Post-Weight Loss Plastic Surgery

After considerable weight loss, there may come a time when your weight is stable but you are troubled by the sagging and excess skin weighing you down. Unfortunately, there is no diet, exercise or non-surgical treatment that can reverse permanently stretched or excess skin. A combination of reconstructive procedures, such as tummy tucks and breast, arm and thigh lifts may be the answer.

Cosmetic and reconstructive surgery after weight loss will enable you to leave the unwanted excess tissue and skin behind, so you can leap into a happier, healthier and more active life. Post-weight loss surgery can decrease pain and discomfort associated with excess skin while boosting self-esteem, mobility and body contour. Just like a dress that is too big can be tailored, so too can excess skin, leaving you more confident and feeling better in your body.


Surgery after weight-loss

The surgery required to address the issues experienced by patients who have undergone massive weight loss is total body reconstruction. For a surgeon to succeed at this type of surgery, they must appreciate anatomy and ‘normal’ aesthetics. However, many surgeons avoid treating these patients because they are considered difficult and ‘not worth the risk’. Such surgeons typically choose ‘easy’ surgical problems to address. Additionally, many surgeons lack the technical and artistic skillset to manage these patients, which is another reason why they choose to not treat them. Any surgeon can cut and sew. However, to be a master reconstructive surgeon requires an artistic flare to sculpt, reshape, restore and reconstruct a living work of art.

What to expect during the first consultation

Your first consultation with a plastic surgeon can be both exciting and daunting. It is natural to experience a combination of anxiousness, uncertainty and eagerness.
During your consultation with Dr Dona, you will discuss the areas that you would like to improve. He will examine and assess those areas and take clinical measurements. You will then discuss the surgical options available, the expected outcomes, risks, recovery period and any other essential considerations, such as your medical history.
We appreciate that the thought of being naked in front of a surgeon can be a little scary, especially when you are seeking surgery for an area of body that you’re uncomfortable or unhappy with. Please remember that surgeons see women, all shapes and sizes, all the time. Dramatic weight loss is a great accomplishment. Your first consultation will inevitably be another step towards a happier, healthier and more active life, not an experience of shame and judgement.

Can overweight patients have cosmetic or reconstructive surgery?

We appreciate that there is no such thing as a ‘normal’ body, so it is almost impossible to determine someone’s suitability for surgery based on outdated measures such as body mass index (BMI). The truth is that being overweight increases the risk of complications from surgery and anaesthesia, such as infection, bleeding and circulation problems, and as well as delayed healing. Common obesity-related conditions, such as heart disease, high blood pressure and diabetes, further compound these risks. However, weight measures like BMI fail to account for body composition, age, ethnicity, genetics and level of physical activity. Therefore, it is essential that you come in for an assessment so that Dr Dona can perform a bespoke risk and complication analysis.
The short answer is maybe. It depends entirely on individual characteristics.

What causes excess skin?

Patients who have lost a considerable amount of weight are likely to struggle with excess skin. That is because the skin stretches and loses its elasticity with weight gain. The skin is then unable to contract and shrink to support the patient’s new figure. While extensive weight loss is a great achievement, the excitement can be undermined by the unsightly and uncomfortable excess skin encasing the smaller body.

Am I a good candidate for post-weight loss plastic surgery?

You may be a good candidate for cosmetic or reconstructive surgery if you are in good health, have realistic expectations and know the risks of the procedure you are considering. Contouring procedures, like a tummy tuck, are not weight loss procedures. If you need to lose weight before plastic surgery, then you should be close to or have plateaued at your desired weight well before the procedure. Smoking can also sabotage your surgery as nicotine constricts blood vessels and oxygen, hindering the healing process and increasing your risk of infection. Smokers face an increased risk of complications under anaesthesia; therefore, it is strongly advised that you give up smoking well before surgery.

What are the risks?

No surgical procedure is risk free, and understanding the possible complications is essential so that you can consider the benefits and risks before you undergo treatment. Typical side effects of post-weight loss surgeries include swelling and bruising. However, the skin and tissue quality of many post-weight loss patients is poor, which increases the potential for complications to arise, such as poor wound healing and infection. This leads to a higher risk of wounds breaking down with skin and tissue loss. Therefore, there is a high risk of further surgery being required in the postoperative stage to address these issues. Higher-risk patients must accept the possibility of experiencing wound healing issues that warrant further surgeries and recovery time. This is all part of the consent process discussed at length prior to surgery.

How many procedures can be performed during one surgery? Will I require multiple surgeries?

