Post Bariatric Surgery

Is achieving ideal body weight required before body contouring?

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.

How does one prepare for body contouring surgery?

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.

What are the risks of body contouring surgery?

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.

What are the body contouring steps?

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.