By Dr. Constance M Chen
Bariatric surgery delivers life-changing benefits for many people each year. In 2017, the American Society for Metabolic and Bariatric Surgery estimates that 228,000 people underwent weight loss surgery. While bariatric surgery can improve underlying physical and emotional health, the dramatic change in body size due to weight loss can also leave patients with excess skin that causes its own new problems.
Excess weight stretches the skin, and after the substantial weight loss that follows bariatric surgery -- sometimes over 100 pounds – the skin and tissues often lacks the elasticity to shrink down to the body's new dimensions. Not only do many people find the excess skin hanging off of the new underlying body frame unsightly and embarrassing, but it can also cause rashes due to the constant rubbing of overhanging skin which can then interfere with activities of daily living. To alleviate these problems, body contouring after bariatric surgery removes excess fat and skin to improve the body’s contours after weight loss.
The parts of the body most affected by excess skin are the abdomen, arms, breasts, thighs, and buttocks. When multiple areas need to be treated, it is usually safest to undergo surgery in staged procedures to minimize anesthesia risk and recovery.
The abdomen is the most troubling area for many people. An overhanging fold or “apron” of skin called a pannus (or panniculus) can cause a rash and irritation, especially in hot weather. Abdominal surgery may just remove the pannus (panniculectomy) or may also repair separated abdominal muscles (abdominal plication in abdominoplasty or tummy tuck).
Upper arms that sag and appear loose and full are corrected with an arm lift (brachioplasty), which removes excess skin from the underside of the arm.
Breasts may flatten and droop due to loss of fat and tissue in the breast. A breast lift (mastolexy) will remove excess skin, reshape the breast tissue, and raise the nipple and areola complex, resulting in a rounder, fuller breast. A breast lift does not change the size of the breast so some patients request an implant or fat grafting to create larger breasts.
The lower back and buttocks may be lifted in a lower body lift, which is accomplished through a hip-to-hip incision across the back, above the buttocks.
The inner thighs can be treated with a thigh lift that shapes the thigh by reducing excess skin through an incision that starts high on the inner thigh near the groin.
Body contouring procedures should be customized for each individual. Sometimes it is possible to modify the incision to minimize or hide scarring. For example, we can hide the scars in the groin crease for a thigh lift or in the armpit for a short-scar brachioplasty.
The best time for post-bariatric body contouring is when the weight has stabilized and the patient is as close as possible to ideal weight, usually 12-18 months after bariatric surgery. There are additional key considerations to ensure a successful body contouring outcome. Patients must be committed to not smoking and to a nutritional and exercise regimen that will help them achieve and maintain their optimal weight. Healthy habits will reduce the risks of complications from surgery and promote healing. It is also important to understand your goals and be realistic about expectations. Bariatric surgery, body contouring, and a commitment to a healthy lifestyle have given countless people a new lease on life.