Significant weight loss after bariatric surgery can be an extensive and emotional journey. One of the most common challenges experienced by patients is excess and loose skin. Stretched and sagging skin can leave patients feeling uncomfortable. It can also cause irritation, rubbing, infections, and general physical discomfort.
A number of surgical procedures have been designed and modified for patients experiencing skin sagging issues resulting from massive weight loss. A combination of these specialist body contouring procedures can address excess skin and fat following massive weight loss, relieving its associated weight and discomfort and resulting in an improved body shape and appearance. However, the process can be extensive and requires multiple surgeries. Due to the challenging nature of this type of surgery, not every patient who has undergone massive weight loss, is suitable for body contouring surgery and thus Dr Taylor has thorough evaluation process and works with a multidsiciplinary team including Psychologists and Dietitians to ensure her patients are well enough, physically and psychologically to undergo more surgery. These health professionals, along with Dr Taylor and her staff, can provide ongoing additional support for patients during their surgical journey.
Consultation
During your initial consultation, Dr Taylor will conduct a thorough medical history and examination to determine whether body contouring surgery is suitable for you and to ascertain your primary concerns and goals. Clinical photographs will be taken and your surgical options will be discussed in detail. Body contouring surgery following massive weight loss involves multiple procedures which need to be staged approach over time. Dr Taylor will develop a plan together with you, that is tailored specifically for you.
It is important for patients to be at their goal weight which they have maintained for at least six months. Any nutritional imbalances following bariatric surgery (eg sleeve gastrectomy, gastric bypass) must be corrected so that patients are fit and healthy before pursuing post-bariatric (post-massive weight loss, PMWL) body contouring surgery. Dr Taylor will explore your readiness for surgery and conduct further investigations including blood tests and radiological imaging to determine your suitability for surgery. You will be required to have an evaluation with a Psychologist and see a Dietitian prior to undertaking surgery and you may choose to continue to see these health professionals for support if you do proceed with surgery.
The procedures
Depending on the procedures performed at each stage the surgery can take between 6-10 hours. It is always performed under general anaesthetic and requires a hospital stay of a few days.
Common procedures following bariatric surgery include:
Thigh Lift
A thigh lift is designed to remove excess skin around the thighs. The inner thigh region is an area that concerns the patient after significant weight loss, and many patients have achieved great results with this procedure. Thigh lift surgeries often involve making incisions along the top of the thigh near the groin. Other procedures may require a downwards incision, from the groin towards the knee. In some cases, liposuction can be used to remove excess fat from under the skin. After the procedure, a recovery period is necessary to facilitate proper healing, and specially prescribed compression garments will need to be worn to ensure an optimal result.
Breast Lift
A breast lift, also known as a mastopexy, is a common surgical procedure for women who experience a significant reduction in breast volume after weight loss or childbearing. The loss of volume can result in skin laxity, making the breasts appear sagged, known as “breast ptosis.” A breast lift can correct these effects. Incisions are usually made around the areola, and depending on the surgical method required, an incision may also run from the areola down towards the fold under the breast. To replace deflated volume and correct the classic flattened appearance of the chest on massive weight loss patients, a breast implant or lipofilling (fat grafting) may be recommended
Facelift
Facial skin drooping and laxity are common concerns after weight loss. A facelift, technically known as a rhytidectomy, is designed to lift facial skin to reduce sagging and produce a more rejuvenated and vibrant appearance. Incisions are hidden in the hairline, extending down in front of the ears. The skin is then tightened and sutured in place to produce the lifted appearance. Bruising, swelling and changes in skin sensation are common following the surgery, but this should be temporary. A recovery period is necessary to ensure proper healing.
Abdominoplasty
An abdominoplasty, commonly known as a tummy tuck, removes sagging skin from the abdominal area and tightens the underlying abdominal musculature. The specifics of the surgery, including location of the incisions, will depend on the individual patient’s requirements. Abdominoplasty aims to enhance the natural contours of the waist, relieve heaviness and discomfort from excess abdominal tissue and produce a smoother and tighter skin texture and appearance. Afterwards, specialised compression garments are required to aid your body in the healing process.
Body Lift
A body lift involves a combination of surgical procedures to reduce skin sagging on multiple areas of the body at once. The procedure addresses the entire lower abdomen, lifting the skin on the stomach, hips, buttocks, and lateral thighs. Skin and fat is circumferentially excised to remove excess whilst lifting and tightening the skin in the surrounding areas. The tissues are then resuspended and the incisions are then sutured and dressed. Downtime is required, and you will need to follow specific aftercare instructions to ensure the best outcome.
Risks and complications
Despite an excellent success rate, each of these procedures come with risks. Surgery in the post-bariatric surgery population is associated with increased risk and higher complications rates, so it is crucial to be fully informed about the procedure, risk and complications and likely outcomes associated with each procedure before going ahead.
These can include but are not limited to:
- Bleeding, bruising, swelling
- Pain and discomfort
- Changes in skin sensation
- Poor wound healing and wound breakdown
- Skin loss
- Seroma (fluid accumulation)
- Asymmetry
- Contour irregularities
- Small lumps due to fat necrosis
- Poor and prominent scarring
- Deep vein thrombosis and pulmonary embolism
- Chest infectionsMultiple procedures to achieve best results