Weight loss following obesity surgery or as a result of lifestyle changes can lead to significant changes in one's appearance. With few exceptions, individuals following significant weight loss develop generalized or focal areas of excess skin.
The primary cause of excess skin following weight loss is relatively simple and similar to pregnancy where the muscles, skin and other tissues of the abdominal wall expand to accommodate the fetus. However, the process of fat accumulation in morbidly obese individuals often begins during childhood or adolescence, prolonging the period of tension on the skin.
With weight loss or following the delivery of a baby, the affected tissues tend to retract. When the tissues do not return to their previous state it is because they have been permanently damaged. The degree of retraction after these events depends on several factors, including the patient's skin health as well as their complexion, amount of sun exposure received over a lifetime, heredity and whether somebody is a smoker.
Body Contouring Procedures
Body contouring procedures should be considered only after one's weight has stabilized after a bariatric procedure. This can take from 12 to 24 months, depending on the individual's preoperative weight and the bariatric procedure they have undergone. Performing a skin tightening procedure prior to weight stabilization may result in the need for further skin tightening in the future.
Abdomen, Thighs and Buttocks
The abdomen is usually of greatest concern to individuals following massive weight loss, as there tends to be both excess abdominal wall skin and loose muscles. In addition to the aesthetic concerns, some patients experience irritation, redness and pain as a result of a condition called intertriginous dermatitis.
These conditions and cosmetic concerns can be corrected through a procedure called panniculectomy, also known as abdominoplasty or tummy tuck, which tightens the muscles of the abdomen and removes excess skin.
Since many patients experience excess skin in the thighs and buttocks, we also offer a generalized body lift or belt lipectomy treatment, which includes an abdominoplasty along with a thigh and buttock lift during one procedure.
Breast size and shape often change significantly in both men and women following weight loss. The effects of aging and gravity cause the breasts to sag with time. Massive weight loss greatly accelerates this process.
There are several treatment options available for women's breasts following weight loss. If a woman desires larger, fuller breasts but has little sag, an implant alone may be satisfactory. However, most women have concerns about sag and may want to be larger. In this case, a breast lift or mastopexy is needed, in addition to placement of an implant. In some instances, particularly for women with sagging and deflated breasts, it is preferable to perform a breast lift several months prior to placing an implant.
Many men also suffer from large or sagging breasts, a condition known as gynecomastia. For men with large breasts following weight loss, liposuction alone may provide adequate treatment, although this is not typical. Most men can benefit from a two-stage procedure that involves liposuction and then a mastopexy performed three to six months later, after initial results have been analyzed.
Loose skin and excess fat at the arms can be a source of great consternation for both men and women following weight loss. A patient may feel forced to wear long sleeved shirts at all times.
There are three surgical options for the weight loss patient seeking improvement in the appearance of their arms. For individuals with excess fat and relatively good skin tone at the arms, liposuction alone may provide a satisfactory outcome, although this is not typical.
When the amount of excess skin is mild, a modified form of brachioplasty or arm lift can be performed. With this technique, the excess skin of the arm and armpit is tightened only from the armpit, leaving a well-concealed scar. The classic procedure for arm lift involves a scar in the armpit as well as along the inside of the arm. It is often combined with liposuction. The drawback of this procedure is of course the scar along the inner aspect of the arm.
With age and significant weight loss, the laugh lines and other wrinkles on the face become more prominent. One important difference between the effects of the normal aging process and rapid weight loss is the excess skin that develops along the neck. The neck serves as a repository for fat in most obese individuals. Weight loss consumes much but not all of this fat. Consequently, weight loss patients often complain of excess skin and fat at the neck.
A facelift, which almost always incorporates a neck lift, effectively treats the deep wrinkles of the face as well as the excess fat and skin of the neck. The technique of face lifting usually involves an incision around the ear before the skin of the face and neck is elevated and the excess removed. Other components of the operation usually include tightening the superficial muscle layer and removing the excess fat of the neck. Face lifting can significantly refresh the appearance of weight loss patients.
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