Weight Loss Reconstruction
Someone who has lost a significant amount of weight either through exercise and/or dieting, or after bariatric surgery, will often be faced with an excess of skin and fat in the lower abdomen. Called an abdominal panniculus, this is the residual stretched skin and fat in the lower abdomen that hangs over the groin area. Other skin problems that may be present include rashes, skin infections, and excess moisture in the groin folds. Patients with previous abdominal incisions may also have a hernia (a weakness in the strength layer of the abdomen) that sometimes can be painful and/or visible as a bulge in the abdomen. Correction of the abdominal panniculus involves removal of the excess skin and fat, usually removal of previous scars, and repair of any hernias if present. Although similar in concept to a tummy tuck (abdominoplasty), panniculectomy often is more complicated as multiple factors determine the shape and extent of the incisions used and planning for hernia repair if needed.
Individuals considering an abdominal panniculectomy should have a stable weight, be in general good health, and refrain from smoking. Although large incisions may be needed to remove the excess skin and fat, the benefit is an improved clothing fit and appearance. The procedure time ranges from 3 to 5 hours. An overnight stay in the hospital is sometimes required. Drains are left in place for 5 to 10 days. Walking is allowed and encouraged immediately after the surgery, but strenuous activity is not allowed for 6 weeks.
Persons who have experienced a significant weight loss through diet and exercise or with bariatric surgery can have loose or hanging skin in the buttock area. Additionally, women may notice a loss of the normal round contour of the buttock area. A buttock lift removes the loose skin in the area, and with a re-arrangement of remaining fat, restores a more normal contour to the buttocks. This operation can be combined with an abdominal procedure (panniculectomy) to correct weight loss deformities of the midsection in one step. The procedure is done under a general anesthetic normally as an out-patient. Recovery time varies but generally normal activities can be resumed in 4 to 6 weeks.
A body lift combines aspects of a tummy tuck and a buttock lift. This procedure removes excess skin and fat from the trunk and upper legs (affecting the abdomen, back, buttocks, hips and thighs). Patients that require a body lift have significant loose and hanging skin affecting the outer hips and buttocks in addition to the loose or hanging skin of the lower abdomen. This procedure is an extension of the abdominal surgery (panniculectomy or abdominoplasty) completely around the waist area. It is a complicated procedure that can take three to seven hours under general anesthesia and involves a more prolonged recovery period of four to six weeks. Patients sometimes require a short stay in the hospital. After surgery, patients are encouraged to walk as soon as they are able, although strenuous activities must be limited for six weeks. Results are visible immediately but improvement may continue for some time.
After substantial weight loss or simply from the effects of aging, skin on the upper arms can become inelastic, loose and flabby. Arm lifts, also known as brachioplasty, remove that excess skin and fat. The procedure is normally performed as an out-patient and requires general anesthesia. Many of our patients request that an arm lift be performed at the same time as other bariatric reconstructive procedures. This is possible in selected patients. The incisions are made along the inner aspect of the arm and extend into the axilla. The resulting scar is visible along the inner aspect of the arm but is hidden when the arm is positioned at your side. Compression garments must be worn for several weeks after the surgery to control swelling. Most patients resume daily activities within a few days of the procedure but strenuous activity should be avoided for about 6 weeks.
After weight loss or simply from the effects of aging, the skin of the inner thigh may become loose and “sag”. A thigh lift removes excess skin from the inner aspect of the thighs resulting in an improved contour. Depending on the amount of skin that needs to be removed, the incision may be limited to the upper inner thigh or extend along the inside of the thigh from the groin to just above the knee. Although thigh lefts remove some fat, the procedure does not remove excess weight from the thighs. Liposuction may be needed to remove the excess fat from thighs to improve the overall contour. Sometimes liposuction and a thigh lift can be combined to provide the best correction of thigh shape.