Liposuction after major weight loss

After a large weight loss the commonest disappointment is that the shape does not follow the number on the scale. Skin that has been stretched for years does not fully retract, and fat that remains is distributed unevenly. Liposuction addresses one of those two things.

Telling skin from fat

Pinch the tissue. Substantial thickness between the fingers is fat. Thin, papery tissue that folds is skin, and no amount of liposuction will improve it — removing volume beneath redundant skin makes it hang more.

Fat commonly persists at the lower abdomen, inner thighs, upper arms, lower back and flanks, and under the chin. Where it is deposited is largely genetic.

Timing

Wait until the weight has been stable — in the region of six months at a settled weight — and allow the skin the time it is going to take to retract, which is substantially longer than most people expect after the loss itself. Operating too early means operating on a shape that is still changing.

Nutritional deficiencies are common after bariatric surgery and after prolonged restriction, and they impair wound healing. Iron, B12, vitamin D and protein intake are checked and corrected before an elective operation, not after it.

What liposuction can and cannot do here

It can refine areas where fat has persisted and the skin quality is still reasonable. It cannot produce a large change where skin excess is the dominant problem, because the result depends on the skin contracting over the reduced volume.

The excisional operations

Abdominoplasty removes redundant skin and repairs separated abdominal muscle. The scar is placed low, to sit within underwear.

Brachioplasty removes redundant skin from the upper arm; the scar runs along the inner arm.

Thigh lift removes inner thigh skin through an incision in the groin crease.

Lower body lift addresses the full circumference of the waistline in one operation, and is the procedure for those with generalised redundancy after very large loss.

Breast surgery addresses the deflation and descent that follow major weight loss, with a lift with or without an implant.

Combining them

Liposuction and skin excision are frequently combined, with each used where it is appropriate — fat removed from one zone, skin excised from another. Where the total operating time would be excessive, procedures are staged, because operative time is itself a risk factor.

Recovery

Combined procedures are considerably more than liposuction alone. Drains are often used and stay in for a period. The early days need pain relief and short, frequent walks to reduce thrombosis risk. Compression is worn throughout. Desk work returns after a couple of weeks, exercise in stages from around six, and normal training between eight and twelve. Residual swelling and scar maturation continue across the first year.

Scars

Incisions are placed in creases and where clothing covers them, but excisional body contouring trades skin for scar and that is the bargain being made. Silicone gel or sheeting, sustained sun protection for at least a year, and massage once healing allows all improve the final appearance.

Risks specific to this group

Complication rates are higher after major weight loss than in the general population, chiefly because of nutritional status and the extent of the surgery. Seroma is common. Wound healing problems are more likely with poor nutrition, a smoking history or diabetes. Venous thrombosis is a real risk and is why early mobilisation and compression stockings are insisted on.

Expectations

Body contouring improves proportion. It does not produce a body that looks as though the weight was never gained, and it does not remove the need to maintain the loss. Several procedures over a period are usual rather than exceptional.