In the past decade the number of patients coming to plastic surgeons after gastric bypass or other forms of massive weight loss has increased exponentially.
With weight loss in the range of 100lb or more, the problem is that the skin envelope has stretched, and cannot always contract as much as the fatty layer beneath the skin has shrunk. This leaves skin hanging in several areas. The extent of the problem has to do with the age of the patient as well as the genetic elasticity of the skin and the amount of weight loss.
Surgery to correct this excess skin is performed when the weight is stable for several months, and when the goal weight has been reached. When weight loss is by surgical means with gastric banding or bypass, this is usually about a year after weight loss surgery.
Most common procedures are abdominoplasty, brachioplasty, breast lift or mastopexy, thigh lifts, lower body lift, belt lipectomy and facelift. Each patient may find the need for all or any combination of these procedures, and is individualized to the patients needs and desired. Other procedures include excision of back folds and localized liposuction.
There are several things to be aware of when contemplating surgery after weight loss. In general, all of these procedures leave scars, as that is how the body heals when skin is removed. Another issue is that the terminology is not standardized, and each surgeon may have varying understandings of the terms such as lower body lift and belt lipectomy. It is best to have an understanding of what areas you would like skin removed from, and what areas lifted, and discuss this with your surgeon. Another issue is gravity, in that with lifts gravity will still take it's toll, and may lower the tissue, and the scars, over time. Nutrition is another issue in that some bypass patients have poor absorbability of some nutrients, and all massive weight loss patients have been in a catabolic or weight loss state for some time. Best cosmetic results and fewer complications will occur with optimal nutritional state before asking the body to heal lengthy scars. And cigarette smokers have a higher complications rate with chance for poor healing.
With an abdominoplasty or tummy tuck, the tummy roll is removed from pubic hair to belly button, and the upper skin pulled taught, tightening the abdominal contour to some extent. Insurance will sometimes cover a panniculectomy, which is just removing the skin hanging over the pubic area, and does not involve tightening the abdominal contour, or repositioning the bellybutton. The scar extends as far as the roll does when sitting down, and is usually hip to hip.
When the skin laxity and roll extends around the back, a belt lipectomy as shown in the photos above is performed, removing skin and soft tissue all the way around like a belt. This combines a tummy tuck with a buttocks lift.
When there is also thigh laxity, a lower body lift may be performed, which removes the belt, tightening the abdomen and lifting the buttocks and outer thighs. Inner thigh lifts can be added or done separately depending on the patient.
Brachioplasty is the procedure perfomred when the upper arm skin is loose, and in taking this skin out and tightening this area a scar is made extending from armpit to elbow on the inside of the arm. In cases with only a small amount of laxity this may be performed leaving only the armpit scar, although of course not as much skin can be removed. Men and women often say that it is only after brachioplasty that they are willing to wear short sleeves again.
