With the euphoria that often comes with the anticipation of major body contouring surgery after a lot of weight loss (and who can blame you after all this time and effort you have put into it), is the reality of what plastic surgery can and can not do. I have observed that all body contouring surgery in the weight loss patient will have a very profound effect. This is unlike some cosmetic surgeries in the non-weight loss patient where the problems are smaller…and the results are subsequently smaller. It is not really possible to remove a lot of sagging skin and fat and not see dramatic changes. And most extreme weight loss patients appropriately see the ‘big picture’ as opposed to some smaller details which may be a focus for other types of patients. For this reason, body contouring patients are usually pretty satisfied with their results.
Despite the largely satisfied patient, body contouring surgery like all plastic surgery has some realities that every patient needs to know. First, the surgery is basically a trade-off of one problem for another. You are exchanging loose hanging skin for scars. And, in general, most of these scars are not great by plastic surgery standards. That is the nature of body contouring surgery…..a lot of scars. If you combine a lot of different procedures together or in stages (for example, circumferential body lift and arm lift) there is going to be a dramatic change but at the price of substantial scarring. Some scars may look great but many others won’t. You must be prepared for the scars…and the time it takes for them to mature and settle down. (6 months to a year)
Secondly, many body contouring surgeries take longer to recover from than one may anticipate. This is particularly true in often often performed combination surgeries. Your bariatric surgery may have been done laparoscopically with small incisions and a reasonable recovery, but body contouring surgery is quite different. Long scars, tightening up body areas, and drains make for a significant recovery. While the actual recovery will vary dependent upon what procedures are performed, circumferential body lifts, abdominoplasties, and the various forms of thigh lifts need 4 to 6 weeks for a really complete recovery. Complete recovery means getting past some healing nuisance issues such as seromas, small wound openings, and spitting sutures. When you think about returning to work, plan on 1/2 days for the first week back and full days the week after. A big surgery means…a big recovery. Don’t underestimate it!
Third, there are some skin issues that plastic surgery will not improve. Specifically, cellulite and stretch marks (otherwise known as striae). Tightening the skin will make some improvement in their appearance but will not eliminate them. Only those skin irregularities within the zone of the skin cut out will be permanently removed.
Lastly, few forms of plastic surgery are ever permanent and body contouring changes are no exception. Time, gravity, and changes in your weight will not have a positive impact on your long-term results. After a few months, there is some skin relaxation (never returning to what it once was) so tissues may not feel as tight as right after surgery. (sometimes this is a good thing!) Like the effort that got you through the weight loss, the maintenance of those bariatric plastic surgery results and the body contouring changes will depend on maintaining good exercise and eating habits.
Dr. Barry Eppley
Indianapolis, Indiana