Plastic Surgery After Massive Weight Loss

As a specialist plastic surgery clinic, we are seeing more and more patients presenting to our clinic to address concerns following massive weight loss.

The unfortunate truth is that obesity has become a major medical health issue in modern society. As such, many methods have been utilised to help patients reduce body weight and improve health.

Ultimately, the fundamentals of weight loss will always remain the same – calorie output must exceed calorie input. As such, a sensible diet combined with appropriate levels of physical activity is the foundations for all efforts to reduce weight, and to maintain a healthy body weight. Unfortunately for many people, this alone is not enough, and as such many medical interventions have been utilised to help these people.

The methods of weight loss can be broadly classified into three groups:

1. Diet and exercise alone
2. Medical treatments – tablets or injectable treatments to help lose weight
3. Surgical treatments

Of course, if medical or surgical treatments are required to help with weight loss, a healthy diet and exercise will always to be foundation and key to maintaining a long-term healthy body weight.

Diet & Exercise To Lose Weight

The foundation of good health requires a sensible diet and physical activity. For those considering losing weight to achieve a healthier lifestyle, then this needs to start at reviewing and modifying your diet and physical activity. Of course, this is easier said than done, and it would be wise to engage the support of a friend or group to help you along your journey.

You should also have a low threshold for enlisting the professional services of a personal trainer and dietitian to help teach you healthy changes that you can adopt to the new lifestyle you wish to lead.

Any change in lifestyle needs to be undertaken with long term objectives, which basically means short term crash diets are largely pointless. A conscious effort to change your life for the better is required to ensure a change that is sustainable, and part of the new you.

Medicinal Treatments To Achieve Weight Loss

Medicinal treatments for weight loss, either tablets or injectable, often serve as an aid for individuals struggling with significant weight loss, particularly when diet and exercise alone prove insufficient.

Weight loss medications have been around for many years, however the newer ones that have become available in Australia over the last few years have become extremely popular due the success that has been demonstrated. They are all prescription medication, and therefore can only be provided by your general practitioner after a formal consultation to determine whether you are suitable to have these treatments.

These treatments typically include prescription medications that work by suppressing appetite, increasing feelings of fullness, or inhibiting fat absorption.

None of these treatments should be taken in isolation, as these medications are most effective when combined with lifestyle changes such as a healthy diet and regular physical activity.

All medical treatments do have potential complications and need to be monitored, and this is where it is vital to have your health and treatment monitored by your healthcare provider.

Bariatric Surgery – Surgery To Help Lose Weight

Achieving weight loss through surgery, referred to as Bariatric Surgery, is often considered when other methods such as diet and exercise or medicinal pathways have proven ineffective.

Bariatric Surgery refers to various surgical procedures designed to assist with major weight loss for individuals struggling with obesity. It is performed by general surgeons and/or upper gastrointestinal surgeons with an interest in this field. These surgical procedures alter the digestive system to help reduce food intake or nutrient absorption.

Common types of bariatric surgical procedures include:

• Gastric Bypass
• Gastric Sleeve
• Adjustable Gastric Band

The surgical technique chosen depends on the patient’s specific weight loss goals, current health condition, and any associated medical issues. Ultimately the bariatric surgeon will determine whether surgery is appropriate and which surgical option has the greatest chance of success for you.

All surgical procedures come with potential complications, and these are issues that will need to be covered by the bariatric surgeon.

Following the surgery, patients often experiencing rapid weight reduction in the first 6 – 12 months.

Recovery periods vary depending on the surgery type, but they generally involve a commitment to long-term lifestyle changes, including diet and exercise. Patients should expect regular follow-ups with healthcare providers to ensure sustained weight management and monitor for potential complications. Proper candidate selection and thorough pre-surgical evaluation are vital for the best outcomes.

