Body Contouring After Massive Weight Loss Surgery

Why do patients want body contouring?

Patients can have gross fluctuations of weight after bariatric surgery (weight loss surgery), lifestyle changes due to diet and exercise or after multiple pregnancies. With fluctuation in weight the amount of fat content decreases. However the skin may not contract proportionally with the decrease in fat content as the elasticity of the skin reduces . The damaged elastin in the skin can be seen as the stretch marks which are very commonly visible in the abdomen of women with multiple pregnancies.

The excess skin may manifest as deflated folds in the abdomen, chest, breast, arms, face and thighs which do not look nice and can prevent one from wearing many nice dresses of their choice.

With multiple folds, there can be some skin excoriation and fungal infection underneath the folds due to the moisture which can be very uncomfortable for the patient.

Even though the weight loss would have made them healthier by reducing their high blood pressure and controlling the blood sugar, they appear older and unhealthy due to the weight loss. When people comment that they don’t look good, the patients tend to again start eating more and getting their additional weight on again.

Some patients have fat deposits in some parts of the body which do not go away even with strenuous diet and exercise which some people would like to get rid of.

Can body contouring be used to reduce weight?

Body contouring surgery is not used to reduce weight. This surgery is used to make people look better. By this procedure the patient may reduce only by 0.5 kgs to 2 kgs depending on the amount of tissue that we remove. Weight reduction is better done by maintaining strict diet ,exercises and bariatric surgery where the surgical gastroenterologists decrease the size of the stomach or they prevent the food from getting absorbed.

Although I have reduced weight, I have localised excess fat in certain places that I am unable to remove with diet and exercises. What can I do?

For localised excess of fat which are resistant to diet and exercises as in the sides of the abdomen or the hips liposuction can be done. Here a small incision of 5 -10 mm is made and the excess fat is sucked out. Liposuction is done only when the skin tone is good as in young people who have not had much fluctuations in their weight. This is because after the fat has been removed we depend upon the good skin tone to contract back to give a good shape. If the skin tone is not good, then we may excise the excess skin and fat to give a better contour.

Who are good candidates for body contouring procedures?

Patients are considered to be good candidates for body contouring procedures if

They have a stable weight for at least 6 months. Patients who put on weight after the procedure may not have a good lasting result and lifestyle changes such as healthy diet and exercises are to be continued after the surgery as well.

Patient should be healthy with adequate haemoglobin, proteins and nutrients. Patients who have health problems are asked to get their health problems sorted out before undergoing surgery

Patients who have lost a lot of weight and have a BMI( Body Mass Index) of less than 30. Patients who are overweight might need to further decrease the weight before they go for body contouring procedures.

Having lost a lot of weight I have multiple folds of skin in my face, chest, breast, arms, abdomen and thighs. How do I correct them and in what order do I correct them?

With weight loss there is generalised decrease in the fat content in the body. This results in multiple folds of skin throughout the body such as in the face, neck, chest, breast, arms, abdomen and thighs. This may need multiple surgeries and the order is also important. We would like to do surgeries which addresses many deformities in one time. We examine and talk to the patient about what they are most bothered about and we do the surgeries accordingly. Sometimes patients may want only one part to be corrected. They are free to choose what they want and we will not force them. We will explain the pros and cons of each decision and make the patient choose what they want. Generally the order in which we would like to do the procedures are

1. Lower Body Lift :- Here the excess skin and fat is removed circumferentially around the lower abdomen. This will improve the abdomen both in the front and the back. This will also lift the sagging buttock and the lateral aspect of the thigh. Some folds in the upper back and in the side of the body may also improve with this procedure. As this procedure improves a lot of areas we tend to do this first as we feel that just this procedure will make other procedures easier to do and some patients do not want correction in other areas.

2. Upper Body Lift :- Here the excess folds in the arms, armpits and the sides of the body are removed. The sagging breast is corrected by doing a breast lift.

3. Facelift, necklift ,blepharoplasty and fat injections to the face :- With loss of weight the multiple folds in the skin make the patient look old, tired and unhealthy. In this procedure fat injections are done to the central part of the face to give the youthful look and the excess skin is removed from the cheek, neck and the eyelids. While doing so the muscles in the face and neck are also slightly tightened to give a good youthful look. The excess skin over the eyelids are also removed. Many patients are happy with this because the excess skin over the eyelids can block a part of their vision.

4. Breast lift and Augmentation:- With excess skin over the breast and with loss of fat, the breast is not only sags, but many feel it unattractive. This is corrected in 2 stages.Breast lift is initially done