Common Issues
People seeking surgery after massive weight loss typically have both functional and cosmetic concerns. From a functional perspective, there are issues with excess skin resulting in rashes, skin breakdown and difficultly fitting comfortably into clothing. Cosmetically, the excess skin and volume deflation from fat loss affect many parts of the body. The breasts often appear droopy and empty. The abdominal area retains folds of excess skin including the mons (area above the vulva) which can rub together, causing painful rashes as well as trapping sweat leading to an unpleasant smell. Excess skin folds of the arms and thighs are also commonly requested for surgical correction.
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Surgical Planning
Usually multiple surgeries are required to address these areas of concern. Staging surgeries helps to minimise the length of surgery, shorten recovery times and reduce the risks seen with combining numerous procedures. From a practical perspective it also helps to reduce time off work and cost. Your hierarchy of concerns is an important consideration in terms of how surgeries are grouped together and in what stages.
It is important to understand that skin problems such as striae (aka stretch marks due to dermal fracturing) are not addressed by surgery except where the skin is removed. In some cases, tension on the skin after surgery may make these marks more obvious. While minimising scars is always an important consideration, due to the volume of skin resection required in multiple directions, scars are typically long. These scars are permanent but usually fade well into a fine line.
There are numerous surgical challenges in weight loss surgery including poor quality skin, loss of elastic tissue and often either an absence or localised collections of remaining fat. As such, wound healing issues are more common, and the way tissues spring back or reshape after liposuction or placement of an implant are more unpredictable. As such, revisions are common and this is another benefit of staging surgeries.
What Can You Do?
Before weight loss surgery, you should have achieved and have maintained your goal weight for at least 6 months. Losing significant weight after surgery will compromise the results. In some cases, a functional procedure (such as an abdominal pannus resection) may be indicated to aid in further weight loss efforts prior to definitive surgery. Optimising your health and ensuring appropriate nutritional support (especially after gastric sleeve or bypass procedures) is important to minimise risks of delayed wound healing. Smoking is a contraindication to surgery. Furthermore, it is important to appreciate that surgical correction, just like the weight loss, is a journey and expectations need to be realistic.
Plastic Surgery after Weight Loss is regarded as a crucial chapter of the weight loss journey and is a significant step in making patients feel more comfortable in their bodies again.
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