Body Contouring After Weight Loss

Losing a substantial amount of weight is the hard part, and it is not always the last part. Skin that has been stretched for years frequently does not retract, and no amount of further diet or exercise makes it do so.

Surgery is not a shortcut and it is not for everyone. It is for a specific situation: excess skin, at a stable weight, in someone well enough to have an operation.

Who is a candidate

The assessment is individual and requires a consultation with a board-certified surgeon. In general terms, a good candidate has:

• Achieved substantial weight loss and held a stable weight for a sustained period.
• Loose skin at the midsection, thighs, upper arms or breasts.
• General health adequate for surgery.
• Realistic expectations of what the result will look like — including where the scars will be, which after this kind of surgery are long.

Weight must be stable first. Operating before then means removing skin that will need removing again.

Which procedures

Abdominoplasty Removes excess abdominal skin, tightens stretched abdominal muscles where they have separated, and repositions the navel. The most commonly performed of the group.

Breast lift (mastopexy) Raises and reshapes breasts that have lost volume and position. Frequently combined with implants where volume as well as position has been lost.

Arm lift (brachioplasty) Removes excess skin from the upper arm, often combined with liposuction.

Thigh lift (thighplasty) Removes excess skin and fat from the thighs.

Surgeons often recommend combining procedures — abdominoplasty with breast lift, or arm lift with thigh lift — where recovery periods can sensibly overlap. Whether that is appropriate depends on total operating time and your general health.

What patients report

Excess skin is not only an appearance problem. Patients describe rashes and chafing in skin folds, hygiene difficulties, restricted movement, and clothing that does not fit a body that has otherwise changed substantially. Removing the excess addresses those directly.

Risks

The risks are the usual surgical ones, with two of particular relevance after massive weight loss:

• Poor wound healing, because skin quality and vascularity are frequently compromised after prolonged stretching and rapid loss.
• Scarring, which after this kind of surgery is extensive by necessity. Where the incisions will run should be discussed and understood before you consent.

Also: infection, bleeding, blood clots and complications of anaesthesia.

Nutritional status matters here more than in most elective surgery. If your weight loss followed bariatric surgery, your nutritional bloods should be reviewed before an operation is planned.

Recovery

Varies by procedure, from several days to several weeks away from work and normal activity. Following the post-operative instructions is what determines whether the wounds heal cleanly, and after this kind of surgery that margin is narrower than usual.

The conclusion

Not everyone who loses weight needs surgery. For those left with significant excess skin, it is generally the only thing that addresses it. The way to find out which group you are in is an examination by a surgeon who does this regularly.