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BODY CONTOURING SURGERY FOR THE MASSIVE WEIGHT LOSS PATIENT
Large amounts of weight loss by whatever means often signals an exciting turning point in one's life. The changes are often profound - a sense of one's old self returning, a boost of self esteem, a noticeable increase in energy, clothes fitting better. But there is more: medical problems such as hypertension, diabetes, and many joint aches and pains are improved and sometimes even totally resolved. However, a look in the mirror reveals there is still something missing - actually not enough is missing -the considerable excess skin. It can lead to a persistent impression of disproportion, embarrassment even discomfort with rash. Clothes still don't fit as well as they could. Something more has to be done and that is where plastic surgery can deliver. Modern body contour procedures offer trading the sagging and the rolls for some scars with contour changes that are usually quite dramatic.
Dr. Hubbard has been actively involved with surgical care of skin laxity following massive weight loss for 13 years. In the past few years more advanced techniques have arrived as plastic surgeons have responded to a phenomenal number of weight loss patients interested in improving body contour. With the experience of recent years in this increasingly popular surgery, better decisions can now be made on who are the best candidates for this surgery, when is timing most appropriate, and when and what pattern of skin is best excised. Dr. Hubbard has found extreme variation among patients in the amount of skin excess and location. Yes, there are indeed patterns to the excess sagging and stretching of skin based partly on the amount of weight loss and inheritance. There are clearly zones of adherence where the skin stays fixated and skin from above rolls over it. There are also areas of little adherence and the skin flows quite a distance before gathering into a roll. With so much variation, this surgery must be customized and planned for each unique individual. There is no substitute to a thorough consultation with Dr. Hubbard where each problem area can be discussed and options for surgery discussed. Underlying medical conditions are brought into the decision making. Often staging is the best way to proceed.
Who is a good candidate for body contour surgery following massive weight loss? In general, it is best to delay body contouring until a stable weight has been reached for 3-6 months. In general, this corresponds to over 1 year after bypass or banding surgery. This maximizes the individual's nutritional status. Further, there are fewer complications and better appearing results when the surgery is performed at close to ideal body weight. World wide experience has shown smokers and diabetics are not good candidates for this surgery, but healthy individuals with a positive outlook can be extremely pleased and excited with their new body contours.
Abdominoplasty/Trunk Contouring
The appropriate variation of abdominoplasty is often the most dramatic change the massive weight loss patient experiences. The length and location of the scars vary greatly depending on the individual. It may only extend across the lower abdomen but it can extend around the side and then actually meet in the midline back depending on the areas and amounts of laxity. Extending around the side and back, the incision may merely be correction of a localized roll of skin. Shifted up on the flank and back it can address low back rolls or more effectively narrow the waist. Shifted down to the top of the buttock area, this extension of scar can be converted to a buttock thigh lift. If the tissues are not heavy and the skin is loose, a buttock thigh lift can lift well into the thigh even though the scar is around the top of the buttock. As to the front of the abdomen, Dr. Hubbard is happy to discuss a number of scar location options that may fit better with one's own particular clothing. Usually the muscle is tightened at the same time and often some liposuction is performed. Trunk contour can actually include even reverse abdominoplasty where skin is pulled up beneath the breasts. It is easy to become confused with so many names for these trunk contouring procedures such as "flank plasty", "around the world abdominoplasty", "belt lipectomy" and "extended abdominoplasty" among many others. These are merely variations on location of excision, amount of excision, and length of excision. Liposuction can be performed simultaneously to certain locations with these trunk contouring procedures and this adds to the surgical options. Remember, there is no standard or ideal skin excision pattern as every patient is unique in his or her location and distribution of excess bulging, sagging or slack skin. The planning and design of such a procedure is just as important as the actual surgery. It is important to know all your options and what your recovery will entail.
Armlift
An armlift, also known as brachioplasty, reduces excess sagging skin that falls downward when the arm is extended away from the body. Skin and often fat are removed from this area. The pattern of scar varies with the distribution and amount of excess skin. The fat is usually removed with liposuction techniques. If a large amount of fat remains in the arm following weight loss, a better result may be obtained by first performing liposuction with another body contour procedure and then months later excising the excess skin of the arm.
Breast Procedures
There is extreme variation in breast deformities following massive weight loss. Usually, a breast lift, also known as mastopexy, is indicated for optimal results. A breast lift can only reposition breast tissue and sometimes breast tissue is removed for shaping purposes. If there is a need for an increase in breast volume or improvement in flattening of the upper chest, a breast augmentation can be a wonderful compliment. This can be done at the same time as a breast lift or at a later time. The scar pattern for breast lift surgery in this setting can occasionally be limited to only around the areola in a purse-string type of lift. Usually though a lollipop or inverted T, also known as anchor scar pattern, is necessary for optimal shaping.
Facial Rejuvenation
Often sagging of the cheeks, jowls and neck result from massive weight loss. State of the art facial rejuvenation techniques can lead to dramatic return of long lost jaw lines and neck lines. Although this is referred to as a facelift, it rejuvenates the neck and jaw line as much as it does the face. Incisions are in front of and behind the ears and beneath the chin. A brow lift can be performed at the same time. A brow lift reestablishes a more rested appearance of the brow just above the bony rim of the eye socket and it often rejuvenates the upper lid at the same time. A brow lift can greatly improve the transverse creases of the forehead and frown lines.
The most optimal facelift for the massive weight loss patient addresses multiple layers of the face and the neck. Localized residual fat in the face and neck are removed while deep layers are tightened. This can be done safely and predictably with very natural results. Laser resurfacing greatly improves wrinkling of the eyelids and upper and lower lip as well as other areas as indicated.
Thigh Contouring
One can probably generalize thigh contouring procedures into two major categories: inner thigh procedures and outer thigh procedures also known as buttock-thigh lifts. Within these general categories many options exist. Entire regions of thigh skin can be lifted and tightened. With a buttock/thigh lift, the scar extends from the low abdominal area or groin all the way across the back to the other side. The amount of excision and exact location depend on the individual. Shifting the scar across the low back upward tightens the waist better, but transmits less pull to the buttock and thigh. Shifting the scar downward to the upper buttock may make it easier to cover with clothes and can potentially lift lower tissues more effectively. Laxity of the inner thigh is addressed with an inner thigh lift also known as a medial thigh lift. This scar extends from the buttock into the groin area as high up as possible so it can usually be concealed very well. Some individuals are best served with a vertical excision extending down towards the knee along the inside of the leg. Again the pattern and location of scars depend on the individual.
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