Bariatric surgery for the treatment of obesity is becoming increasingly popular. Procedures such as gastric bypass and laparascopic gastric band (lap band) can produce a dramatic loss of weight, and promote a state of both physical and emotional health. Not infrequently, diet and exercise regimens will result in a similarly substantial weight loss. Unfortunately, excessive hanging skin and fatty deposits of the abdomen, thighs, breasts and arms are an unwelcome consequence for those successfully achieving their goals in weight loss. After a weight loss plateau has been reached, plastic surgery is performed both to improve aesthetics and to alleviate symptoms. Abdominoplasty (tummy tuck), lower body lift (belt lipectomy), mastopexy (breast lift), augmentation mastopexy (breast enlargement and lift), brachioplasty (arm lift),
upper body lift (a combination of arm lift and breast lift that also removes the excess tissues of the sides of the ribcage), thigh lift or facelift may be performed: all involve the removal and tightening of excess skin with sculptural tissue contouring, leading to a smoother, more youthful, and more natural appearance. The needs of patients who have experienced significant weight loss are extremely unique; every individual's story, hopes, concerns, and goals are quite different. Dr. Kolker and all of his highly experienced staff members are sensitive not only to the medical and aesthetic technical requirements of the procedures, but also to the very real emotional ramifications for every individual.
My post bariatric surgery results are absolutely amazing. I've gone from wearing a size 18 jeans (down from a 26 before my bariatric surgery) to a size 12 and from not wanting to even wear a bathing suit to wearing my very first bikini this past summer. I can truly say that I don't remember being happier or more self-confident at any other time in my life.
After fat stores beneath the skin and within the abdomen shrink, both excess abdominal wall skin and loose abdominal muscles result. The optimal procedures to treat the excess of the torso will directly remove excess skin and fat, tighten the muscles and fascia of the abdomen, and remove regional excess fat and restore contour to the abdomen with liposuction. Occasionally, when the excess is limited to the front of the abdomen, an anterior abdominoplasty, tummy tuck, or "classical" abdominoplasty is in order. More frequently, the excess progresses around the sides to the back, and a lower bodylift is indicated. The lower body lift not only removes the excess skin and fat of the abdomen, flanks, and back, and tightens the abdominal wall, but provides a lift to the buttocks and lateral thighs as well.
Occasionally, there are medical symptoms that are produced by the heavy, hanging skin along the lower abdomen that can lead to moisture trapping, recurrent rashes, and infections (intertriginous dermatitis and panniculitis). When symptoms are present, and courses of medical treatment have been documented to have been ineffective, insurance companies may recognize this problem and provide coverage for a portion of the lower body lift or belt lipectomy (the portion known as a panniculectomy, or the direct removal of the hanging excess below the navel).
Women in whom the breast sag and "involute" after bariatric surgery and massive weight loss can be treated with breast lift (mastopexy) alone, or a breast lift and a breast enlargement (augmentation mastopexy) to both lift the breasts and to restore breast volume lost after bypass. Breast implants are most often used to restore breast volume, however in selected individuals with excess skin and fat of the sides of the chest wall, your own excess tissue in the region (maintaining its own nourishing blood supply) may be used to give you a breast augmentation without the use of breast implants during the breast lift (mastopexy) procedure (this is most often performed during an upper body lift).
Men may develop breast sagging or enlargement, or gynecomastia. Occasionally, liposuction alone may provide adequate treatment, however skin removal and tightening is most often required in conjunction with liposuction techniques.
Loose, hanging skin and excess fat of the arms are treated by brachioplasty, or arm lift. With the brachioplasty or arm lift procedure, excess fat is removed, and the skin is tightened, trimmed, and redraped to restore a more youthful form to the arms.
When there is droop or ptosis of the breasts, excess skin and fat of the arms, and excess tissue of the sides of the ribcage and upper back, an upper body lift procedure should be considered. An upper body lift combines the breast lift (mastopexy) and arm lift (brachioplasty) procedures, while at the same time removing the skin and soft tissue excess of the upper torso in one confluent incision line.
The excess skin and fat of the thighs is removed with one of several procedures. The medial thigh lift, or isolated inner thigh lift, is geared for those individuals with only mild or moderate excess limited to the inner thigh area. The medial thigh lift removes a crescent of inner thigh skin, leaving an incision line in the inner groin crease only. A circumferential thigh lift combines removal of not only medial thigh excess (medial thigh lift), but the removal of excess from the front (anterior thigh lift) and sides (lateral thigh lift) of the thighs as well as the thigh beneath the buttock area (posterior thigh lift). Most often, the circumferential thigh lift is preceded by a lower body lift to serve as a foundation for thigh lift.
With significant weight loss, wrinkles on the face become more prominent, and cheek and neck skin may become lax. The facelift and neck lift are performed through incisions concealed inconspicuously within the hairline and around the ears. The muscles and deep tissues are tightened and the fat is sculpted to restore a more youthful shape to the face and neck.
When is appropriate to begin the process? Which procedure should I have first, lower body lift or arm lift? Thigh lift or breast lift? Which procedures can be performed at the same time? How long do I have to wait between procedures?
Any procedure that is performed to remove excess skin and fat as well as to tighten and contour the underlying tissues is best begun after a weight loss "plateau" has been achieved. Although there is no specific number with regard to the actual weight loss or body mass index (BMI), you should be at a sustained weight for approximately six months (or more). This allows you to strike a comfortable balance with the maintenance of physical health through your diet and exercise regimen, and, equally important, allows for the skin's own elasticity to be revealed (some individuals will have a lot of skin laxity, while others may "spring" back into place). It is therefore essential to allow your body to settle at its comfortable "tension"; the selected lift procedures will simply take you the rest of the way.
Dr. Kolker's approach to the sequence of procedures is tailored to your desires, meaning, if the excess of the mid-section bothers you the most, the lower body lift or belt lipectomy procedure is performed first, if the arms give you the most trouble, the brachioplasty or arm lift procedure is the first, and if breast droop concerns you most, the mastopexy or breast lift is part of the initial procedure. If the thighs are your greatest concern, thigh lift first may be considered. Often, if you do not have a particular preference, Dr. Kolker recommends that the lower body lift or belt lipectomy be performed first to set the "foundation" for other potential procedures to come.
Safety is the most important factor in your care following massive weight loss, so only combinations that will not subject you to prolonged operative times and those that allow for the quickest recovery will be combined. Most often, the lower body lift or belt lipectomy is performed as a "stand alone" procedure, although in selected individuals, where the mid-section excess is largely "skin-only", other procedures such as breast lift (mastopexy), or arm lift (brachioplasty) can be considered at the same time. More often, the procedures are "staged", with a waiting period between each procedure. The breast lift (mastopexy) and arm lift (brachioplasty) procedures are often combined at the same time, and frequently as an upper body lift procedure that not only provides an arm lift and breast lift, but a lift and tightening of the excess skin and fat of the sides of the chest and upper back. The thigh lift is most often performed after the "foundation-setting" lower body lift or belt lipectomy procedure. The most common waiting period between lift procedures after bariatric surgery and massive weight loss is twelve weeks.
If you would like to learn more about having surgery after massive weight loss in New York, and about the specific body lift techniques and sequence that will suit you best, we invite you to meet with Dr. Kolker for a private consultation at our office, located at Park Avenue and 70th Street, by calling 212-744-6500, or by scheduling an appointment online.