With extreme weight loss (100 pounds or greater), the excess skin that results is usually everywhere. While it may be problematic at one body area more than another, the loose skin often poses an overall concern that literally may be from head to toe. Since most body contouring patients have needs that exceed just one corrective plastic surgery operation, it becomes important to establish an absolute needs list and a wish list. In essence, a list of the body areas that are most problematic to those of the least concern.
Over the years, I have seen hundreds of patients who have lost a lot of weight. (and some that really should lose some more) The bodies of extreme weight loss patients come in a wide variety of sizes and shapes,,,and many will differ by how much and where the excess skin is. However, in counsel with patients I find that there are almost always two body areas that are on the top of most patient’s concerns…. the stomach/waistline area (abdomen) and the arms. (women only, I have yet to have a male that wants to do an armlift) These top two concerns also make up the most common combination of bariatric plastic surgery procedures that I perform…abdominoplasty/circumferential body lift and brachioplasty. (arms) Sometimes they are done together and sometimes they are done separately but they are the most frequent initial requests of most weight loss patients.
For women, breast surgery (breast lift with or without implants) is at the second tier of concern while for men it is the sagging chest area. The thighs for both men and women, while a significant concern, are lower on most patient’s priority list. (I have yet to do thigh surgery first as the initial operation in any weight loss patient)
These priority lists are not set in stone but are what I have observed as general trends in extreme weight loss patients. I always recommend to patients that they choose as the first operation the most important concern…the one procedure that they are dying to do. Not necessarily the easiest or the simplest problem but the area they have dreamed about improving. For some patients, this may be the only surgery that they may ever do for any variety of reasons, mainly financial and medical concerns. So even if they do only one surgery, they will have addressed the most important concern. The point being….come into see your bariatric plastic surgeon with a list of body concerns based on what bothers you the most, what can wait until another day, and nice if we ever get to it but can live without it.
Dr. Barry Eppley
Indianapolis, Indiana