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Body-Contouring Surgery After Significant Weight Loss

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


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