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After achieving major weight loss, bariatric patients are often left with loose, excess skin that embarrasses them and makes their weight loss achievement less obvious. Depending on the problem areas, there are a variety of body contouring procedures that may be recommended to help further improve the body's shape after losing a significant amount of weight.

Here, Sami U. Khan, MD, associate professor of surgery and director of our cosmetic surgery program, answers frequently asked questions about body contouring after major weight loss.

Q: What is body contouring?

A: Body contouring refers to a broad field of plastic surgery procedures that address areas of excess fat and/or skin. Body contouring procedures can be performed in normal-weight patients, patients who have lost significant weight through diet and exercise, and patients who have lost weight after bariatric surgery.

Often, when people talk about body contouring, they are referring to the post-bariatric weight loss patient. At Stony Brook, our plastic surgeons are on the interdisciplinary team of the Bariatric and Metabolic Weight Loss Center.

Body contouring procedures can be performed in normal-weight patients, as well as patients
who have experienced significant weight loss through, diet, exercise, or surgery.

Q: What happens during a body contouring consultation?

A: The body contouring consultation serves two main purposes. It allows the patient to meet the surgeon and express their goals for the body contouring procedure. It also allows the patient to understand the process of staging procedures.

The surgeon is able to evaluate the patient's overall medical condition, and assess any potential co-existing medical conditions that may affect the proposed procedures.

Usually, the surgeon will assess the patient's concerns and goals and create a plan. Often, these patients will require multiple procedures, which usually are staged. The stages can be reviewed, and timing can be planned.

Q: Is achieving ideal body weight required before body contouring?

A: It is important for weight loss patients to achieve weight stability prior to proceeding with any body contouring procedures. Ideally, patients should be weight stable for a minimum of 12 months. This is important because weight fluctuations, both gain or loss, can affect the aesthetics of body contouring procedures. This can lead to poorer outcomes, and increase the incidence of need for secondary procedures.

Q: How does one prepare for body contouring surgery?

A: Many post-bariatric patients prior to weight loss had weight-associated medical conditions. Prior to any procedures, these patient should have general medical clearance.

If a patient is a smoker, they should go through a smoking cessation program. In order to reduce the risk of significant wound healing complications related to alteration in tissue perfusion by nicotine, all patients should be nicotine free for a minimum of six weeks prior to and after any elective surgical procedure.

Bariatric patients are at risk for nutritional deficiencies that can affect healing and thus put them at risk for wound healing complications. They should all undergo nutritional assessment, and any deficiencies should be addressed.

Before and after body contouring performed by Dr. Khan.
Before and after body contouring performed by Dr. Khan.

Q: What are the risks of body contouring surgery?

A: The risks of body contouring procedures are similar to any other major surgery. The most common complications are related to wound healing, including wound infection, wound breakdown, and seroma formation.

Massive weight loss patients often have other medical conditions, related to their previous obesity, including sleep apnea, hypertension, and diabetes that can increase the risk of surgery.

Skin quality is altered in patients who were previously obese and have subsequently lost significant weight. This can lead to increased incidence of poor wound healing, scar-related issues including scar migration, and skin laxity leading to aesthetic-related issues, which can all lead to increased need for revision procedures.

Q: What are the body contouring steps?

A: Massive weight loss patients often require multiple surgical procedures to address excess skin and fat throughout their entire body. From the healing and safety standpoint it is not feasible to perform all of these procedures in one operation.

Typically, panniculectomy (removal of excess skin and fat from the abdomen) or lower body lift procedures are performed as the first stage. Breast reduction/lift procedures can be combined with either brachioplasty (arm) or medial thigh lift.

The remaining procedure can be performed as a third stage. If there is significant facial laxity, a face lift can be performed, often, as the final stage.

Typically, the time period between stages is three to six months to allow for recovery and healing.

The procedure that health insurance most commonly covers is abdominal panniculectomy, that is,
the surgical removal of excess skin and fat from the abdomen, without muscle tightening.

Q: How long does it take to get back to normal after body contouring?

A: Typically, body contouring procedures require at least three months for the overall cosmetic results to be fully apparent. This allows enough time for all residual swelling to resolve and for soft issue to soften. Scars typically require 12 months to go through the remodeling process, and, because body contouring procedures require significant incisions, they often are apparent during this time period.

Q: How long do the results of body contouring last?

A: The major factor that affects the longevity of results in post-bariatric body contouring is weight fluctuations. This is the main reason that these procedures are delayed until patients are weight stable for a minimum of 12 months. If patients are able to maintain their weight, long-lasting results can be achieved. The main issues in this patient population are related to scar migration and soft tissue laxity leading to contour deformities. These are the result of the altered skin/soft tissue characteristics related to the previous obesity.

Q: How much does body contouring cost? Does insurance cover it?

A: Not all insurances cover body contouring procedures. More insurance companies are specifically excluding body contouring from coverage. The most commonly covered procedure is abdominal panniculectomy.

Q: What makes body contouring at Stony Brook Medicine special?

A: At Stony Brook Medicine, our academic plastic surgeons approach body contouring with a patient-first attitude. Our plastic surgeons are considered leaders in their field. Some of their research activities focus on patient safety, outcomes analysis, and developing state-of-the-art surgery, thus allowing us to incorporate the latest techniques into creating a safe surgical environment in which we can maximize our patients' experience and outcomes.

Click here to visit the body contouring before-and-after photo gallery of the American Society of Plastic Surgeons. For consultations/appointments with our plastic surgeons, please call 631-444-4666.

Comments

Great post, found very good information. Since I’m thinking of having an arm lift I’ve been doing my research on the web and I found most of the answer for my questions. Thank you!
We all know that weight loss surgery and cosmetic surgery go hand in hand for best results. What should be the ideal time after bariatric surgery to undergo plastic surgery procedures?
Thank you for your comment. To answer your question, the ideal time for cosmetic body contouring surgery is after one has lost all desired weight and is weight stable for ideally 9-12 months. — Sami U. Khan, MD
Thanks, Dr. Khan. Very informative indeed.

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