Losing a large amount of weight (100 pounds or more) as a result of weight
loss surgery or through diet and exercise is a major accomplishment that will
enhance your health, your outlook on life, and your appearance.
Many people who have achieved great weight loss can be left with large
amounts of heavy, loose folds of skin around the abdomen, arms, thighs, breasts,
buttocks and face. Skin can sag and lose elasticity as a result of being
stretched for a long period of time. After significant weight loss, the skin
often fails to shrink back to its former size and shape.
Problems of excess skin
Excess skin can make getting dressed a chore, limit mobility, and cause
hygiene and medical problems. Chronic skin-on-skin contact can result in rashes
and other sores that can lead to infection. In addition, excess skin can be a
cosmetic issue. People who have lost a large amount of weight often want their
bodies to reflect the new, more positive image they have of themselves. Many
times, the only way to remove excess skin left after extensive weight loss is
through body-contouring plastic surgery.
Is body-contouring surgery right for me?
The best outcomes from contouring surgery are achieved when these important
criteria are met:
Weight trend: Has your weight been stable for at least a year with no
further weight loss expected? For optimal results, body contouring should not be
done for approximately 2 years following the start of any massive weight
loss program. This time allows the skin to shrink as much as possible and
your nutrition to be stabilized and optimized, factors that will aid in your
recovery.
Overall good health: Are you in good health overall? Do you have any
chronic medical conditions, such as diabetes or heart disease? People in
poor health are not good candidates for body-contouring procedures. Each
patient should see his or her primary care physician for approval to proceed
with surgery.
Nutrition: Do you have a healthy diet? Problems such as protein
deficiencies can interfere with healing after surgery.
Smoking history: Smoking slows down the healing process and increases
the risk of serious complications during and after surgery. You must quit
smoking 6 weeks prior to surgery.
Psychological status: Contouring procedures require mental stamina.
Are you psychologically prepared?
Expectations: Realistic expectations are a must. Surgery will lead to
marked improvements in your shape, but it is impossible to restore the skin
or body to what it would have been without the weight gain or to what it was
in your teens or 20s. Even after body-contouring surgery, skin continues to
sag over time as part of the normal aging process.
Risks and side effects of surgery
Most body-contouring procedures involve making an incision in the least
obvious part of the area to be trimmed, removing excess skin, and suturing the
area with fine stitches to minimize scarring. With these types of procedures,
scarring is unavoidable. Liposuction may be used in conjunction with some procedures.
Because of the significant amount of skin to be removed during contouring
surgery, there are greater associated risks than with standard cosmetic surgery.
Risks include:
- Bleeding
- Infection
- Separation of incision
- Skin laxity (looseness)
- Skin necrosis (tissue death)
- Abnormal scar formation
- Formation of a seroma (a mass or lump caused by fluid buildup in a tissue or organ)
- Asymmetry (unbalanced appearance)
- Unsatisfactory results
Rare risks include:
- Deep vein thrombosis (blockage caused by restriction in a vein, possibly
leading to the formation of a clot)
- Pulmonary embolism (blood clot in the lung)
- Myocardial infarction (heart attack)
- Pneumonia
Side effects include:
- Swelling
- Bruising
- Soreness, pain
- Numbness
- Scars
- Depression
Multiple surgeries may be needed
Skin reduction is done in stages to minimize complications such as infection
and blood loss, and is often done over a period of years as one or two areas of
the body are addressed at a time. Also, touch-up surgeries are often required later.
Your surgeon will make recommendations about the best strategy to address all
of your needs in the safest and most efficient manner.
Areas of attention
These are the areas of the body most often treated through body contouring
after great weight loss. Your surgeon will work with you to identify areas that
are the most problematic or bothersome to you.
Abdomen: Also known as a "tummy tuck," abdominoplasty
involves removing excess skin and tightening of the underlying abdominal
muscles. An incision is made just above the pubic area from hip to hip,
occasionally extending to the back. Sometimes a vertical incision is
necessary, too. You and your surgeon may determine that you need only a
panniculectomy, which is simply the removal of excess skin. Having the
abdominal muscles tightened or extending the incision to the back is most
often considered cosmetic and is not usually covered by insurance. At times,
an abdominal hernia may be found. Hernias up to a certain size can be
repaired at the time of the abdominal procedure for removal of excess skin.
However, your surgeon will refer you to a general surgeon if the hernia is
too large to be repaired during the abdominal procedure.
Buttocks/upper thighs: A body lift, or belt lipectomy, is a procedure
to remove skin and lift the thighs and buttocks. This is usually performed
as a continuation of an abdominal procedure. The incision is made in the
belt area in the upper hips and excess skin is removed below the incision.
Thighs: A medial thigh lift, designed to remove excess skin from the
upper leg, involves an incision along the inner thigh starting at the groin
and extending as far as the knee.
Breasts: A number of breast procedures are available, including
breast lift with or without augmentation (enlargement with implants) and
breast reduction. To remove excess skin, incisions can be made vertically
down the center of the breast. Sometimes incisions are made underneath the
breast in the form of an upside-down "T."
Arms: In surgery to remove excess skin from the arm (brachioplasty),
an incision is made starting at the armpit and extending to the elbow.
Sometimes this procedure can be combined with a breast procedure.
Face and neck: Removing excess skin around the face or neck after
weight loss is akin to a traditional facelift, except that more skin is
removed. As a result, incisions need to be planned very carefully. One
incision is made in front of the ear, while another follows the hairline.
A combination of surgeries may be done at the same time, as long as safety
can be maintained. An "upper body lift" may include a combination of
surgeries to the arms, back, and breasts/chest. A "lower body lift"
may include combination surgeries to the hips, thighs, abdomen, and buttocks.
The exact procedures to be performed at one time will be individualized by the
plastic surgeon and patient.
How long is the recovery time?
All surgeries are performed in the hospital under general anesthesia, and
most patients stay in the hospital one to four nights. After surgery, tubes are
usually placed in the wound to drain excess fluid, and medications are given to
control pain and discomfort. A certain degree of soreness, swelling and bruising
for two to three weeks after surgery is normal.
Most people can return to work after two to four weeks, but people with
physically demanding jobs need to wait at least three weeks. During this
recovery period, you will return to your doctor’s office regularly to monitor
your progress.
Will insurance cover body-contouring surgery?
Insurance companies usually do not cover body-contouring surgery because they
consider it cosmetic. In addition, insurance companies might not pay for
treatment of any complications that can result from the surgery. It is important
for you to check your insurance benefits if you are considering body-contouring
procedures. Your surgeon’s office can give you estimates of how much you can
expect each procedure to cost.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/22/2010…#13588
