With the growing trends of athleisure, healthier lifestyles, and access to bariatric surgeries, I have more and more patients that come into my office at Cosmetic Surgery Affiliates wanting body contouring after massive weight loss. Theses are some of my most favorite patients, because they are some of them most compliant and disciplined by nature of their journey in losing weight. They also are very realistic with goals, often stating that they have worked so hard to lose fat and build muscle but know they need to help get rid of the loose skin.
Every individual is different in the areas that need the most help and in what bothers them the most. Many come to their consultation and ask “Dr. Caplin, I don’t know where to start?” In those situations, I provide an algorithm of surgeries and interventions to achieve their goals. To simplify, I would say my patients’ desires typically fall into one of two categories: shaping the core or contouring what’s visible to others.
The group of patients wanting to start by focusing on their core have the goal to have clothes fit better and be able to wear smaller sizes since they have lost the fat, but skin still gets in the way. When patients are focused on their core, we will often begin by evaluating the extent of loose skin. Essentially all of these patients will need a tummy tuck also known as an abdominoplasty which removes the loose skin from above the belly button down below the bikini line. The skin above the belly buttons then gets pulled down to meet the lower incision leaving the abdomen smooth and tight. However, many of my patients after massive weight loss have loose skin that does not stop at the abdomen but continues circumferentially around their bodies. In these situations, I will often recommend what is call a body lift. In a body lift the incision is carried a full 360 degrees around the body and then an entire belt of tissue is removed. In essence, it is three surgeries in one: a tummy tuck in the front, a thigh lift on the sides, and a butt lift in the back. I always recommend performing this surgery prior to any thigh lift surgery. Patients are amazed about how much thigh improvement they can achieve with this surgery. I often explain that it is like pulling up your pants in the back and tucking in your shirt on the front.
The breasts or chest are usually next on the list if not tied for first place. At Cosmetic Surgery Affiliates, we have our own surgery center that is dedicated to excellence and patient safety in cosmetic surgery, so we are able to combine service if patients should want to attack both the abdomen and the chest at the same time. With evaluating the breast or male chest, the goals are actually similar in the nature that we want the nipple and areolar complex to return to where it used to be and removed the sagging skin and gland. Obviously the shape is quite different for females and males, but the goals are similar to returning to how they used to look. For women we typically discuss performing a breast lift with or without an implant depending on the desired size. For men, we discuss either a male breast reduction or chest reconstruction to contour and recreate the masculine chest.
The other group of massive weight loss patients want to start with what is visible to others. These patients often want to start with their necks to reestablish their jaw lines or their arms to “get rid of their wings”. Many options exist for treating the neck and arms and can range from simple skin tightening procedures like Vivace (microneedling with radiofrequency heat) or liposuction with Renuvion (helium plasma and radiofrequency heat) to needing to excise the loose skin with a neck lift or arm lift. The best treatment option is determined after a conversation over the patient’s goals in combination with examination of the patient.
Treating massive weight loss patients is an honor. I feel so special to be a part of their weight loss journey and more times than not become very good friends with these patients over the course of several surgeries. There is no questions that they become a part of our Cosmetic Surgery Affiliates family.