Benefits Of Weight Loss

Achieving significant weight loss carries profound benefits – it drastically reduces the risk of weight-related health conditions, including type 2 diabetes, heart disease, and high blood pressure. Furthermore, it enhances overall physical fitness, leading to increased energy levels and mobility, which significantly improve quality of life.

Additionally, significant weight loss can lead to reduced joint pain, reduced long term arthritis issues, and contributing to overall physical and mental health improvements.

Better sleep quality is another advantage, as losing weight can help combat disorders like sleep apnoea, leading to more restful nights.

Furthermore, adopting habits that promote weight loss, such as balanced nutrition and regular physical activity, can promote long-term lifestyle changes. These changes contribute to overall well-being and can prolong life expectancy by preventing obesity-related complications. Embracing a healthier lifestyle not only transforms one’s physical health but also boosts overall quality of life.

Excess Skin Issues After Massive Weight Loss

People who are carrying an excessive amount of weight may choose to lose that weight, either through diet and exercise, or via medical or surgical assistance – such as lap band, gastric sleeve and gastric bypass surgery. No matter what method of weight loss is employed, individuals who have lost a massive amount of weight experience the same issue – their bodies become smaller, but their skin does not. The skin has a limited amount of ability to contract, or ‘shrink wrap’ around a smaller body.

Individuals who have lost a massive amount of weight become smaller, fitter, and healthier but the more they lose, the more excess skin they have and the more it sags.

This excess skin is both a significant physical and psychological burden on the patient. Amongst many other issues, the excess skin and skin folds often poses serious skin hygiene issues, along with clothing, physical mobility and social issues.

Although massive weight loss affects skin in every area of the body, the common areas are the arms, the breasts and chest area, back, buttocks, stomach, and the thighs. Plastic Surgery after massive weight loss is effectively surgery designed to tailor your skin to fit your body.

In order to help patients understand the patterns and scars necessary for these surgeries, Dr Dona will often use dressmaking as an analogy. In dressmaking, you remove material and run a seam; in surgery, you remove skin and the ‘seams’ are the scars. The greater the amount of excess skin to be removed, the more scars necessary.

Basically, we start with the areas that most concern an individual and then we continue in stages depending on the degree of concern and other considerations such as lifestyle and financial constraints. The minimum time between each surgery is three months.

The decision to undergo plastic surgery after weight loss extends beyond the physical; it significantly impacts emotional and psychological well-being. Redundant skin can serve as a constant reminder of one’s previous weight, potentially affecting self-esteem and mental health. Body contouring procedures can provide a sense of closure and a fresh start, allowing individuals to fully embrace their new, healthier selves.

Types Of Surgical Procedures After Weight Loss

After experiencing massive weight loss, many individuals face the challenge of dealing with excess skin or redundant skin left behind.

Dr Dona’s private practice has a key focus on this unique area of plastic surgery. For teaching purposes, Dr Dona has created a list of these surgical procedures required after massive weight loss that all start with the letter B:

1. Brachioplasty (Arm Reduction)

Brachioplasty, commonly known as an Arm Lift surgery, is designed to remove extra skin and fat from the upper arms. This is a common request following weight loss as the arms are often the only thing patients can’t hide and wants addressed. By contouring the arms, the surgery effectively reduces skin redundancy and enhances the overall tone and appearance of the upper body.

2. Breasts – Lifts, Reductions & Augmentations

The type of breast surgery required after massive weight loss is entirely dependent on the state of the breasts and what the patient desires.

Breast Lift (Mastopexy) – is designed to lift and reshape the breasts, and this can be performed with or without the use of an implant.

Breast Reduction – a breast that is too heavy (and typically too low after weight loss), can be lifted, reduced and reshaped.

Breast Augmentations – sometimes after significant weight loss the breast can reduce in size (become deflated) without any significant droop (ptosis). In this scenario the patient may simply want additional volume via the use of an implant to enhance the breasts size and shape.

