Institute for Advanced Bariatric Surgery - Our Services

Plastic Surgery

Plastic surgery after weight loss surgery is not recommended until the active weight loss period has stopped. This will vary from patient to patient and vary from procedure to procedure. A patient that underwent a bypass can expect it to be between 1 to 2 years, and a patient that underwent a lap-band anywhere between 1 to 5 years.

With significant weight loss over a relatively short period of time (usually 15-18 months), the remaining skin often does not retain the elastic qualities necessary to "shrink back down" to your new underlying shape. This often leaves patients with excessive amounts of hanging skin that creates a multitude of problems such as daily hygiene and finding clothes that fit properly.  Skin elasticity and genetics determine skin tone and skin type. Unfortunately not much can be done to influence these factors. But it is no secret that exercise and muscle toning, which we do have control over, play an important role in getting back into shape and helping skin tone.  It can be difficult at times to predict who will require plastic surgery and who will not. In some patients this can be predicted in advance or early in the weight loss period, while in others time will only tell.

In the bariatric patient seeking plastic surgery, the dominant problem isn't so much the weight-related problem areas as much as it is the redundant or excess skin left behind after weight loss. In some cases it can present hygiene and skin care problems. In others fitting into clothes can be an issue.  In more severe cases it can shift the center of gravity causing back pain and difficulty in maintaining balance. If documentation of these issues can be maintained, insurance companies usually will cover the "tummy tuck" operation to remove the excess skin to improve a medical problem. Most of the time the insurance companies perceive the operation as "cosmetic", and will not provide coverage.

The bariatric patient considering plastic surgery faces a different problem than usual. The surgeon is not removing a problem area as much as he/she is removing large amounts of excess skin.  Every patient is different with different needs. One of the most important considerations for a patient is to realize that a bariatric patient must be treated differently from non-bariatric body contouring patients. What has worked well for many years on other patients simply does not provide adequate shaping and contouring for the bariatric patient.

When you are ready to consider plastic surgery let us know.  Together we can discuss what options are available to you and then begin to decide which plastic surgery approach will best fit your needs.

Patients who have undergone gastric bypass surgery and the subsequent significant weight loss may have numerous but similar areas of concern. These areas include:

• Breast ptosis, or droopiness, as well as a loss of breast volume (Mastopexy is a procedure to lift the breasts and may be performed with or without the addition of breast implants to improve shape, fullness and cleavage.)
• Sagging of the facial skin (Face lifting, forehead lifting and eyelid surgery may be necessary to achieve complete facial rejuvenation, or you may be a candidate for endoscopic or minimally invasive techniques)
• Excess abdominal skin and a laxity of the muscles of the abdominal wall, sometimes with an accompanying hernia. (Abdominoplasty or a lower body lift procedure can contour the abdomen, hips and buttocks)
• Hanging skin under the arms (Brachioplasty is a technique to lift the arms)
• Wrinkling and excessive bagginess of the thighs (A medial thigh lift can lift the inner thighs)

Obviously all of these concerns cannot be addressed simultaneously during one operation. However, two procedures usually can be safely combined. During your consultation, your surgeon will assess your anatomy as well as your own priorities to help you develop a comprehensive plan, or blueprint, for your body contouring. It is not uncommon to combine a tummy tuck with a breast lift (with or without the addition of breast implants), or a thigh lift with an arm lift, as well as other combinations of procedures.

The cornerstone of a successful approach to body contouring is to individualize treatment to your specific circumstances and goals and to ensure that you have an adequate understanding of the issues involved so that you are able to make a fully informed decision. This will help you achieve the appearance you desire with the least invasive procedure available, thus creating a mutually rewarding experience.

Body Contouring
After a person has stomach stapling or gastric bypass and loses tremendous amounts of weight, he or she finds the skin on his/her body may become very stretched, and it can be like wearing an extra garment, so loose skin hangs on legs, arms, stomachs and chests. Body shaping and contouring is the surgical process that removes the extra skin.

Another option is surgically tightening the skin around the entire body in one stage - a body lift. This is much more extensive surgery, has greater risks, and requires extended hospitalization. Body lifts are often completed in two or three operations.

With the increasing popularity of various cosmetic surgery procedures, including body shaping and contouring, it is important that the prospective patient research and understand different issues like what the procedure can and cannot treat, inherent risks, costs, and other factors. Keep in mind, cosmetic surgery is just that – a surgical procedure whose results cannot simply be erased. While the information contained in this website will provide you with a good introduction to body shaping, when considering this or any other cosmetic procedure, we recommend that you consult a surgeon.

