New York City · Body Lift

Central Park Plastic Surgery^{SM .} New York ^. New York City ^. Manhattan ^. E-mail ^. 212.496.6600

Dramatic weight loss, whether achieved by proper nutrition and exercise, or as the result of bariatric surgery, or from other forms of medical treatment, has many benefits. However, once you reach your weight loss goals, you may find that you still don't have the fit and healthy body image you desire. Skin may be loose, sagging, and in many cases, your body contours may appear irregular and disharmonious.

If you have undergone dramatic weight loss that has resulted in excess sagging skin, surgical body contouring may be right for you. In general, body contouring following major weight loss reduces excess fat and skin that has developed in multiple areas of the body. The result of surgery is a smoother, more attractive body contour. Body contouring after major weight loss is an important and rewarding phase of your challenge to have a healthier, more proportionate body, and can help you further enhance your body image and self-confidence.

What is body contouring following major weight loss?
The condition of being significantly overweight can cause stress on your health in many ways. If your physical activity has been limited due to your overweight condition, you may have weak muscle and skin tone, and your skin may be severely stretched.

Bariatric surgery, sometimes called gastric bypass surgery, is one method of major weight loss for individuals clinically defined as obese. Following weight reduction surgery, or any substantial amount of weight loss, the skin and tissues often lack elasticity and cannot conform to the reduced body size. As a result, skin that has been severely stretched now is unsupported, and begins to sag in pockets that most commonly develop around the:

• Face, neck and jowls, resulting in a droopy, sad appearance
• Upper arms, resulting in a bat-wing like appearance
• Breasts, causing them to flatten and hang with nipples pointed downward
• Abdominal area, extending around the sides and into the lower back area, resulting in an apron-like overhang
• Buttocks, groin and thighs, causing hanging pockets of skin

Weak and sagging skin that becomes macerated (wet or infected) is not only unattractive, it is also a serious threat to your health that must be treated.

Surgical body contouring following major weight loss improves the shape and tone of the underlying tissue that supports fat and skin, and removes excess sagging fat and skin. The result is a more normal appearance to the body, with smoother contours. This is, in essence, the final phase of your total weight loss experience.

However, before you decide to undergo body contouring following major weight loss, it is important to understand that your weight loss must have stabilized. If you continue to lose weight, sagging pockets will redevelop. If you rapidly regain the weight you have lost, you will traumatically stress your already weakened and thinned skin, causing further stress to the skin, visible stretch marks and wide scars. If you have had weight reduction surgery, your plastic surgeon will work closely with your physician to determine when it is appropriate for you to begin body contouring.

In general, good candidates for body contouring are:

• Adults of any age whose weight loss has stabilized
• Healthy individuals who do not have medical conditions that can impair healing or increase risk of surgery
• Non-smokers
• Individuals with a positive outlook and realistic goals for what body contouring can accomplish
• Individuals committed to leading a healthy lifestyle including proper nutrition and fitness

Where do I begin?
A consultation with your plastic surgeon is the first step to learn how body contouring following major weight loss can help you achieve better health and an improved appearance. A consultation is designed to fully educate you about body contouring in a non-pressured environment, and will include:

• A discussion of your goals and an evaluation of your individual case
• The options available in body contouring surgery
• The likely outcomes of body contouring procedures and any associated risks or potential complications
• The course of treatment recommended by your plastic surgeon
• Your plastic surgeon will also answer your questions.

Evaluation
Overall health and personal outlook can greatly impact the outcome of your surgery. These will be carefully evaluated in your consultation with your plastic surgeon. The success of your procedure, safety and overall satisfaction require that you:

• Honestly share your expectations
• Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
• Commit to precisely following all of your plastic surgeon's instructions

Safety
By making the decision to consult with your plastic surgeon and following all the instructions given, you are taking an important step in helping to assure your safety.

Your plastic surgeon is certified by The American Board of Plastic SurgeryŽ or The Royal College of Physicians and Surgeons of CanadaŽ. This certification designates surgeons who are specifically trained in plastic surgery of the face and entire body.

My body contouring
Your body contouring following major weight loss will be individualized to your specific conditions and the regions to be treated. The procedures necessary to achieve your goals will be defined along with a plan for the timing of these procedures. Specific plastic surgery procedures that may be recommended for your body contouring include:

• Facelift: to reduce sagging of the mid-face, jowls and neck
• Breast lift: to correct sagging, flattened breasts
• Tummy tuck: to correct the apron of excess skin hanging over your abdomen
• Lower body lifts: to correct sagging of the abdomen, buttocks, groin and outer thighs
• Medial thigh lift: to correct sagging of the inner, outer and mid thigh
• Brachioplasty: to correct sagging of the upper arms

Information on all of these procedures is available. Ask your plastic surgeon for information on any procedure recommended for you.

