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Plastic surgery following weight loss

It is a tremendous achievement to have lost weight and then to maintain your new weight. Nowadays people not only lose weight through careful dieting and exercise, but also through bariatric surgery, such as gastric banding or gastric bypass operations.

For some people (and depending upon the amount of weight lost) the unfortunate side effect of weight loss, is that once the excess fat disappears, the stretched skin does not shrink back correspondingly. This can leave unsightly excess skin and stretch marks in a variety of areas on the body. This excess skin can be very distressing to live with, but fortunately, modern plastic surgery techniques are available to address these problem areas, including the following examples:

Body area Possible procedure
Abdomen Abdominoplasty
Lower body lift (belt lipectomy)
Reverse abdominoplasty
Flankectomy
Breasts Mastopexy (breast lift)
Augmentation-mastopexy (breast lift with implants)
Thighs Thigh lift
Face/neck Face and neck lift
Upper back Upper body lift

Surgery following weight loss should be considered a journey, rather than a single procedure. For the reasons elaborated on below, it is normal to require more than one procedure, with possible revision procedures. If you are aware of this to begin with, your mental approach will be more positive and you will be better able to cope with the process. The end point of the journey is incredibly rewarding and transforms peoples’ lives and a comprehensive understanding of the process makes the journey much smoother. Mr Pacifico has therefore written this page with the aim of informing anyone considering this type of surgery about the wider issues and nuances involved with post-weight loss surgery.

Despite the wide range of operations available, it is important to take a step back before considering what may be the most appropriate procedure (or procedures) for you. It is vital to understand the effect of your initial weight gain and subsequent weight loss on your tissues, your skin and your healing ability. If you understand this, you will appreciate why surgery following weight loss differs from other plastic surgery operations. Below are some points that Mr Pacifico feels it is important to understand if you are planning to undergo post-weight loss plastic surgery:

Nutrition and post-weight loss plastic surgery

Whether your weight loss was achieved through diet and exercise or by means of bariatric surgery, in order for you to have lost weight, the energy you spent must have been more than the energy that you consumed (i.e. take in as food and drink). This imbalance is needed for you to burn away fat and lose the weight. During the period of energy imbalance your immune system and your wound healing ability are affected. Therefore it is unwise to perform surgery if you are still losing weight (as well as the fact that your result will not be as good as it could be).

Once you have reached your target weight it is important for this to be kept steady for at least 6-months. This allows the imbalance (of what goes in compared with what energy is spent) to be levelled – i.e. for you to maintain a steady weight, the energy (calories) that you eat must equal the calories that you burn on a day-to-day basis. Once this balance has been achieved, your wound healing ability is improved and the chances of a speedy post-operative recovery are increased.

Therefore, Mr Pacifico recommends that all weight loss patients (especially massive weight loss patients) have plateaued at their target weight for at least 6-months prior to their plastic surgery.

Weight loss and skin quality

One of the side effects of weight gain and weight loss is a negative effect on skin quality. This can be seen by the stretch marks (which are thin areas of skin as a result of breakdown of collagen links, the building blocks of skin) and the reduced thickness of skin. Unfortunately, once skin quality has been reduced, it cannot be improved. This must be considered when understanding what can be achieved through surgery: your contour will be significantly improved, the excess skin will be removed, but the remaining skin will be the same skin that you started with.

Weight loss and skin elasticity

Tied in with skin quality is skin elasticity, and how the skin behaves and responds to surgery. Using the example of weight gain on your thighs; imagine you were wearing a pair of stretchy leggings which were the equivalent to your skin. When you gain weight, these leggings stretch and increase in size (circumference); however, when you lose weight, although your legs may shrink down in size, the stretchy leggings stay at their stretched out size as they have lost their elasticity. This is effectively what happens to your skin with significant weight loss, and the same analogy can be applied to other parts of the body. Furthermore, when other areas of the body are affected by stretching for other reasons (such as a tummy that has been subjected to multiple pregnancies), the skin in these areas will behave similarly.

Much like a balloon or elastic band that has been overstretched; once skin is overstretched, it loses its elasticity and capacity to shrink back down. Unfortunately, this is a permanent effect: therefore even after post-weight loss plastic surgery, the skin’s elasticity will not improve (despite potentially removing large quantities of it). Therefore, even if your area of surgery is tight in the early post-surgical period, there will inevitably be skin relaxation in that area due to your skin’s elastic properties being reduced with your change in weight – your skin will not remain “drum tight”. It is important to understand this, so as to have realistic expectations of your future post-surgical result.

Weight loss and wound healing

As mentioned above, the effects of losing weight (and burning more energy than you take in) can have an effect on wound healing capacity. In addition, due to the reduced quality of the skin, and the skin thickness being reduced (as a result of stretching when being overweight) the wound healing ability of the skin is reduced even after your weight plateauing.Therefore minor wound breakdowns, delayed wound healing and minor wound infections are more common in plastic surgery following weight loss than in other situations.

These issues are all surmountable, but may require a period of dressings to certain areas of wounds or post-operative antibiotics to get things settled down and healed in certain cases. As long as you are aware of this possibility, you will be better placed to understand and cope with this situation should it occur to you following surgery. There are no guarantees of complication-free surgery in any area of plastic surgery, but in surgery following weight loss, the complication rates are higher than for other areas of plastic surgery. During your post-operative course you will be cared for and guided through any dressings or other requirements by Mr Pacifico’s team, meaning that you are in the best possible hands to get you to your final result.

Scars and post-weight loss plastic surgery

Despite some of the problems outlined above, with time the scars from post-weight loss surgery usually settle down very well indeed. All scars will go through a natural cycle of becoming red and thickened before they soften and pale. This process can take longer than normal in post-weight loss plastic surgery, especially if there have been areas of delayed wound healing or infection of the wound. However, please be reassured that in most cases, the scars will improve, even if it takes a long time (over 2-years in some cases).

The need for revision surgery

If you are considering surgery following weight loss, it is important that you understand the frequent requirement for revision surgery. This may be to “tidy-up” scars or irregularities such as “dog-ears” (puckering of skin at the end of the scar), or surgery to tighten up a related area of the body (such as the need to undergo a reverse abdominoplasty or upper body lift after a lower abdominoplasty). During your consultation, Mr Pacifico will outline the nature of the surgery he proposes as well as the implications for revisions or further surgery. Most minor revision procedures can be carried out under local anaesthetic, and will not usually be charged for. However, additional procedures that are operations in their own right will incur a charge (such as the example of the upper body lift given above). Please feel confident to have an open discussion with Mr Pacifico about these matters, as it is important that you know where you stand before embarking on your plastic surgery journey.

Despite what has been outlined above, patients who have undergone post-weight loss plastic surgery are some of the most satisfied of all plastic surgery patients. The positive impact on their lives as a result of their surgery can be felt everyday. Clothes they wouldn’t have dared wear beforehand become normal to wear, and their self-esteem and confidence is boosted significantly.