Surgery after massive weight loss

by Courtney Caplan, MD, DMD
Cosmetic Surgery Columnist

With the growing trends of athleisure, healthier lifestyles, and access to bariatric surgeries, I have more and more patients that come into my office wanting body contouring after massive weight loss.

These are some of my most favorite patients because they are some of the most compliant and disciplined by nature of their journey in losing weight. They also are very realistic with goals, and they have worked so hard to lose fat and build muscle. Now they need to help get rid of the loose skin.

Every individual is different in the areas that need the most help and in what bothers them the most. Many come to their consultation and ask, “Dr. Caplin; I don’t know where to start?” In those situations, I provide an algorithm of surgeries and interventions to achieve their goals.

To simplify, I would say my patients’ desires typically fall into one of two categories: shaping the core or contouring what’s visible to others.

The group of patients wanting to start by focusing on their core has the goal to have clothes fit better and be able to wear smaller sizes since they have lost the fat, but skin still gets in the way. When patients are focused on their core, we will often begin by evaluating the extent of loose skin.

Essentially, these patients will need a tummy tuck, (abdominoplasty) which removes the loose skin from above the belly button down below the bikini line. The skin above the belly button then gets pulled down to meet the lower incision leaving the abdomen smooth and tight.

However, many of my patients after massive weight loss have loose skin that does not stop at the abdomen but continues around their bodies. In these situations, I will often recommend what is The a body lift.

In a body lift the incision is carried a full 360 degrees around the body and then an entire belt of tissue is removed. In essence, it is three surgeries in one: a tummy tuck in the front, a thigh lift on the sides and a butt lift in the back.

I always recommend performing this surgery before any thigh lift surgery. Patients are amazed about how much thigh improvement they can achieve with this surgery. I often explain that it is like pulling up your pants in the back and tucking in your shirt on the front.

The breasts or chest are usually next on the list if not tied for first place. Where I practice (Cosmetic Surgery Affiliates), we have our surgery center dedicated to excellence and patient safety in cosmetic surgery, so we can combine service if patients should want to attack both the abdomen and the chest at the same time.

With evaluating the breast or male chest, the goals are similar in that we want the nipple and areolar complex to return to where it used to be and removed the sagging skin and gland. The shape is quite different for females and males, but the goals are like returning to how they used to look.

For women, we typically discuss performing a breast lift with or without an implant depending on the desired size. For men, we discuss either a male breast reduction or chest reconstruction to contour and recreate the masculine chest.

The other group of massive weight loss patients will start with what is visible to others. These patients often want to start with their necks to reestablish their jawlines or their arms to “get rid of their wings.”

Many options exist for treating the neck and arms and can range from simple skin tightening procedures like Vivace (micro-needling with radiofrequency heat) or liposuction with Renuvion (helium plasma and radiofrequency heat) to needing to excise the loose skin with a neck lift or arm lift. We determine the best treatment option after a conversation over the patient’s goals in combination with an examination of the patient.  

Treating massive weight loss patients is an honor. I feel so special to be a part of their weight loss journey and more times than not, and we become very good friends with them for several surgeries. There is no question they become a part of our Cosmetic Surgery Affiliates family.

Copyright The Gayly. 9/17/2019 @ 7:02 a.m. CST.