Body Plastic Surgery Procedures in Philadelphia

Body Lift Cosmetic Surgery After Massive Weight Loss

One of the fastest growing areas in plastic surgery is the group of procedures designed to remove excess skin following massive weight loss. Due to the popularity of bariatric surgery, scores of patients are now interested in removing the excess skin they acquired while overweight.

It is estimated that over 100,000 morbidly obese patients will undergo gastric bypass surgery in the United States during 2003.

Due to inadequate skin elasticity, massive weight loss results in excess skin, usually in areas most affected by weight gain: abdomen, breasts, inner thighs and arms. Besides being unsightly, excess skin can interfere with clothing and activity while also leading to skin irritation and breakdown. Fortunately, there are plastic surgical procedures designed to remove this skin excess and recontour problem areas.

Who is a Candidate for Surgery?

For instance, a patient with thick abdominal tissue who still weighs 200 pounds at the time of their abdominoplasty will never look as good as the patient with thinner abdominal tissue who weighs 175 pounds at the time of their surgery. Moreover, the risk of significant surgical complications will diminish as the patient approaches their goal weight. Though it may be emotionally hard, it is usually prudent to lose as much weight in the affected area before proceeding with plastic surgery.

Body Lift Procedure Options

Following gastric bypass surgery, some patients have a tremendous excess of lower abdominal skin called a pannus. This excess skin is simply excised directly in an operation call a "panniculectomy." This surgery is usually considered in patient with significant localized skin excess who really need to los more weight before a more definitive operation should be done.

When a patient is closer to their goal weight, they become a candidate for a more complex surgery known as an "abdominoplasty," where all the surplus skin from the umbilicus (belly button) to the pubic area is removed. This is commonly associated with tightening and repositioning the abdominal (rectus) muscles. With greater weight loss and skin excess, the surplus may extend around to the patient's back. A "circumferential abdominoplasty" may then be chosen to provide the smoothest contour.

Finally, a more extensive form of a circumferential abdominoplasty called a "body lift" may be done for the additional purpose of lifting one's thighs and buttocks. Obviously, the more extensive procedures with potentially the most dramatic results are associated with greater cost, risks and recovery; therefore each patient must be considered individually.

Breasts: Despite weight loss, some patients still have large breasts and are candidates for "breast reduction" surgery where the primary goal is to reduce the patient's breasts to more appropriately match the rest of their body. A secondary benefit of this operation is that it lifts the breasts as it reduces them.

Alternatively, many patients' breasts look deflated after weight loss, with both volume loss and sagging. This sagging, or ptosis as plastic surgeons call it, can be treated with a "breast lift" or "mastopexy." When a patient also wishes to restore breast size, a "breast enlargement" can be done at the same time, using either saline or silicone breast implants.

Face: While clothing can be used to conceal most areas with excess skin, most patients find it impossible to mask excess neck and facial skin following significant weight loss. The truth is many patients, despite feeling better after their weight loss, actually look suddenly older. This apparent aging can be treated with standard facial rejuvenating procedures such as a "facelift" and "brow lift."

Inner arms: Loss of upper arm fat can result in floppy skin from the axilla (armpit) to the elbow. As a result, women frequently avoid sleeveless garments, even in the heat of summer. A "brachioplasty" or "arm lift" can be used to reduce excess skin and residual fat. While new techniques help diminish and camouflage scarring, unsatisfactory scars are not uncommon with these procedures.

Inner thighs: As with arms, excess skin in the inner thigh is unsightly and often interferes with clothing choices. When the excess is only vertical, a "thigh lift" can be done and the scar will lie in the groin crease. However, frequently after massive weight loss, the excess skin is circumferential extending towards the knee, and therefore the excision must also extend down the inner thigh.

Combined surgery: All if these operations take a lot of time to perform properly and therefore few plastic surgeons would endorse treating all areas in one session. Commonly, two or three sessions, usually 2-3 months apart, are needed to achieve the patient's desired results. The exact sequence or combination depends on many factors, mostly dictated by what bothers the patient the most.

After Body Lift Surgery

The most obvious consequence of surgery is scarring. Scars may be good or they may be bad, but when skin is excised the long incisions always heal with some type of scar. These scars are usually well-tolerated, but it should be clear before proceeding where these incisions will be and what they could look like. Numbness is a common and sometimes disturbing consequence that can be prolonged and even permanent in the areas where the surgery is performed.

Complications of extensive procedures like those discussed above are numerous and varied, some minor and other potentially lethal. As with any surgery, there is always the risk of bleeding and infection. Bleeding that requires transfusion or more surgery is uncommon, occurring less than 5% of the time. Minor infections are much more common, in the range of 5-l0%, but can usually be treated with oral antibiotics. Significant infections requiring hospitalization and intravenous antibiotics are less common but do appear to be more frequent in patients who are still considerably overweight at the time of their surgery.

Delayed healing is probably the most common complication noted in these types of plastic surgery procedures. Delayed healing can be due to skin tension following skin removal or diminished skin quality as when stretch marks are prevalent. Smoking dramatically increases the risk of delayed healing and should be completely discontinued prior to surgery. Most problems are small and can be handled with dressings, though occasionally additional surgery is necessary.

Rarely, surgery such as this can be complicated by deep venous thrombosis which can lead to blood clots in the patient's lungs, a condition that can be lethal. Most plastic surgeons utilize special equipment and procedures to minimize this risk. Like infection, this type of risk is more common in the obese patient.

Insurance coverage: While surgery to induce weight loss is frequently a benefit of most insurance plans, coverage for procedures to deal with the excess skin is much less common. A limited abdominoplasty or panniculectomy may be an exception, if the insurance company can be convinced that the excess abdominal skin is causing significant medical problems that cannot be managed without surgery.

Conclusion: Overall, surgery for morbid obesity means patients can look forward to longer and healthier lives. In carefully selected cases, plastic surgery can help these patients enjoy their weight loss by relieving them of some of their unwanted skin.