Post-Weight Loss
Surgery for Loose Skin
Losing large amounts of weight can often result in loose, saggy, excess skin which can be very troubling for the patient.
While exercise and creams may help to tone or condition the skin, some people struggle with the amount of skin left and for some, surgery is the only option to tackle it.
There are a number of potential options, depending on the patient’s particular requirements and difficulties.
The most popular are outlined below:
ABDOMINOPLASTY
This is an operation to remove excess skin and fat from the anterior abdominal wall, to re-shape and re-profile it. As part of the procedure, I will usually tighten the two 6 pack muscles (recti muscles) which have become loose with ageing or with pregnancy. I will often carry out liposuction to the lateral hips because if the abdomen is tightened without attending to the hips, the hips can look disproportionately larger after surgery. Sometimes in younger patients there is not a great deal of excess skin and fat and it is possible to carry out a mini abdominoplasty which avoids a scar around the umbilicus and leaves a shorter transverse scar in the lower abdomen. Patients will often recover slightly quicker from this.
The indications for full abdominoplasty are middle age spread, weight loss leaving loose and excess skin, ladies who have carried a large number of babies, twin births or large babies and sometimes tethering from caesarian section scars.
The operation is carried out under general anaesthetic and patients are usually admitted on the day of surgery. The operation takes 2 hours and after surgery there will be 2 drains in place, all the stitches apart from around the tummy button will be of the dissolving type and the wounds simply taped. Following surgery, you will have to wear anti thrombus stockings for 2 weeks and a soft girdle for 4-6 weeks. Although after 2 weeks, you may change from the girdle to using support like pants, which you may find more comfortable. You will need to simply body wash to keep clean in the first 10 days, but after this, you should be able to return to normal bathing and showering. The stitches around the tummy button are usually removed between 7 and 10 days.
Recovery & Aftercare
In terms of pattern of recovery, most patients will require help around the house or with children for the first week and are up and about and pottering by the end of this week. Patients can usually return to driving in between 2 – 3 weeks and return to a light job in 2 weeks and a heavy job at 3 weeks if the recovery goes well. It is possible to return to light sport at 6 weeks and build up thereafter.
All patients notice numbness of the lower abdominal skin and this can last for up to 3 months. Although the sensation returns, it never returns fully.
There is a varying degree of bruising and swelling, particularly in the side of the hips where liposuction is carried out. This usually lasts two to three weeks.
Important Information
There are disadvantages and risks as with all surgery.
Most patients’ abdomens have settled well at 6 weeks, but it does take up to 12 weeks to settle fully and the scars themselves can take longer. Whilst many patients scars settle and look fine at 3 months, some patients can take up to 2 years for the scars to settle fully. There is some discomfort on vigorous exercise, which is common in the first few months, but in some patients can last up to 9 months.
- Scarring– Most scars settle well, they start off as a fine line and become red and will often go lumpy particularly in the centre of the abdomen and then will settle. In some patients, however, the scarring takes a lot longer to settle and my take up to 2 years. This is called hypertrophic scarring. Rarely, some patients develop keloid scarring where the scars grow to become quite unfavourable. However, in the majority of patients the scars settle and look reasonable at 3 to 4 months.
- Discomfort on Exercise– This is some discomfort on vigorous exercise commonly within the first few months, but in some patients this can last up to nine months. This is due to pulling on the repaired recti (6 pack) muscles.
Risks and minor complications
- Infection and Bleeding– There is a small risk of infection and bleeding which can delay and sometimes spoil the end result and necessitate secondary surgery.
- Necrosis– The death of some of the skin is rare but can occur and is more common in heavy smokers, the elderly and sometimes in re-do abdominoplasty (this is where the skin does not survive the insult of being lifted up and pulled tight).
- Delayed Healing – Occasionally, there can be delays in healing which requires dressings for a longer period than the usual few week period.
- Secondary Minor Surgery – Sometimes as the fat and skin settle there can be fullness at one part of the scar requiring minor revisional surgery which is usually carried out under local anaesthetic and will not usually incur further costs.
