Massive weight loss is considered a range of greater than 100 pounds or 40% or more of your excess weight. Many factors contribute to the flatness or contour of the human abdominal wall. The most significant factor is visceral fat.
Visceral fat is the adipose tissue or fatty tissue inside the abdominal cavity surrounding the internal organs. It includes an anatomic structure called the omentum or the fatty apron that separates the internal abdominal organs from the musculature of the abdominal wall. To have the flattest abdominal wall this internal fat must be minimized. Changes in this body of fat are more a result of diet and lifestyle.
Prolonged obesity and subsequent loss of fatty tissue results in damage to the dermal structures responsible for the appearance and position or laxity of the skin. The structures in the dermis have undergone irreversible damage, especially to collagen, elastin, and fibrin. Massive weight loss does not reverse the damage done to these important dermal structures.
Provided the visceral fat is not excessive, the remaining layers can be addressed to achieve the flattest abdominal wall possible in any given patient. This will require a very aggressive removal of excess skin and fat beginning at the pubic area and extending up to the rib cage with surgery. This entire apron of skin and fat is removed leaving just enough skin to cover the abdominal wall.
In addition, before this new apron of skin is advanced and secured the abdominal wall muscles are tightened. Occasionally strategic liposuction may be added to the procedure to produce the best result. So, the answer to the question is most likely no – following massive weight loss a flat abdominal wall cannot realistically be achieved – in my opinion without surgery.
I’m constantly amazed at the life-transforming improvements achieved by body contouring surgery after weight loss. These patients are given a new lease on life looking better and feeling better.