James J. Romano, MD
The desire for a healthy, reduced, contoured, shapely, and smooth body is precisely the reason that plastic surgery for body contouring and weight reduction surgery complement each other so nicely.
Plastic surgery for this purpose dates to as far back as the early 1900s, when procedures were performed to complete the results obtained from weight-loss techniques. At times, plastic surgery has also been used to “jump start” the weight-loss process. In around 1905 this began as breast reduction and lift techniques and tummy tucks. It has now spread to virtually every area of the body that is plagued by excess hanging folds of skin. The entire spectrum of plastic surgery techniques has naturally benefited from this long span of time, and techniques have improved tremendously.
Nowadays, many plastic surgeons have taken an interest and become very skilled at surgery to lift, reduce excess skin, tighten, smooth, contour, and shape the face and body after weight loss. In so many of my patients who have undergone weight reduction, the whole journey of surgery, weight loss, nutrition, and maintenance has all been so much more exciting and speedy since they saw me early in the course and knew the shape and contour of their new body that they could soon plan on! Computer imaging has added a potential whole new dimension and enabled us to help visually predict the results of the weight loss and plastic surgery.
Patients particularly desire plastic surgery after surgical bypass procedures. This is for several reasons. First, the weight loss is often so rapid that the skin does not have time to contract, and one is left with large folds of excess hanging skin that are unsightly, uncomfortable, and irritating. Patients want these removed. Second, since the weight loss is relatively rapid, patients also want to look better and look complete as rapidly as possible. Third, since the weight loss is accompanied by better nutrition, better sense of well-being, and better attitude, what better than plastic surgery to contribute to these total well-being goals and complete the picture of what one wants to obtain? Better size and health through weight loss, and better contour and shape through plastic surgery.
The spectrum of plastic-surgical procedures that are an adjunct to weight reduction range from simple or minimally invasive liposuction all the way up to large incisional and surgical procedures that lift the entire lower body from the knees on up. What we see mostly are patients who desire and will benefit from breast lifts, facelifts, inner thigh lifts, outer thigh lifts, buttock lifts, arm lifts, and abdominal tightening (tummy tucks). Often patients will benefit from more than one of these, and several procedures are performed at the same time.
The safety of these surgical procedures is very well known. There are tremendously reduced anesthesia and medical risks once the weight has been lost, so these plastic-surgical procedures can be undertaken in stages or often all at once. The other fact that makes this surgery safe is that these procedures mostly involve only “skin surgery” and since there is no cutting through muscles, ligaments, or bone (things that hurt), the surgery is much better tolerated. Lastly, most doctors now enlist the help of many of the well-known nutritional supplements and dietary changes that go a long way to reduce swelling, speed up healing, and make for an overall faster and safer recovery.
The timing of plastic surgery after weight reduction is really just a matter of the message your body sends you and me. If your weight is stable, you are healthy, and there are no major medical problems present, then it is usually safe to proceed. The interest and enthusiasm for eventual plastic surgery often speeds up this process.
Most procedures require a general anesthetic, and patients are admitted for an overnight stay in the hospital. Incisions are placed in the most inconspicuous places, usually in body folds and beneath undergarment lines. Drains may be used in some places and can often be removed on the next day. Some or most procedures can be performed as outpatient procedures, or you can stay overnight. There is only mild pain that usually resolves in two to four days. You can shower on the second day after surgery. You will feel groggy for the first two days and slightly weak for about seven to ten days. Swelling is mild to moderate for the first week afterwards and then disappears rapidly. There is mild to minimal bruising. You can resume many activities within the first week and most all activities by three weeks. There are usually no stitches to remove. Most patients plan to take about a week off work.
The result is a balanced, youthful, trim appearance that compliments all your health and lifestyle changes. It is a very natural result that only gets better with time.