- Blood Clots– Rarely, there is a small chance of blood clots in the legs, as with any abdominal surgery and we try to reduce this risk by requesting that patients stop the contraceptive pill one cycle prior to surgery and by giving anti thrombosis stockings to wear for the first two weeks after surgery.
Note
Quite often one side of the surgery will settle quicker and different from the other. Initially, you should not be upset or concerned about this as it is quite common and to be expected. The slow healing side will catch up with the fast healing side usually over the first twelve weeks.
It is important after undergoing abdominoplasty to adjust ones life style i.e., keeping ones weight stable and keeping reasonable abdominal muscles toned with regular exercise in order to avoid reverting to the pre operative state.
I insist that patients who smoke stop 2 weeks before surgery and if they are on the contraceptive pill this must be stopped one cycle before surgery. This is to reduce the risk of delayed healing and blood clots respectively.
Due to the subtleties and intricacies of the healing tissues sometimes there can be minor imperfections following surgery that may benefit from some revisional surgery. It is my policy not to charge any professional fees for this surgery however the hospital will make a charge for this unless it has arisen following an acute complication such as infection or bleeding.
POST MASSIVE WEIGHT LOSS ABDOMINOPLASTY
Depending on the extent of skin excess three different approaches can be taken to address skin problems after weight loss in the abdominal area:-
- Extended transverse scar abdominoplasty
This is like a normal cosmetic abdominoplasty but it leaves a more extensive transverse scar as a result of the skin excess. This is not usually suitable for patients who have excess skin in the upper, mid and lower abdomen. - Tri-radiate abdominoplasty
This is for patients who have either a double apron or significant upper abdominal skin looseness. This leaves more extensive scarring but can produce a better body contour than those that have more excessive skin. - Belt Torsoplasty
In some patients the degree of deformity is such a circumferential front and back approach is required for the surgery. This goes by various names, of a belt Torsoplasty, circumferential body contouring or 360˚ Torsoplasty.
INNER THIGH LIFT
This is an operation to tighten the inner thighs after weight loss or aging changes.
It is usually done under general anaesthetic, takes 1 ½ hours and involves a one night stay. The stitches will all be on the inside and there will be tapes and dressings for some 10 days. Patients have to wear anti-thrombose stockings for 10 – 14 days and sometimes drains are used which are removed before discharge from hospital.
In terms of recovery, bathing is fine but you will have to try to keep the legs dry. It is possible to do gentle light activity after the surgery but one has to be careful so that the wounds do not get pulled open or the other healing is damaged for 2 weeks. Most patients in a light job are back at work in 10 days and in a physical job 2 – 3 weeks. Return to the gym and doing sport is 3 – 6 weeks and driving around 2 weeks if one feels safe to do so.
As mentioned above this procedure will leave extensive scarring and as always there is a range of scarring depending on the biology of how your skin will heal. The majority of patients heal with nice scars but some unfortunately heal with poor scarring or unsightly scarring.
As always with surgery there are the general complications of any surgery and anaesthetic. It is also important to note the following complications:-
- It is not unusual for the scarring and the result to be slightly different on each leg as the legs are often different pre-operatively.
- As mentioned above poor scarring.
- Infection and bleeding
- Swelling of the leg which can take the form of generalised swelling and is usually temporary but rarely it can be permanent.
- Lymphocele – small cystic collections of lymph fluid
- Numbness from damage to small sensory nerves in the leg and rarely to the more significant nerves.
- Delayed healing which is sometimes due to complications where a prolonged period of dressings or further treatment is required.
UPPER ARM LIFT
This is an operation to tighten the upper arm skin between the elbow and the arm pit after weight loss or with aging changes.
It is usually done under general anaesthetic, takes 1 ½ hours and involves a one night stay. It leaves a transverse scar in the axilla and a longitudinal scar from the axilla to the elbow. The stitches will all be on the inside and there will be tapes and dressings for 10 days. Patients have to wear anti-thrombose stockings for 10 – 14 days. Sometimes drains are used which are removed before discharge from hospital.
