Body contouring is a general term that refers to any surgical procedure that alters different areas of the body, whether it is in a massive weight-loss patient or not. Body contouring after massive weight loss refers to a series of procedures that eliminate and/or reduce excess skin and fat that remains after obese individuals lose a significant amount of weight, in a variety of places including the torso, upper arms, chest, and thighs.
In response to a serious obesity crisis, medical science has devised a handful of bariatric (obesity treatment) surgeries, including gastric bypass, stomach stapling, lap banding, stomach reduction and other techniques that reduce the amount of food the stomach can hold. Usually, by 18 months after the surgery, patients report having lost anywhere between 45 to 136 kg (100 to 300 pounds).
Food-restriction operations to the stomach have several side effects. One such undesirable side effect that is very bothersome and visible is the loose, hanging skin that covers much of the patient’s body. Because hundreds of pounds have stretched the patient’s skin to the maximum, it has lost its elasticity and the ability to spring back. Instead, the newly slimmed patient must deal with so much extra hanging skin, he or she can actually stumble on an overhanging panniculus – the large apron of skin hanging from the stomach that can cover the pubis and groin areas. Notably, many extra inches of floppy skin can hang from the upper arms, the chest, the stomach, the upper thighs and buttocks.
Most people who have lost massive amounts of weight complain about the difficulty of getting their fleshy arms into sleeves and their excess stomach skin tucked into clothing. Many say that sitting on the loose skin is like sitting on Jell-O. Most women in this state condition require a mastopexy, or breast lift, often in conjunction with breast implants. Men who have body shaping surgery usually undergo male breast reduction surgery to remove the pendulous skin hanging from their chests.
The extra rolls and sheets of skin rub against each other, creating many spots of irritation and leading to hygienic difficulties. The masses of excess skin also make any form of exercise difficult.
It usually leaves long, visible scars on the arms, chest, stomach and legs. Most surgeons break the surgical task into an upper, and a lower, body lift. A lower body lift removes the sagging skin on the back, abdomen, buttocks and thighs while the upper body procedure removes loose skin from the arms, breasts and chest.
Potential risks and side-effects
Body lifting is not lightly undertaken. The process requires a commitment on the part of the patient who must stay with the program through bariatric surgery, during the 18 months required for weight loss, then the body contouring procedures and recovery. Often, beginning to end takes three years. A single body lifting operation can require seven to 10 hours. Plastic surgeons advise patients that body shaping is not an obesity operation. A patient who is more than 50 percent over his or her ideal weight must first drop as many kilograms as possible before proceeding. The hospital stay for the procedure can require from one to four days while recovery can require about a month for a total body lift. Essentially, the patient trades “skin for scars”. But skin relaxation is always a risk and may not be stopped with a single procedure.
Body lifting surgical procedures
While body shaping can be done in one marathon session, it is usually broken into one to three surgical stages, with the patient under general anesthesia. But if the patient is a smoker, has a history of deep venous thrombosis or clotting disorders along with a high BMI and other medical risk factors, the surgeon will probably insist on doing several short procedures in a hospital setting to insure maximum safety for the patient.
The following are the individual components of body contouring:
Arm lift or brachioplasty. The extra flesh on the arms of bariatric patients virtually always appears on the underside of the upper arm and is sometimes referred to as “bat wings”. Surgeons make incisions made from the armpit to the elbow to remove the skin and create a more pleasing contour. Consequently, surgeons open the arm on its underside so that the resulting scar is fairly well hidden. An arm lift procedure can employ some liposuction after the incision is made. With the arm opened, the surgeon pulls the skin tight and then trims away the excess skin which, depending on the patient, can be a pound of skin per arm or more.
Breast lift or mastopexy. By trimming excess tissue from the upper breast, the surgeon can move breasts which usually droop to the umbilicus to a more upright and full position. The procedure also often requires an implant to make up for lost fat and tissue inside the breast. Scars on women are almost always hidden inside the area covered by the bra.
Stomach lift or abdominoplasty. Excess skin hanging down over the pubic region is often the distorting feature that most concerns and bothers patients. The stomach pannus retains moisture, and causes rashes due to skin rubbing against itself which usually leads to poor hygiene. While the surgical procedure to remove it is known as a panniculectomy, there is often more work to be done for patients who suffer from large amounts of hanging skin. To provide improved contours on the waist, back and flanks, surgeons sometimes perform a belt lipectomy, (also known as a torsoplasty or a circumferential lipectomy). The incision goes all the way around the patient’s midsection at the level of the lower waist. The surgeon uses more liposuction on the stomach and flanks while trimming excess skin from the patient’s back and sides as well. The abdominoplasty and belt lipectomy incisions are placed so that the resulting scar is hidden within most underwear and swimsuits.
Lower body lift trims excess skin on the buttocks and thighs. For an inner thigh lift, the surgeon makes an incision high on the inner leg, starting near the groin and continuing down to the knee. Some fat may be removed with liposuction. The surgeon then removes excess skin and redrapes the remaining skin before closing the long incision, leaving the patient with tighter and more attractive thighs.
The outer thigh and buttock can be lifted through a hip-to-hip incision across the back, above the buttocks.
While considered major surgery, the outcome of body shaping can require several months to see the full effects of the procedure.
Most body lifting patients return to non-strenuous work in about two to three weeks.
Except for arm lift, virtually all body shaping procedures require the patient to wear a support or compression garment for two to six weeks. The garment speeds and aids in healing.
Patients can usually drive again within one to three weeks, depending on the extent of the surgery, their health and general robustness.