Plastic Surgery After Massive Weight Loss
Losing a significant amount of weight is a life-altering accomplishment. But excess skin and fatty tissue can persist after weight loss and may necessitate body-contouring treatments. Dr. Bray has over 25 years experience in major body-contouring plastic surgery procedures, and is well-known for providing excellent clinical care results.
DR. BRAY’S PHILOSOPHY
Post Weight-loss Procedures
Massive weight loss results in deflation of multiple body areas. The skin, having undergone significant stretching, is unable to contract and tighten completely yielding loose, sagging folds. While Dr. Bray has techniques to remove loose skin in practically any area it accumulates, there is a safety limit as to what can be accomplished in a single surgical procedure. Dr. Bray utilizes a 2-3-step process approach to surgery after massive weight-loss:
- Step 1: The torso and trunk. This step targets areas of the body like the waist, flanks, abdomen, buttocks, and sometimes breasts.
- Step 2: The arms and legs, (and breasts if not addressed in step 1 above). This targets inner, outer, and general appearance of your extremities.
- Step 3 or Step 4 (Optional): If needed, the final step addresses any scar revisions, focal liposuction, contouring needs, fat transfer, non-surgical skin tightening, or non-surgical scar management. All of which help patients achieve the best possible final result.
Individual priorities play a major role in the surgical strategy. For example, some patients are concerned only with loose skin in the anterior abdomen, whereas others may be particularly concerned with their arms and breasts. By working alongside your goals, Dr. Bray works to achieve natural, long-lasting results.
What to Expect with Plastic Surgery After Weight Loss
What procedures do I need?
The outcome after major weight loss can vary dramatically between patients, depending on the amount of weight lost, skin elasticity, volume of remaining fat, previous pregnancies, and genetic factors, just to name a few. Consequently the extent and combination of procedures required to accomplish a patient’s goals can also vary. These procedures might include, but are not limited to abdominoplasty (tummy tuck) to remove excess skin, a full circumferential body lift, breast surgery to eliminate sagging or volume loss, facial rejuvenation to tighten skin, arm-lifts or thigh-lifts to remove excess or sagging skin. Dr. Bray will evaluate your individual situation and create a surgical plan designed to accomplish your goals.
When can I return to regular activities?
The amount of time off work or physical activity will depend mainly on:
- The particular surgical procedure(s) you undergo
- The type of physical work or activity you are hoping to resume
Extensive surgery, like a body lift, will require greater downtime than something like a breast/chest lift. Dr. Bray will work with you to create a sensible recovery plan. Typically, patients can expect to avoid exercise or physical work for 6 weeks. Those patients who are able to work from home, with low physical demands, can often resume work within a week or so. Those patients who have young children will definitely need to arrange for help during the first few weeks after surgery.
What if I’m still losing weight?
Prior to surgery, you should be close to your ideal weight. Before undergoing these surgeries, it’s important to maintain a stable weight for at least 3-6 months. Once you have maintained your ideal weight for 3-6 months, schedule a consultation with Dr. Bray. He will work with you to tailor the surgeries to your goals, anatomical demands, and overall health.
The body lift surgery is the most common procedure used to improve a body’s appearance after massive weight loss. It is also very long-lasting, so long as the patients’ weight is kept stable. During the process, an incision is made along the lower abdomen, extending laterally across the upper hips, and then posteriorly along the upper buttock curve to meet in the middle. The loose, sagging skin is removed and “droopy” areas, like the outer thighs and buttocks, are lifted, almost like pulling-up a pair of saggy jeans.
A tummy tuck is part of the body lift surgery, but can be performed as a single component in situations where the excess skin and sagging is confined mostly to the front of the body. Tummy tucks help flatten the stomach when exercise, diet, and weight loss have not done enough. Tummy tucks are not the same as liposuction, although Dr. Bray may use liposuction if needed.
Butt enhancements improve the buttocks’ contour, shape, and size. Dr. Bray accomplishes this by using fat transfer (BBL), surgical buttock lifts, or a combination of these. Buttock implants are silicone-filled items that Dr. Bray surgically placed within the deep tissue of the buttocks. With the increasing popularity of fat transfer (BBL) surgery, silicone buttock implants have become much less popular. Butt enhancement through fat transfer involves him transferring fat from one area of the body into the buttocks’ tissues in as safe and strategic a process as possible.
Those who have had major weight loss, with significant sagging and deflation of the buttock and outer thighs, will typically require a surgical buttock lift. This procedure is a powerful option to lift and reposition the buttock region, and can be a component of a circumferential body lift or as an isolated procedure.
Normal breasts consist of a large proportion of fat, much of which can be lost with major weight reduction. This process results in breast deflation, volume loss, and sagging. Many women are interested in restoring some breast volume or fullness, a goal that can be achieved either by augmentation with implants or her own fat tissue.
A breast augmentation with fat transfer is a safe alternative to breast implant surgery, but is less powerful in terms of the possible increase in size. Fat is removed using gentle liposuction from the hips, abdomen, or thighs and transferred to the breasts where it can be expected to yield modest improvements to breast volume and shape. Your expectations, goals, and Dr. Bray’s advice determines the outcome of your treatment.
Size, shape, and asymmetry can be addressed during the procedure. Depending on the severity of the deflation, an implant may be required – rather than mere fat injections. As such, Dr. Bray works to create a natural-looking, feeling, and youthful breast enhancement.
