Body contouring after weight loss is a major part of our practice. There is a distinct difference between two types of patients. First, for example is the patient who has lost 20 or 30 pounds. They have loose skin on the lower abdomen. They have muscle weakness that would benefit from abdominoplasty and muscle tightening. And secondly, there is the patient who has lost over 100 pounds or more. The large weight loss patient has greater challenges facing them than the average abdominoplasty or tummy tuck.
First, a long time of obesity can create high blood pressure diabetes, and other major medical problems that the average tummy tuck patient may not face. Therefore, preoperatively all these issues must be addressed and stabilized prior to undergoing major body contouring surgery.
Furthermore, long-standing obesity can damage the healing potential of the body elevating the risk of postoperative complications and slow wound healing. The biggest difference visually is the massive amount of skin and fat that the massive weight loss patient presents to the surgical procedure. The average weight of the skin and fat from a standard tummy tuck may not be more than three or four pounds. With massive weight loss patients, we have removed well over 20 pounds of skin and fat at one time. This alone creates a greater challenge to the surgical team.
As stated, the long-standing obesity may have damaged the healing capacity and skin quality which may lengthen or compromise the healing process. Internal muscles are always addressed and tightened. Furthermore, once the large flap of skin and fat of the major weight loss patient is removed a vertical incision may be required to achieve maximum improvement.
This vertical excision of skin and fat can add a profoundly better result in some instances. Also, with the massive weight loss patient postoperative weight gain is more of a risk than with the standard tummy tuck patient. The massive weight loss patient may also desire breast reconstruction, arms, and leg lifts. Therefore, there is a distinct difference between a so-called standard abdominal plastic and the abdominoplasty and body contouring of the major weight loss patient.
THOMAS TREVISANI, MD
BOARD-CERTIFIED PLASTIC SURGEON
MEMBER OF AMERICAN SOCIETY OF AESTHETIC PLASTIC SURGERY
