explore options for a more comfortable, confidence-boosting figure.
Citations:
- Brethauer SA, Hammel JP, Schauer PR. A systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469-475. doi:10.1016/j.soard.2009.05.011
- American Society of Plastic Surgeons. New statistics reflect the changing face of plastic surgery. Accessed November 29, 2023. https://www.plasticsurgery.org/news/press-releases/new-statistics-reflect-the-changing-face-of-plastic-surgery
- Ortega HW, Reid J. Body contouring after massive weight loss: optimizing patient selection and outcomes. Can Fam Physician. 2017;63(5):354-359.
- American Society of Plastic Surgeons. Body contouring after weight loss: risks. Accessed November 29, 2023.
- American Society of Plastic Surgeons. What you really need to know about body contouring. Accessed November 29, 2023.
- Johns Hopkins Medicine. Body contouring. Accessed November 29, 2023. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/body-contouring
- MedicineNet. Body lift. Accessed November 29, 2023.
