After major weight loss where previously the skin has been stretched, skin can lose elasticity and fail to “snap back” as the weight is lost. Losing the weight is hugely beneficial for your health, particularly your heart and your joints. However for many, one of the next concerns is how to deal with the loose skin that may be left behind after dramatic weight loss. This, now unsupported, skin and underlying fat can hang down and sag. As well as being unsightly and significantly affecting self esteem, the extra skin can make exercising more difficult, getting clothing to fit properly more difficult and can cause skin hygiene and irritation problems. Over the years, a number of procedures have been developed in plastic surgery to address this issue and fortunately we can now deal with most problem areas. I have briefly mentioned some of the more common operations and what they achieve.
The skin in the inner part of the upper arms can sag and appear loose. Excess skin can be removed from the inner arm and a more contoured appearance achieved in an upper arm lift or Brachioplasty procedure.
Flattening of the breast shape and flopping of the breast can be corrected by lifting the breast, a Mastopexy or breast lift procedure. This repositions the nipple and reshapes the breast, removing excess skin. If more volume is also desired in the breast, implants can be placed at the same time as the mastopexy in an Augmentation Mastopexy procedure or as a separate procedure. If less volume is desired in the breast, a Breast Reduction can be done. This combines the lift of the breast and repositioning of the nipple done in a mastopexy with a reduction in size of the breast as well.
For men, excess chest skin can also be removed by liposuction and or excision of the skin in a modified Gynaecomastia procedure. The nipple may need to be lifted to an improved higher position as part of this surgery.
For the abdomen, the overhang of skin that occurs can be removed in a “tummy-tuck” procedure or Abdominoplasty. A standard abdominoplasty removes and tightens tissue concentrating more on the lower abdomen in terms of tissue removal. In some cases, a second Reverse Abdominoplasty procedure is needed at a later stage to address residual loose skin on the upper abdomen and lower chest area. Sometimes the overhang extends around the side of the body and the buttocks can drop as well. A Lower Body Lift can address this problem and help lift the upper outer thighs as well.
A Thigh Lift removes the excess skin from the inner thigh and helps to reshape the thighs. It is similar in concept to the brachioplasty procedure for upper arms.
Lower Body Lifts address loose skin on the lower back and buttocks at the same time as that on the lower abdomen. An Upper Back Lift addresses loose skin on the upper back – in women, the incision is usually placed along the bra line.
Liposuction may be used in combination with all these techniques to optimize the final result. Some patients also desire facial rejuvenation surgery in addition to the body contouring surgery.
Before having surgery, it is important to be at your goal weight or as close to it as possible and to be at a stable weight. If you are still losing weight e.g. after gastric band surgery, you may not get the best result from your surgery as more weight is lost after the skin has been tightened. Wound from surgery will not heal as well while you are actively losing weight. They heal best when you are at a stable, healthy weight. Weight loss should be part of a lifestyle change. It is essential to have incorporated a healthy diet and regular exercise into your lifestyle in order to maintain the benefit of your weight loss. Stopping smoking should be part of this change in lifestyle as well. If you lost weight following a surgical procedure such as a gastric band or bypass, your bariatric surgeon can help advise on the timing of surgery.
After significant weight loss, it is common to need one or more of the above-mentioned procedures. Some can be combined and performed at the same time. However, it is common to plan a series of procedures to deal with all the problem areas in stages. It is often major surgery and there is a limit to how much is feasible and safe to undergo in one sitting. This is something that will be discussed with you at your preoperative consultations.