Some important elements you should understand regarding skin removal include the following:

How is Body Contouring Performed?
Depending on how much skin is going to be removed, the operation usually requires two to five hours and is done under general anesthesia. Surgeons may do one operation or may schedule two to four to complete the work. For a total body lift, the surgeon does a tummy tuck (abdominoplasty), a breast lift or reduction, upper arm lift, middle thigh lift and lower body lift. While doing the tummy tuck, the surgeon will also tighten the muscles along the abdominal wall which helps create a flatter stomach. The overall effect is smoother, flatter tummy and far less baggy skin on arms, chest, buttocks and legs.

The operation usually starts with a horizontal incision just above the pubic area. Surgeons incise a circle around the belly button (the umbilicus) so it stays attached to the body. They then tighten the abdominal muscles by stitching the overlying sheet of tissue and that allows the muscles to grow back together again. (Pregnancy can also force the stomach muscles to part.) Physicians trim away excess skin and fat, perhaps do some liposuction and then pull the sheet of skin toward the rib cage, trim it and create a new hole for the belly button. Doctors insert small plastic drains – which stay in place for one to several days – and then stitch the incision closed. Finally, a tight elastic dressing is applied to the stomach.

In an arm lift (brachioplasty), excessive skin and fat hanging down from an extended arm (known as a “bat wing”) is removed by first doing liposuction to remove excess fat. During the procedure, an incision is made on the inside of the arm – where it is less visible -- from above the elbow to the armpit. Sometimes, depending on the amount of skin to be removed, an incision can be made just within the armpit. The excess skin is removed and – if needed – more fat is suctioned away.

The procedure is much the same for removing loose, hanging skin on the upper leg. A thigh lift is performed through incisions placed in the natural groin crease. The excess skin is removed and the tissues are lifted to improve the contour and smooth the skin of the entire area below it extending to the knees. The time for the procedure varies – the average is three to four hours -- based on your body and the extent of lift required. It is usually performed as a day surgery in an accredited facility, although it may require an overnight stay depending on your overall health.

A breast lift restores a youthful shape and position to sagging, deflated breasts that happens with aging, pregnancy, the effects of gravity and weight change. It improves both your self-confidence and appearance. Because many weight loss patients also have had a loss of breast volume, breast implants may be inserted in conjunction with the lift to recreate a fuller appearance. The procedure removes some of the stretched skin to create an uplifted, shapely form. The location and length of the incision will vary depending on the amount of lift required. Doctors make every effort to limit the length of the scar and place it in the most inconspicuous location possible. Fortunately, the best incisions can be easily covered by bras and bathing suits.

What Are the Risks and Limitations of Body Shaping?
Risks include blood clots, infection and bleeding under the skin flap. In a few cases, poor healing results in conspicuous scarring or skin loss and creates the need for a second operation. If patients gain significant weight after excess skin is removed, the skin will stretch again. Patients can return to work in two to four weeks and must avoid strenuous activity for another four to six weeks. The fading of scars can require three months to two years; scars may lighten after six to nine months. Returning to work usually occurs after two to four weeks.

Questions Body Shaping Patients Should Ask Their Surgeon
Prior to any body shaping procedures, a consultation will occur between the prospective patient and the providing surgeon. During this consultation, the surgeon and patient will discuss the treatment plan like the desired outcome, various options that are available to achieve it, the procedure itself as well as various risks and limitations. The surgeon will also provide information regarding anesthesia options, and associated costs. A discussion regarding the patient’s medical history, as well as a physical examination of the area to be treated will also take place during the consultation.

To better educate the patient about body shaping, as well as assist in formulating realistic expectations, it is recommended that the patient look at before and after photographs, and get answers to the following questions:

1. Are the desired results I described realistic?
2. How long will the procedure take?
3. In my case, what technique and which shaping technique are most appropriate?
4. What kind of anesthesia will the surgeon use during the surgery?
5. How much does body shaping cost and what other elements factor into that cost (i.e., hospital fee, anesthesia, etc)?
6. What percentage of patients experience complications with body shaping?
7. What is the surgeon’s policy in regards to correcting or repeating the procedure if the body shaping does not meet agreed-upon goals?
8. What should I expect, post-operatively, in terms of soreness, scaring, activity level and so on?

This site provides information about plastic/cosmetic surgery and is designed to help users make decisions regarding their own treatment options. But medical information is not the same as medical advice – the application of medical treatment to a person's specific circumstances. Although we go to great lengths to make sure our information is accurate and useful, we recommend you consult a qualified medical practitioner if you want professional assurance that our information, and your interpretation of it, is appropriate to your particular situation.

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