3. Belly – Abdominoplasty (Tummy Tuck)

Abdominoplasty is perhaps the greatest area of concern following significant weight loss. The surgery in this region is effectively an abdominal wall reconstruction designed to address several issues:

• Excess skin folds
• Rectus Divarication – muscle separation and damage
• Ptotic (droopy) mons region
• Possible abdominal wall hernias

The type of abdominoplasty procedure will be determined by the degree of problems that need to be addressed.

• Standard Tummy Tuck (Abdominoplasty)
• Extended Tummy Tuck (Abdominoplasty)
• Fleur De Lis Tummy Tuck (Abdominoplasty)
• OPEN BOOK TUMMY TUCK™ (Abdominoplasty)

4. Bra Lipectomy (Upper Body Lift)

An Upper Body Lift or Bra Lipectomy is an operation performed to address excess skin rolls and associated fat, in the upper and middle part of the back around the bra strap area.

These areas of excess skin can be mild to severe for individuals that have undergone significant weight loss. A Bra Lipectomy scar pattern varies depending on the severity of the excess skin. However, the scar pattern typically extends from the back, through to the front of the chest wall, under the bust area.  This scar pattern is near or fully circumferential.

5. Belt Lipectomy (Lower Body Lift, 360 Tummy Tuck)

A Belt Lipectomy, often called a Lower Body Lift, A Belt Lipectomy is an operation designed to remove rolls of excess skin and the associated fat in the lower back, flanks, upper outer thighs and abdominal region. It also lifts the buttock and pubic regions. A Belt Lipectomy combines two operations: a Buttock Lift and a Tummy Tuck (Abdominoplasty), which results in one continuous circumferential scar contained within the belt line.

6. Buttocks

A Buttock Lift (Lipectomy) describes a surgical procedure that involves the removal of excess skin from the lower back, lifting and tightening the buttocks. If combined with an Abdominoplasty (aka Tummy Tuck) then the operation with the resultant circumferential scar is often referred to as a Belt Lipectomy.

7. Below The Waistline – Thigh Lifts

Thigh lifts are designed to remove excess skin and tissue from the thighs, particularly the inner and outer thighs. This procedure addresses the common issue of sagging skin in the thigh area post-weight loss.

Combining Surgical Procedures After Weight Loss

It is often not wise to combine operations due to surgical safety issues. These decisions can only be made after a formal consultation with Dr Dona and determining an individual’s suitability for surgery, and what type of surgery can or should be performed. For many patients that have lost a significant amount of what, they will often have to undergo surgeries in a staged manner over a period of time.

Some common combinations include:

• Belt Lipectomy with a Tummy Tuck (Abdominoplasty)
• Bra Lipectomy with an Open Book Tummy Tuck (Abdominoplasty)
• Breast Surgery with a Tummy Tuck (Abdominoplasty)
• Arm Reduction (Brachioplasty) with Breast Surgery

Ultimately, Dr Dona will begin with the areas that most concern the patient and then continue in stages depending on the degree of concern and other considerations, such as lifestyle, financial and health constraints.

Benefits Of Post-Weight Loss Plastic Surgery

Excess skin after major weight loss can lead to significant physical discomfort. Skin folds can cause chafing, irritation, and infection, impacting daily activities. Surgeries like arm lifts and upper body lifts alleviate these issues by removing loose skin that contributes to physical discomfort. Consequently, individuals can experience improved mobility and comfort, making it easier to engage in physical activities and maintain their health post-weight loss.

Of course, the obvious psychological and mental health benefits associated with plastic surgery after massive weight loss cannot be understated.

Timing Between Weight Loss And Plastic Surgery

Achieving major weight loss is a commendable milestone, often following bariatric surgeries or dedicated lifestyle changes.

Specialist plastic surgeon Dr Dona recommends waiting until you reach and maintain a stable weight for at least six months before undergoing body contouring surgery. This stability ensures that further weight loss won’t result in additional skin folds, impacting the outcome of the surgery. Moreover, it gives your body time to adjust, ensuring your new body has achieved a physiological balance and in a nutritional stable state for optimal healing and recovery.

