Body Contouring After Massive Weight Loss
Many terms are used to describe the surgical procedures that are performed for massive weight loss patients. The areas that are affected most often are the arms, breasts, abdomen, buttocks, thighs, face and neck. After a patient has reached a plateau in their weight loss, which usually occurs approximately 18 months after their bariatric procedure, they can begin to pursue body contouring. When I assess a patient for body contouring after massive weight loss we have a thorough discussion about your areas of concern and attempt to determine an order of importance. What is most important to you may be less important to another. I have had patients who only want their arms corrected and others who only want to address the tummy, while others have three or four body parts contoured. The point being that each individual has different needs and desires, all of which are part of the discussion we have at your consultation.
Following massive weight loss, the skin of the abdomen is affected more than any other body part. Although some retraction may occur, patients usually end up with over-hanging skin that may be as cumbersome as it was prior to losing the underlying fat. The issues of skin irritation and rashes in the folds may still be present as well. The deepest portion of the abdominal wall is also affected since most patients lose considerable intra-abdominal fat in addition to the fat directly under the skin. This results in a weakened and bulging tummy that can only be corrected by surgery at the time of the body lift or tummy tuck. It is referred to as diastasis recti which means that the “six-pack muscles” have been spread apart in the midline. As you can see, every layer of the torso is addressed to provide a greatly improved circumferential contour.
The term “body lift” in my practice means a circumferential, lower body lift which addresses the abdomen, buttocks and outer thighs. Other terms used to describe a similar procedure include donut lipectomy, belt lipectomy and torso lift. The torso lift is the most accurate of the alternate terms because the lift portion is an important component compared to the donut and belt lipectomies. The lower body lift in my practice not only removes a substantial amount of circumferential skin and fat, but also elevates the buttocks and thighs eliminating loose, sagging skin on the lower extremities. The result is a tightening of the torso and upper thighs from below the breast to the knees. When patients ask which procedure I recommend they have first I usually say the lower body lift because it provides the most dramatic improvement over the largest area. It will allow you to exercise more efficiently and help to ensure that you maintain your target weight by doing so. In addition, it will also dramatically change the way you fit into your clothing so that you can start realizing more of the benefits of massive weight loss.
What’s The Difference?
The Consult
I tell all of my massive weight loss patients that once you are a patient of mine we become a team working together to help you achieve the final endpoint of the journey that started with your decision to lose weight. At the time of your consultation, all areas of concern will be examined for laxity. If a diastasis recti or hernia is present, it will be repaired at the time of your surgery. All of the details of the procedure will be discussed including the location of your scar, the routine on the day of surgery, what to avoid immediately before and after surgery, and things you can do to optimize your result.
Many photos are available as are past patients to whom you can speak for support if you desire. If you decide to have surgery, you will receive paperwork detailing pre- and post-operative instructions, consents, prescriptions and everything else you might need to make the procedure as stress-free as possible. Together we will plan your procedure so as to restore the form and function you are seeking.
Body Lift FAQs
A lower body lift takes approximately four to five hours to complete. You then spend several hours in the recovery room until you are fully awake and are then transported to your room. I only perform these cases as the first case of the day given the length of surgery. Later that afternoon you will be allowed to eat and drink and will be required to take several short walks in your hospital room or hallway. By requiring you to be out of bed we greatly reduce the risk of deep vein thrombosis (blood clots) and also decrease your pain by preventing muscle spasm. You will have several drains in place, as well as mildly compressive garments to make you more comfortable and help decrease swelling during the early portion of your recovery. By the next morning you will be feeling much better, ambulating more readily and tolerating more food and liquids. Over the last 8 years, ninety percent of my body lift patients are discharged on the day after surgery. Patients that have pre-existing medical conditions or are uncomfortable may stay an extra day or two if necessary. Prior to discharge you will be instructed as to how to care for your drains and thorough discharge instruction sheets will be provided.
Body lifts are performed under general anesthesia. This is the safest method and allows you to receive medications to minimize your pain and any anxiety you may have surrounding the time of surgery. Multiple agents are administered to prevent nausea and vomiting so you should not be concerned about that being an issue postoperatively. You will wake up gradually and sleep in the recovery room for several hours and before you know it you will be up and able to begin eating and drinking.
You will have a moderate amount of discomfort the first few days, but it improves quickly as you begin to become more active. Until you are able to take medication orally, intravenous pain medications will be administered by your nurses. By the next morning you will be taking a combination of medications by mouth to maximize your comfort. I encourage you to take whatever you need during those first two or three days to be comfortable so that you can mobilize and gradually increase your activity. The most important thing to remember is to take what you need prior to the onset of pain. Most patients are able to manage their pain with Tylenol or Advil within a day or two after surgery but you will also have narcotic analgesics prescribed until you no longer need them.
I require you to walk several times the evening of surgery. The most important thing you can do to minimize pain and decrease the risk of complications is early ambulation and keeping yourself well-hydrated. Within 2-3 days you will no longer be hunched over and can walk completely upright. I tell my patients to act as if they had a bad cold, meaning you still remain active but get as much rest as you can. I encourage you to resume light exercise within a few days and even allow you to walk around outside or on a treadmill if you desire. After six weeks I remove all restrictions and you can do as many sit-ups or run a marathon if you wish. Once your drains are removed you can begin swimming or using a hot tub.
The incidence of major complications from lower body lifts in my practice is exceedingly low and certainly below 1%. The most common complication is a collection of fluid that needs to be drained in the office; perhaps 5% of my body lifts require this. It is painless to drain and usually resolves after being drained once. Other complications include infection and bleeding but are, as I mentioned above, exceedingly infrequent. As with all of my procedures, we make sure you are cleared by your regular physician and check all pertinent lab work that may be indicated. The national data reported by plastic surgeons demonstrates a blood transfusion rate in this type of surgery approximately 20-25% of the time. Over 8 years of performing these procedures less than 5% of my massive weight loss patients have required a transfusion.
All body lifts require an overnight stay and are performed at the main campus of The Elliot Hospital. The operating room staff is very experienced in these complex procedures and every effort is made to make your procedure flow as smoothly as possible. Your markings will be completed in the comfortable office setting the afternoon prior to surgery since it takes approximately 30 minutes to do. This is done so that you can relax the morning of surgery and not have to worry about standing for an extended period of time.
Your first visit is one week after discharge from the hospital. Then you are seen weekly until your drain is removed and at 3, 6 and 12 months, all included in the cost of surgery.
Photos can be seen here (many more are available in the office):