The thought of combining multiple cosmetic surgery procedures may seem overwhelming to some. But, if you’re looking to achieve multiple aesthetic goals fast, the idea of combining plastic surgeries may be an attractive one. There are certain situations where combining procedures may be the best option and others where it is inadvisable.
Breast surgery (breast augmentation, breast lift or breast reduction), tummy tucks (abdominoplasty) and arm lifts (brachioplasty) are commonly combined procedures. However, thigh lifts (thighplasty) are something Dr Dona never combines with procedures in other areas of the body. A big concern of combining a thigh lift with another procedure is the potential for complications to occur. A thigh lift is a major operation. Combining this with another procedure would lead to a more complex and demanding recovery, which can ultimately compromise the quality of your results.
Put simply, Dr Dona will begin with the areas that most concern the patient and then continue in stages depending on the degree of concern and other considerations, such as lifestyle and financial and health constraints.

How long do I need to wait between surgeries?

It is extremely common for a patient to undergo more than one cosmetic or reconstructive surgery. In some cases, as outlined above, multiple procedures can be combined into the same surgery. In other situations, the minimum period of time between each surgery is approximately three months. Overall, there is no hard and fast rule about how long a patient should wait between surgeries; it largely comes down to your rate of healing and overall health.

What should my BMI be before surgery?

Some plastic surgeons may elect not to operate on patients with a high BMI, fearing an increased risk of perioperative and postoperative complications. However, BMI cannot accurately identify whether a person is at a healthy body weight because it fails to distinguish between fat and muscle or to consider fat distribution. Overall, BMI can be inaccurate and misleading and, therefore, does not determine one’s suitability for a procedure.

What happens if I lose weight after surgery?

It is best that you achieve your desired and stabilised weight before undergoing surgery. Losing an excessive amount of weight after surgery may lead to loose, overhanging skin again and ultimately compromise your previous results. If this situation were to occur, you may require revisional surgery. In the event of slight postoperative weight loss, there may be no effect on the surgical outcome. This largely depends on the individual patient’s anatomy, specifically the quality of the skin tissue.

What happens if I gain weight after surgery?

Body contouring procedures remove excess skin and fatty tissue to improve the appearance of your body after weight loss. While procedures like abdominoplasty, brachioplasty and thighplasty create a toned and slimmer figure, they do not prevent you from gaining additional weight. Gaining an excessive amount of weight after surgery can damage your weakened skin, leading to stretch marks and wide scars. Gaining a small amount of weight after your procedure will inevitably cause fat cells to enlarge, but the overall improved body contour provided by the surgery may still be visible. Body contouring procedures are not an alternative to weight loss, a healthy diet or exercise. Severe weight fluctuations can reverse and compromise the results of your surgery, and in extreme cases, cause complications like scarring. That is why it is best to achieve a stable weight for a period prior to the procedure.

Will my surgery be covered by health insurance or Medicare?

Medicare does not cover elective surgical procedures purely undertaken for cosmetic purposes. Plastic surgery after weight loss is typically considered a cosmetic procedure, but in certain situations, it may be medically necessary and, therefore, considered reconstructive surgery. If complications, like irritating excessive skin, arise from weight loss and are causing chronic discomfort or distress, you may be eligible for a rebate. The best thing to do is to speak with your GP and get a referral for a plastic surgery consultation. Without a referral, a claim cannot be made even if you are eligible. Whether your private insurance covers plastic surgery largely depends on the policy you have. If you have private health insurance with hospital cover, you may be eligible to have the costs for the hospital component and anaesthetic subsidised. It is best that you clarify what will be covered with your health insurance fund before you book the surgery.

Will there be scars from my surgery?

All plastic surgeries promise to leave behind a scar somewhere. Here’s what to expect in the most common procedures after weight loss.
An abdominoplasty surgery, or tummy tuck, typically involves the surgeon making a horizontal incision along the lower abdomen so that the underlying abdominal muscle can be tightened and the fatty tissue and excess skin removed. The incision is strategically placed along the public hairline so that the scar can be hidden underneath your underwear. The fleur-de-lis abdominoplasty is a more extensive excess skin reduction surgery than the traditional abdominoplasty procedure. Skin and fatty tissue are removed in both vertical and horizontal directions. Therefore, there is a scar along the pubic bone and a vertical scar along the midline of the abdomen extending from the ribs vertically down to the pubic area. In the beginning, the scars will be raised, with a reddish-pink appearance. As they heal, the scars will eventually flatten and fade. On darker skin types, the scar may heal dark and pigmented at first and then lighten over time.
Incision scars from an arm or thigh lift are permanent and generally more pronounced. During an arm lift (brachioplasty), excess skin and fatty tissue are removed from between the armpit and elbow. The scar will be visible when a patient exposes the underside of their arms. Thigh lift (thighplasty) scars are generally T-shaped, with the horizontal component tracing along the top end of the thigh and the vertical component along the inner thigh. If you are considering an arm or thigh lift, it is important to be realistic about what is achievable and accept that a scar might be a trade-off for a desirable contour.

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