Plastic surgery can play a very important role with massive weight loss. It is already well known that fat pads can be removed by plastic surgery. Recently, plastic surgeons have been exploring methods of plastic reconstruction after massive weight-loss, such as that obtained after digestive surgery. Gastroenterologists using non invasive methods as the Intragastric Baloon and Bariatric Surgeons are aware that their patients will often undergo extensive reconstructive procedures with a post-operative course not always pain free. This treatments deeply benefit from a multi-disciplinary approach staff (plastic surgeons, anaesthesists, gastroenterologists, nutritionists, nurses, psicologists, fisiotherapists, etc.).
Successful weight-loss can be associated with two types of side-effects:
Excessive skin laxity: The tension and elasticity of the skin vary greatly from one person to another. A 25 kg weight-loss can be as troublesome as a 80 kg one, depending on the patient.The quality of the skin will also vary on different parts of the body. Many patients find the abdomen to be their major area of concern, although the arms, the interior side of the thighs, or breasts can be just as troublesome.
Persistent fat in some areas: This depends on the type of obesity. The goal of plastic surgery is to re-harmonize the two parts of the body by removing excess fat and skin. Weight loss should be achieved in first instance by changing eating habits an adjusting the life stlyle. However it is true to say there is a loss of significant weight amounts associated to plastic surgery in this group patients: for example an abdominoplasty can remove 2 to 3 kilos, a bodylift 4 to 6 kilos, a breast reduction 1 to 2 kilos, and a liposuction 3 to 4 kilos.
We start with the most troublesome area for the patient, which is usually the abdomen. Some patients prefer to start with a breast reduction because postoperative care is short and allows them to return to work rapidly. For others, reshaping their face is a priority because of its obviousness, even if concerned by hanging abdomen problems.
Abdomen. The most frequent operation(80%): it aims to remove excess fat tissue and excess skin in the umbilical area. Moreover its aim is to repair overdistended muscles resulting from pregnancy or the pressure formerly exerted by body fat before weight loss.
Exceeding fat in suprapubic region may also be liposucted during this procedure (pubic rejuvenation).
Hospitalisation lasts about one week. The main complications patients may face are thrombo-embolism, and wound healing problems. The patient should remain off work for about one month, this period varies depending on the type of work.
Breast reduction: The psychological role according to breast shape is major, and any flaw in their shape or size can cause much distress. Overweight breast patients normally complain about back, neck and shoulder aches. Hence, the aim of surgery is to recreate a normal shape and volume. The procedure is relatively straightforward: only requires an hospitalisation of 1 to 3 days.
Post-operative scars are visible in patients with considerable breast reductions but thanks to the rapidly improving techniques these are getting smaller with consequential benefits for the healing process as well as the aesthetics.
Internal part of the thights. Crural lifting: The skin-fold thickness and fat amount are especially reduced in this area. As the patient loses weight, the skin shrinks, creating a loosen roll of fat, which in turn leads to aesthetic and functional problems (“it rubs”).
Surgery is effective and about 1,5 kilos of skin and fat tissue are removed from each thigh. Scar healing does take longer than usual because the scar is located in a fold which is very mobile and is also prone to steep. Seromas (due to the density of blood vessels in the area) and infections (given by bacteria flora) may occur. Patients generally are satisfacted by this operation.
This is one of the areas of the body where skin is the thinnest. As the patient loses weight, the skin shrinks, creating a distressing roll of fat, which in turn leads to functional and aesthetic problems (“it rubs”).
Torsoplasty. Body lift: This is a complete lift of the lower body, with a scar going right round the body, low enough to be hidden by the swimsuit.
A bodylift is often performed in conjunction with liposuction of the fat on the buttocks.
The bodylift is a relatively heavy procedure because of the amount of skin removed and the weight of the tissues (4 to 6 kg or more), the length of the intervention (4 to 5 hours). Also the fact that the abdomen, buttocks, hips, and thighs are all lifted at the same time makes this intervention very invasive. The recovery period is often marked by extreme fatigue.
Achieved results can be very satisfacting.
Braquioplasty. Inner arms loose skin:
The excess of fat and skin on the arms can be a problem with clothing. Lifting of the arms is therefore very sought. The operation itself is relatively straightforward, and the scar is inevitable but easily hidden under the arm.
This operation can, for example, be combined with a breast reduction.
Cara. Elevación de tejido facial y de cuello. Lifting facial-cervical:
• Facial lift can decrease the ‘droopiness’ of the skin on the face and the neck. Individual bone shape, heredity and quality of the skin all play an important role regarding the outcome, and to a certain extent how long the lift will be effective. The aim is to enable the patient to “look good for his age”, and to give the face a sharper outline and a brighter look.
• The surgeon works on one side of the face, then the other, through small incisions made in the scalp, or in the natural creases around and at the back the ears. Incisions are designed to obtain the smallest possible scars. If necessary, excess fat is removed and distended muscles are tightened. The skin is then pulled and any excess skin is removed.
The aim is to give the face a firm and fresh contour. The colour of the skin may temporarily change after the operation, and the patient may experience a feeling of tingling and hardening of the skin on the face and the neck. Healing is slow, and it can take weeks or even months before the final result is obtained depending on the amount of the weight loss.
The scars can be hidden within the hair, and by appropriate make-up. The skin remains fragile for several weeks. It is therefore recommended to avoid exposure to the sun and to protect the skin with a total sunblock cream. The patient may use make-up very soon after surgery.
During consultation Dr. Cerqueiro will explain you the objectives of surgery, its limitations, complications and side effects in relation to your specific needs and individual circumstances. As it occurs in other plastic surgery treatments the coordination and collaboration of all the specialists involved in your care is essential.
