Post Bariatric Body Contouring
Obesity is a significant medical problem that has been considered an epidemic across the United States. There are many methods of weight loss including:
- Lifestyle changes like diet and exercise
- Support groups such as weight watchers® and 12 step programs (Overeaters Anonymous(OA))
- Medications which act as on absorption of fats and appetite suppressants
- Bariatric surgery (Lap Band, Gastric Sleeve, Gastric Bypass, Duodenal Switch)
Successful, long term weight loss programs use a combination of these methods to positively change the health and lives of these patients. Bariatric surgery has been shown to be a very important component in the recovery of the obese patient. Successful bariatric surgery enables the patient to lose a significant amount of weight which has been shown to improve multiple health markers including Body Mass Index (BMI), diabetes, arthritis, and cardiovascular disease.
Self-image is a very important part in recovery process after weight loss. This does relate to internal emotional stability, though it is difficult after weight loss because patients are often left with the problem of significant hanging, excess skin. This excess skin can cause medical issues such as fungal rashes and postural difficulties, and it can affect clothing selection and self-confidence. As part of the recovery of the obese patient, removal of excess skin can be medically indicated for the treatment of refractory rashes, open wounds, and postural changes from hanging skin folds.
What are my options?
Body contouring after massive weight loss is commonly performed on the abdomen and chest, though may include the arms, the thighs and the back. Body contouring procedures can be combined into one operation with one recovery, however only selected procedures can be combined at one time. Medically indicated procedures include a panniculectomy which removes hanging abdominal skin and a breast reduction which can remove heavy, sagging breast tissue. Other procedures, like brachioplasty, abdominoplasty, body lifts and thighplasty are not typically looked at as medically indicated. Common indications for body contouring after massive weight loss:
- Weight loss greater than 60 to 100 lbs, either through diet and exercise or after bariatric surgery (Lap Band, Gastric Sleeve, Gastric Bypass, Duodenal Switch)
- Significant excess skin with skin hanging below the pubis
- Recurrent skin rashes which are difficult to treat and are refractory to topical anti-fungal and steroid creams
- Difficulty fitting into clothing because of the hanging, excess skin
- Postural difficulties and difficulties exercising because of the excess skin
Body contouring after weight loss can help tighten and contour areas which have sagged and flattened. Patients, both men and women, should be healthy, non-smoking and at a stable weight for greater than 6 months prior to considering any body contouring procedure.
The post-bariatric patient should be very mindful about the importance of nutrition in and around the time of any body contouring procedure. Bariatric surgery does restrict and/or cause malabsorption of nutrients which is the purpose of the procedure, though with any body contouring procedure, these nutritional states negatively affect healing and the ability to fight infection. Protein and vitamin supplementation at least 3 weeks prior to surgery and until the surgical sites are healed is vital in the success of these procedures.
The extent, location and condition of the excess skin all factor into the decision of the procedure and scar pattern for any surgery. The scar is the most difficult factor to accept when approaching any body contouring procedure. Dr. Trussler will give his honest opinion on the right scar pattern for your individual post-weightloss contouring procedure and with time and active scar care these scars will fade.
Many patients do inquire about combining body contouring procedures at the time of consultation. Dr. Trussler will discuss possible combinations of cosmetic procedures after weight loss that are safe and effective at addressing multiple areas of excess skin.
Realistic expectations are important when considering body contouring surgery after weight loss. The majority of these procedures are considered cosmetic surgery despite the fact that there is bothersome hanging skin. Dr. Trussler will listen to your goals and factor into the extent and location of sagging, excess skin to help come up with a contouring procedure that is right for you. No matter what incision pattern is performed there will be a scar. Scar quality and how the scar heals depends on what is done before, during and after body contouring surgery. Choosing the right incision type for your procedure and Dr. Trussler’s surgical experience do help with scarring, but good nutrition, smoking cessation, avoidance of sun, limiting activity, and active scar care all help to improve the healing process. Dr. Trussler will provide detailed instructions for your body contouring procedure after weight loss.
Gaining or losing weight after body contouring procedures can affect the long term results, so patients should undergo these procedures when they are comfortable with their weight and lifestyle. Patients must remain committed to maintaining their health after cosmetic procedures, through a healthy diet, regular exercise, and maintenance of their support group. With a positive outlook and realistic goals, patients are able regain confidence in their body and reap the rewards of their hard work in weight loss.
Body contouring surgery after weight loss can take approximately five to six hours under general anesthesia depending on what procedure is performed and the extent of excess skin, fat, and soft tissue laxity. Dr. Trussler does recommend at least one night in the after care unit to help make the recovery safe and comfortable. The areas of skin excision and the incision placement are typically marked during the pre-operative appointment. Dr. Trussler may perform one or more procedures for patients after weight loss.
Panniculectomy is the removal of hanging abdominal skin that contributes to medical issues such as refractory rashes, non-healing wounds, and postural difficulties. This hanging abdominal skin may have areas of lymphedema which are collections of fluid filled scar tissue. This can make the weight of the excised skin significant, and it can contribute to the high patient satisfaction after this procedure. Upper and lower abdominal skin incisions are made and the excess hanging skin is removed in a large wedge of tissue. The abdominal incision is typically closed without the need for undermining or tightening the abdominal skin and muscle.
Additional procedures performed after massive weight loss are included in the cosmetic surgery after weight loss section.
In the majority of these cosmetic procedures after weight loss, Dr. Trussler closes all incisions with deeper supporting stitches and then aligns the scars with stitches under the skin. Drains are often placed in these procedures to help collect fluid that accumulates after the operation. A compression garment is placed at the conclusion of the operations to hold the contour in place and avoid collections of fluid.These procedures may be performed separately or at the same time depending on the location and extent of correction required. Dr. Trussler will provide detailed instructions for your surgical procedure(s).
After Care & Recovery
After any body contouring surgical procedure, patients will likely experience mild soreness and swelling for a few days. Dr. Trussler advises at least a one night stay in the aftercare unit to encourage early ambulation and make the first night after the surgery comfortable. Early ambulation has been shown to decrease the risk of venothromboembolism or blood clots after these procedures, which are a major source of morbidity and mortality after any surgical procedure, especially after body contouring procedures.
- Dr. Trussler does make it easy to recover after surgery by limiting the amount of care needed on the incisions and surgical areas for the first week.
- In general, a compressive garment is kept on the abdomen and extremities depending on the procedures, and the torso may be flexed to protect the abdominal incision.
- After the first week, drains and stitches are removed and the compression garments are downsized.
- Protein and vitamin supplementation is important before and after these procedures. Dr. Trussler will give you recommendations on protein supplements and amounts (typically 30 to 60 grams of protein per day).
Most patients will be able to return to caring for their children, work and light exercise within two weeks, although vigorous exercise and other strenuous activity should be avoided for about a month. Heavy lifting greater than 30 lbs is limited for 6 weeks. Dr. Trussler will provide you with specific instructions for your individual recovery.
The results of any cosmetic procedures after weight loss are visible immediately after surgery and will continue to improve as swelling subsides and scars fade. Your shape will evolve over a three month period. Scar treatment will be initiated at the 3 week visit and may be continued for 3 to 6 months after the operation, or until the scars soften and fade.
Whether you have a question or would like to setup a body contouring after bariatric surgery consultation, Dr. Trussler and his staff are here to help. Please fill out our contact form, call our office at 512-450-1077 to schedule in directly. Start your journey to not only looking, but feeling better today!