You must accept that all body contouring requires incisions to remove excess skin. In many cases, these incisions may be extensive. Incision length and pattern depend on the amount and location of excess skin to be removed, as well as personal preference and surgical judgment. Advanced techniques usually allow incisions to be placed in strategic locations where they can be hidden by most types of clothing and swimsuits, but this is not always the case.

Body contouring following major weight loss is often performed in stages. Your conditions, goals, health, safety and comfort as well as the surgical judgment of your plastic surgeon will define a surgical plan for you. While it may have taken you two years or more to lose all the excess weight, it may take equally as long for the results of your body contouring to be complete.

In addition to preparing yourself for stages of contouring and recovery following procedures, you must also accept that a single procedure to treat a specific area may not achieve your results. Uneven contours can develop following your body contouring surgery, and in some cases, skin elasticity is so poor that relapse of sagging skin is possible.

Preparing for surgery
Your plastic surgeon will carefully explain your body contouring plan. Prior to any surgery, you will be given specific instructions that may include:

• Pre-surgical considerations, diagnostic testing and medications
• Day of surgery instructions and medications
• Specific information related to the use of anesthesia
• Postoperative care and follow-up

In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the procedure or procedures you will undergo and any associated risks or potential complications.

Possible risks of body contouring following major weight loss include bleeding, infection, fluid accumulations, delayed or poor wound healing, skin loss, blood clots, excessive or widened scars, numbness and other changes in skin sensation, and irregular or asymmetric contours or scars. Any surgery carries risks associated with anesthesia. These risks and others will be fully discussed prior to your consent.

It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcomes or preoperative stress. Discuss these feelings with your plastic surgeon.

What to expect
Body contouring procedures may be performed in your plastic surgeon's accredited office-based surgical facility, an ambulatory surgical facility or a hospital, possibly with an overnight hospital stay. Procedures are most commonly performed under general anesthesia, although local anesthesia with sedation may also be used. These decisions will be based on the requirements of your specific procedure and considerations of patient and surgeon preference. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.

Following surgery
Once your procedure(s) are completed, dressing or bandages may be applied to your incisions. Areas of the body that have been treated may be wrapped in an elastic bandage to minimize swelling and to support your new contours as you heal. Small, thin tubes may be temporarily placed under the skin to drain excess fluid or blood that may collect. Before you are released, you and an accompanying caregiver will be given specific instructions that may include:

• How to care for the surgical site and drains
• Medications to apply or take orally to aid healing and reduce the potential for infection
• Specific concerns to look for at the surgical site or in your general health
• When to follow up with your plastic surgeon

Progress and healing
Initial healing will include swelling at the incision sites. Discomfort is common and can be controlled with medication. You will be instructed to return to light walking as soon as possible to minimize the potential for blood clots and other complications.

In many cases, you will be instructed to avoid bending, straining or lifting for several days to weeks. Where tightening of the abdomen or thighs is involved, your plastic surgeon may also instruct you to avoid standing fully upright and stressing any internal sutures as they heal, and to sleep with pillows elevating your knees. Follow all instructions carefully - this is essential to the success of your outcome.

Initial wound healing may take 7 to 14 days, after which time sutures will be removed if necessary. You will be ready to return to work and normal activity in a few weeks, so long as you do not engage in any heavy lifting or vigorous exercise.

Healing will continue for many weeks as swelling resolves and incision lines continue to improve. Numbness and a firm feeling over the skin's surface will improve over time. Once you have completely recovered from one series of procedures, it may be time to begin preparing for additional procedures to target other areas of the face or body. You must practice diligent sun protection until the healing process is fully complete. It may take a year or more following a given procedure for incision lines to refine and fade to some degree. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.

Results and outlook
The results of a body contouring following aggressive weight loss are visible almost immediately; however, it may take as much as one to two years, or more, for the final results of all the recommended body contouring procedures to fully develop. Visible scars are something you must accept in your goals to achieving a body contour that matches your new body weight and proportion. The results of body contouring following major weight loss generally are long lasting, provided that you maintain a stable weight and general fitness. As your body ages, it is natural to lose some firmness. However, most of your initial improvement should be relatively permanent.

© Copyright 2004, American Society of Plastic Surgeons

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