Most women will experience a reduction in breast size along with major weight loss. Despite this change, the breasts often remain heavy, uncomfortable, and out of proportion with the rest of the body. Breast reduction surgery can be a very successful procedure to reduce the breast size, making them smaller and lighter, but also lift, shape, and tighten them. To accomplish this, a significant amount of liposuction, lifting, and tightening is often required. Dr. Bray uses a variety of liposuction techniques, including BodyTITE™ in addition to removal of loose skin and breast tissue. Breast reduction procedures can ease discomfort or achieve a breast size more appropriate for their body.
A breast lift, or mastopexy, is a reshaping and raising of the breasts to correct the “droopy” shape. In contrast to a breast reduction, Dr. Bray makes every effort to preserve the breast size, as opposed to making them smaller. By also raising the nipple’s position and reshaping excess skin, the patient is left with firmer, natural-looking breasts.
Breast reduction for men is very different than for women. The goal for a male breast reduction is to achieve a flat, masculine final contour as opposed to the round, projected shape of a female breast. The requirements and surgical options vary dramatically between patients, given the differences in amount of fat, breast tissue, loose skin, and sagging between male patients.
Dr. Bray uses two main strategies to achieve a masculine chest contour, depending on the severity of the breast enlargement in men:
(1) The minimally-invasive technique is best-suited to men who have a satisfactory nipple position, and small to moderate amounts of sagging skin. Dr. Bray reduces the breast size, making the chest flatter and more masculine, without visible scars on the front of the breast. With the use of advanced technology, like radiofrequency-assisted liposuction, special instruments and methods of his own development, the only scar will be in the armpit region. In patients with poor skin quality after weight loss, he might recommend the use of additional skin-tightening technologies, like Morpheus8 Body™ For more information please click here.
(2) The excisional technique is for men who have undergone major weight loss often have significant drooping of the breasts, a low nipple position, and loose, deflated skin in both the breast and lateral chest regions. In this situation, a more invasive solution is required, involving removal of loose skin and lifting of the nipples, often with additional liposuction contouring to remove excess fat. This method is a powerful option for lifting and tightening the breast/chest region but requires creation of longer, more extensive scars. The length and position of the scars can vary, but will most often be located within the crease at the base of the breast/pectoral region, then extend laterally along the side of the chest toward the underarm. A circular scar will surround the border of the areola. Dr. Bray will show numerous photos of typical scars such that you can decide if this solution is right for you.
Inner and Outer Thigh Fat Reduction
The most resistant fat cells in the body are those that are controlled by hormones. You cannot easily lunge or squat away your thigh fat because spot reduction workouts are not effective. This is why inner and outer thigh fat is infamously resistant to diet and exercise in many women. Dr. Bray’s treatment allows you to target fat loss in specific places, such as the thighs. Dr. Bray liposuctions excess fat, then lifts and tightens hanging skin.
Thigh Lift (Medial/Inner Thigh Lift)
A thigh lift can help you regain the youthful contours of your inner or outer thighs. An outer thigh lift is a typical component of Dr. Bray’s body lifts. An inner thigh lift; however, this must be performed in a subsequent surgery. Patients who are unable to reduce their sagging skin after massive weight loss, and are committed to maintaining a healthy lifestyle are candidates for this procedure.
The type of thigh lift a patient requires will depend on the amount of loose skin and excess fat that is present in the inner thigh area. This factor, as well as the goals of the patient, will determine whether a medial thigh lift will be adequate, or a more extensive, extended thigh lift will be necessary.
- A medial thigh lift targets loose, sagging skin mainly in the upper half of the inner thigh. Dr. Bray places the incision within the groin crease, a natural hiding-place. From here, the loose skin of the inner thigh is lifted and removed, usually combined with liposuction to remove excess fat. This procedure results in a slimmer, tighter inner thigh area. Those patients who need or desire improvement in the lower half of the thigh, closer to the knee, will need to consider an extended thigh lift.
- An extended, or “stocking-seam” thigh lift is more powerful than the medial thigh lift described above. It tightens both the upper and lower portions of the inner thigh region. The consequence, however, is that it requires the creation of a longer scar, extending along the inner aspect of the thigh from the groin crease toward the knee, like the seam on a pair of stockings or jeans. The presence of this scar requires careful consideration, as it might be visible when wearing shorts or bathing suits. Dr. Bray will show photos of typical examples allowing each patient to decide if it suits their goals.
An arm lift (brachioplasty) involves removing excess skin and fat from the upper arm. It might also effectively reduce sweat build-up, making people feel uncomfortable during hot days when they work out. Dr. Bray works to reshape a patient’s arms, highlight muscle tone and reduce the appearance of cellulite. Through the use of liposuction and lifting, the result is a more toned, muscled contour. Dr. Bray aims to position the final scar on the inner aspect of the upper arm, running from the underarm region down, typically stopping short of the elbow.
Plastic surgery after weight loss is common for those aiming to fully realize their weight transformation and get rid of excess skin. While a stable, healthy, sustainable final weight can vary dramatically between patients, Dr. Bray does not recommend plastic surgery until you have achieved a Body Mass Index of less than 30. It is important to note that only those who have maintained their ideal body weight for 3-6 months should consider such plastic surgery. If you have any questions regarding your candidacy for these procedures, please schedule a consultation with Dr. Bray.
Generally, it takes 6 weeks to fully recover and return to exercise and work after body contouring.
Schedule a private consultation with Dr. Bray by submitting the form below or calling his offices directly at 416-323-1330.