Do You Have To Stop Your Weight Loss Medications Before Plastic Surgery?

The short answer to this question is yes! Some of the weight loss medications can increase the risk of anaesthetic complications with your surgery quite significantly. It is therefore recommended that you cease all such medications approximately four weeks prior to your scheduled surgery.

What Should Your BMI Be Before Plastic Surgery?

Many patients have undergone significant weight loss and have then stabilised. However, often their now new stable weight is still considered by many measures to be ‘obese’. BMI is one such measure of a person’s health based on their weight but is a poor indicator of health and often cannot accurately identify whether a person is at a healthy body weight because it fails to distinguish between fat and muscle or to consider fat distribution.

That aside, it is true that those individuals who are deemed overweight, by whichever measure one uses to assess this, do carry increased surgical risks. They have a greater risk of anaesthetic complications, and a greater risk of surgical complications, including would healing problems such as wound breakdown and skin necrosis.

Furthermore, the plastic surgical procedures that fall under the umbrella of body contouring surgery after massive weight loss are primarily designed to address excess skin. Whilst the fat associated with that excess skin is also typically removed, that is not the primary issue.

If a person has aways been fuller figured, and they are unable to lose any more weight, then it is Dr Dona’s opinion that they should not be denied reconstructive surgery to address their excess skin concerns. Patients with large abdominal wall aprons and overhang suffer tremendously with significant functional and medical issues, regardless of what their weight is. For an appropriately qualified surgeon to deny them important surgery and demand that they attain a certain unachievable weight is unfortunate.

Every decision for surgery is based on a risk versus benefits assessment, and if the potential benefits are deemed to exceed the potential risks, then surgery should still be offered. Insisting that a patient to be a weight that they are never going to achieve, or never be able to sustain is in the opinion of Dr Dona, poor medical management.

Potential Risks Of Plastic Surgery After Weight Loss?

No surgical procedure is risk free, and understanding the possible complications is essential so that you can consider the benefits and risks before you undergo treatment.

For massive weight loss individuals, the skin and tissue quality are often poor, which increases the potential for complications to arise, such as poor wound healing and infection. This leads to a higher risk of wounds breaking down with skin and tissue loss. Therefore, there is an increased risk of further surgery being required in the postoperative stage to address these issues.

All surgeries carry general potential risks, and surgery specific potential risks.

The general potential complications for surgery can be found here – LEARN MORE

The specific potential complications can be found on our website on the relevant page for the procedure/s you’re considering.

How Much Does Plastic Surgery After Weight Loss Cost?

Experience and excellence acquired over decades of commitment to the specialty often comes at a price. Your total fees are based on many factors, including:

• What surgery you will require?
• How many hours do they anticipate it will take?
• How complex your surgery will be?
• Do you have private health insurance?
• Will your private health fund cover any part of your fees?

Medicare item numbers often apply to surgical procedures following massive weight loss. Whether this applies to you can only be determined after a formal consultation.

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Importance Of Selecting A Qualified Surgeon

Choosing a qualified and experienced plastic surgeon is crucial when considering surgery after major weight loss. A specialist, familiar with procedures like tummy tucks, arm lifts, bra lipectomies and breast lifts, ensures you have the best chance of an excellent outcome. Their expertise in dealing with excess and redundant skin following massive weight loss is vital for both safety, functional and aesthetic outcomes.

Dr Dona has spent his lifetime honing his craft and a large part of his private practice is dedicated to looking after patients after massive weight loss.

He values the unique honour of being a Plastic Surgeon, recognising the privilege it brings in assisting others. This appreciation, coupled with his understanding of the potential of what Plastic Surgery can do, guides the care he provides to all his patients. As a meticulous practitioner, Dr Dona consistently refines his surgical skills, maintaining a steadfast commitment to delivering excellence in Plastic Surgery.