BODY
CONTOURING

Dramatic weight loss has many benefits. But after any substantial amount of weight loss, including weight loss after weight reduction surgery, the skin and tissues often lack the elasticity to conform to the reduced body size.

Surgical body contouring following major weight loss removes excess sagging fat and skin while improving the shape of the underlying support tissue. The result is an improved appearance with smoother contours.

Is it right for me?
Body contouring procedures may include:

• Facelift, to address sagging of the mid-face, jowls and neck
• Breast lift, to addresssagging, flattened breasts
• Tummy tuck, to address anapron of excess skin hanging over the abdomen
• Lower body lifts, to addresssagging of the abdomen, buttocks, groin and outer thighs
• Medial thigh lift, to addresssagging of the inner, outer and mid thigh
• Brachioplasty (arm lift), to addresssagging of the upper arms

In general, good candidates for body contouring are:

• Adults whose weight loss has stabilized
• Healthy individuals without medical conditions that impair healing or increase risk of surgery
• Non-smokers
• Individuals with a positive outlook and realistic goals
• Individuals that are committed to leading a healthy lifestyle with proper nutrition and fitness

During your consultation, be prepared to discuss:

• Why you want the surgery, your expectations, and desired outcome
• Medical conditions, drug allergies and previous medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
• Previous surgeries

Your plastic surgeon will:

• Evaluate your general health and any preexisting health conditions or risk factors
• Examine your body and take detailed measurements
• Take photographs for your medical record
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of body contouring and any risks or potential complications

Prior to surgery, you may be asked to:

• Get cleared for surgery by your bariatric surgeon or primary care doctor
• Get a lab test
• Take certain medications or adjust your current medications
• Stop smoking well in advance of surgery
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Body contouring surgery should be performed in an accredited office-based surgical facility, a licensed ambulatory surgical center or hospital. If your body contouring is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

The procedures necessary to achieve your goals will be defined along with a plan for the timing of these procedures. Plastic surgery procedures that may be recommended by your physician include:

• Lower body lift: to correct sagging of the abdomen, buttocks, groin and outer thighs
• Breast lift: to correct sagging, flattened breasts
• Arm lift: to correct sagging of the upper arms
• Thigh lift: to correct sagging of the inner, outer and mid thigh

Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision
All body contouring procedures require large incisions to remove excess skin. In many cases, these incisions may be extensive. Incision length and pattern depend on the amount and location of excess skin to be removed, as well as personal preference and your doctor’s surgical judgment. Advanced techniques usually allow incisions to be placed in strategic locations where they can be hidden by most types of clothing, but this is not always the case.

Body Lift
A complete lower body lift treats sagging buttocks, abdomen, waist, hips and outer thighs in one procedure. Incision patterns vary, and may include a circumferential incision around the body to remove the “belt” of excess skin and fat.

Breast Lift
The incision patterns for lifting a woman’s sagging breasts will be determined based on the amount of excess skin to be removed. These may include one or a combination of incisions in a circular pattern around the areola, in a line extending from the areola to the breast crease and/or horizontally along the breast crease. A breast implant also may be recommended to enhance breast shape and size.

Arm Lift
Sagging skin in the upper arms is treated with an incision from the underarm area extending along the inside or back of the upper arm. Additional incisions on the arms may be necessary anywhere excess skin has formed sagging pockets. Although initially obscured by swelling and bruising, the smoother, tighter contours that result from upper arm contouring are apparent almost immediately.

The ultimate scar will be more obvious when the arms are raised.

Thigh Lift
Reshaping of the thighs is achieved through incisions in the groin that can extend downward to the knee along the inner portion of the thigh. Improving contours of the outer thigh may require an incision extending from the groin around the hip. Through these incisions your plastic surgeon will tighten tissues for a smoother thigh.

The decision to have body contouring surgery is extremely personal. You will have to decide if the benefits will help you achieve your goals and if the risks and potential complications are acceptable. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications.

Risks include:

• Bleeding
• Infection
• Fluid accumulation
• Poor wound healing
• Skin loss
• Blood clots, deep vein thrombosis (DVT) and pulmonary embolism
• Excessive or widened scars
• Numbness or other changes in skin sensation
• Anesthesia risks
• Unfavorable scarring
• Residual skin laxity or contour irregularity

These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon.

Following surgery, dressings or bandages will be applied to your incisions. Small, thin tubes may be temporarily placed under the skin to drain any excess blood or fluid that may collect.

You will be given specific instructions that may include how to care for the surgical site(s), medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon.

You may be instructed to avoid bending, straining or lifting for several days to weeks. Where tightening of the abdomen or thighs is involved, your plastic surgeon may also instruct you to avoid standing fully upright and stressing any internal sutures as they heal, and to sleep with pillows elevating your knees.

To minimize the risk of DVT (blood clots in the legs) you will need be up and walking as soon as possible, and drinking plenty of fluid.

Follow all instructions carefully – this is essential to the success of your outcome.

Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period:

• Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery?
• When will they be removed?
• Are stitches removed? When?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?

The results of body contouring following aggressive weight loss are visible almost immediately; however, it can take two years or more to see the final results. Visible scars are something you must accept to achieve a body contour that matches your new weight and proportion. The results of body contouring are generally long lasting, provided you maintain a stable weight and general fitness. As your body ages, it is natural to lose some firmness. However, most of your initial improvement should be relatively permanent.

Although good results are expected from your procedure, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Cost is always a consideration in elective surgery. Prices for body contouring procedures can vary widely. A surgeon’s cost for body contouring procedures may vary based on his or her experience, the type of procedure(s) used and geographic office location. Many plastic surgeons offer patient financing plans, so be sure to ask.

Cost may include:

• Surgeon’s fee
• Hospital or surgical facility costs
• Anesthesia fees
• Prescription medication
• Post-surgery garments
• Medical tests

Health insurance may not cover body contouring surgery or its complications.

Your satisfaction involves more than a fee:
When choosing a plastic surgeon for body contouring, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.

Plastic surgery involves many choices. The first and most important is selecting a member of the American Society of Plastic Surgeons (ASPS) surgeon you can trust. ASPS member surgeons meet rigorous standards:

• Board certification by the American Board of Plastic Surgery® (ABPS) or in Canada by The Royal College of Physicians and Surgeons of Canada®

• Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
• Pass comprehensive oral and written exams
• Graduate from an accredited medical school
• Complete continuing medical education, including patient safety, each year
• Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities

Do not be confused by other official sounding boards and certifications.
The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS-recognized certifying board with “cosmetic surgery” in its name. By choosing a member of The American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly trained plastic surgeon who is board-certified by the ABPS or The Royal College of Physicians and Surgeons of Canada.