In terms of recovery, bathing is fine but you will have to try to keep the arms dry. It is possible to do gentle light activity after the surgery but one has to be careful so that the wounds do not get pulled open or damaged for 2 weeks. Most patients in a light job are back at work in 10 days and in a physical job 2 – 3 weeks. Return to the gym and doing sport is 3 – 6 weeks and driving and 2 weeks when one feels safe.
As mentioned above this procedure will leave extensive scarring and as always there is a range of scarring depending on the biology of how you skin will heal. The majority of patients heal with nice scars but some unfortunately heal with poor scarring or unsightly scarring.
As always with surgery there are the general complications of any surgery and anaesthetic. It is also important to note the following complications:-
- It is not unusual for the scarring and the result to be slightly different on each arm as the arms are often different pre-operatively.
- As mentioned above poor scarring.
- Infection and bleeding
- Swelling of the arm which can take the form of generalised swelling and is usually temporary but rarely it can be permanent.
- Lymphocele – small cystic collections of lymph fluid
- Numbness which is usually around the arm pit from damage to small sensory nerves but rarely in the more significant nerves.
- Delayed healing which is sometimes due to complications where a prolonged period of dressings or further treatment is required.
BODY CONTOURING POST MASSIVE WEIGHT LOSS
Patients who have lost massive weight have excess skin and require body contouring surgery to try to address some of the unsightly issues that the skin excess produces. This presents quite a challenge both to the surgeon and to the patient and one has to balance the risk of surgery, the recovery period, the degree of improvement and the costs for each individual patient.
However, some general principles can be applied:-
- In my view it is better to keep each operation to 4 hours maximum as this gives the best balance of risk versus gains for each patient i.e. safer outcome of surgery with less complication. It is therefore best when planning surgery to pick the area that bothers the patient most and operate on this first and then sequentially do each area or combination of areas to suit at a later date in accordance with the principles outlined above.
- Staged surgery should be at least 3 months apart to allow the body to recover physiologically and psychologically after each surgery to give the patient the best chance of a good result following the surgery.
- It is better to be at your best health for these types of surgery. It is important to take Multivitamins trace elements and Iron to make sure that you are not malnourished in anyway prior to surgery.
- It is important that patients do not smoke for at least 1 – 2 months prior to surgery and continue this for 1 – 2 months post surgery to reduce the risks of complications.
- Ideally it is better if patients are doing exercise of some form as patients who do this have a speedier and smoother recovery.
- It is better to have been at a steady weight for at least 6 months and ideally have the support that the timing is right from your weight loss team or psychologist.
There are particular challenges for massive weight loss patients as biologically their skin having been stretched does not behave as the same as non-massive weight loss cosmetic surgery patients. As a result of this we have problems after surgery of secondary loosening and also of increased risk of delays in healing.
In the legs of patients who have had massive weight loss there is often chronic lymphoedema and this produces swelling from the knee area all the way down to the ankles and feet. It is not possible to help this with surgery and the only thing which seems to help is the wearing of Class II stockings.
TORSOPLASTY
Torsoplasty is a term used for a procedure to remove excessive skin around the entire torso of the body.
The surgeon will make an incision around the circumference of the entire mid-section of the body in order to remove excessive skin. This procedure can improve not only the abdomen, but also the hips, back and buttocks.
You might also consider…
Facelift
Losing weight can be quite ageing and the face is an area where this is often most visible. The loss of fat means that the skin is left looser and lines, wrinkles and hollows can appear, lending the face a saggy and aged appearance. A facelift after weight loss can be very satisfying for the patient, allowing them to appear both slimmer and younger.
Breast Procedures
After weight loss, women can find the size and cup size of their breasts dramatically reduced. Not only the volume of the breasts but also the shape can be affected. A breast uplift is designed to remove excess tissue and lift the bustline for firmer, smoother breasts. Some women may choose to combine this with an implant to replace some of the lost volume.
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Losing weight is a tremendous achievement, but it can leave loose skin.
Often, only surgery can deal with the excess tissue, revealing your new shape.