Tailoring the dress or suit: The benefits of skin removal surgery after major weight loss
April 21, 2021
Bariatric surgery can be a transformative procedure for people who have lived for years with morbid obesity. Not only do many patients experience significant weight loss, but their blood pressure typically improves and other serious health conditions such as heart disease and diabetes become much more manageable.
After losing so many pounds, excess skin often will not shrink back to the underlying muscle and bone structure. Instead, it hangs from the body like a poorly fitted piece of clothing, making it tough to move on with your new, healthier life.
The excess "dress" or “suit” – also called the skin-fat envelope – can affect everything from how you look to how you feel and move.
Bariatric surgery was pioneered at the University of Iowa, and it was there that we first developed plastic surgery procedures tailored to meet the goals of patients following significant weight loss.
Eventually, we wrote the first book on the subject: "Body Contouring After Massive Weight Loss," which is still considered the gold standard. Since then, our surgical techniques have been taught in more than 35 countries around the world.
As weight loss surgery became more common in the early 2000s, we developed safe, effective procedures to tighten the skin-fat envelope around the underlying musculoskeletal structure, bringing patients closer to their ideal shape.
Our approach offers tightening in four key areas of the body:
- Lower trunk (the belly, buttocks, and flanks)
- Upper trunk (breasts/chest, mid-back and upper back, and arms)
- Upper arms
UT Southwestern’s Post-Bariatric Body Contouring Team works closely with colleagues in our accredited Bariatric Surgery Center and Medical Bariatric Wellness Program to provide patients access to the most advanced medical and surgical approaches, which, ultimately, give them the best chance at living the lives they’ve always imagined after substantial weight loss.
About the procedures
Eligibility for surgery
Body contouring procedures are major surgeries. To achieve the best outcomes, you must be in overall good health and be:
- A nonsmoker: Tobacco use constricts the blood vessel system, increasing surgical risks.
- Stable weight close to your goal weight: Generally, being at a lower weight leads to better results and fewer complications. Ideally, you'll be at that stable weight for three to six months before surgery.
- Emotionally stable: Going through drastic physical changes requires resilience and the ability to focus on the end goal.
- Willing to maintain adequate nutrition: Eating a healthy diet supports successful healing after surgery.
- Prepared to maintain your weight: Regaining a substantial amount of weight will reverse any, and possibly all, of the benefits of body contouring surgery.
Three factors affect the presentation to the plastic surgeon once weight loss has stabilized:
- Current weight
- The pattern in which fat deposits on your body
- The quality of your skin-fat envelope.
Based on these factors we work through your goals and delineate what you can expect from surgery.
We’ll discuss the benefits and risks of body contouring. Complications can include:
- Blood clots if patients do not mobilize quickly after surgery
- Fluid collections (seromas) at the surgical site
- Infection and bleeding, which are risks of any surgery
- Slow wound healing or wound separation
Each of the four body contouring procedures result in some scarring, which your surgeon will try to conceal as much as possible. For most patients, scarring is a worthwhile tradeoff for losing excess skin.
Body contouring procedures
Belt lipectomy: Buttocks, abdomen, and flanks (love handles)
Belt lipectomy, or a lower body lift, is a more comprehensive alternative to the tummy tuck for patients after massive weight loss. The procedure addresses the excess skin and fat envelope 360 degrees around the body, including the love handles and rear end.
Our team of board-certified plastic surgeons has been performing belt lipectomy longer than any other team in the world. (Our techniques also do not require surgical drains, which makes postoperative care and recovery a bit easier.)
The midsection carries most of a patient's excess skin, and the trunk helps support and control nearly all of your daily movements. Because of this, belt lipectomy requires a 360-degree approach to the abdomen, flanks, and buttocks, all performed in a single surgical procedure.
During this procedure, your surgeon will make incisions around the body, removing a wedge of skin and fat that is shaped like a boxing championship belt, wide in the front and narrow in the back. This will create a flat belly, lift the pubic area, create as much waist definition as your anatomy allows, and lift your thighs and buttocks.
Recovery: This is an extensive surgery that should be approached as a major life event. Although you will be out of bed the day of surgery, your return to normal activity can take six to eight weeks.
Benefits of a belt lipectomy after major weight loss
Dr. Al Aly explains how a lower body lift, or belt lipectomy, addresses the excess skin and fat envelope 360 degrees around the body. The procedure, which he helped pioneer, is considered more comprehensive than a tummy tuck for patients who have lost a significant amount of weight following bariatric surgery.
Upper body lift: Chest, upper back, and upper arms
Loose skin that rolls or sags around the chest, upper back, and upper arms greatly decreases the types of clothing a patient may feel comfortable wearing. An upper body lift is designed to eliminate these types of problems. This procedure involves a harmonization of multiple procedures to reshape the upper body.
Depending on your needs, your upper body lift may include:
- Creating a more muscular-looking chest shape in a male, eliminating excess breast tissue
- Lifting, reducing, and/or augmenting the breasts in a female
- Eliminating skin rolls of the mid and upper back
- Contouring the upper arm skin closer to the body's frame
The upper body lift may require incisions across the mid-back, underarms, chest, and/or breast. As much as possible, your surgeon will attempt to hide these incisions in natural body creases and/or less visible areas of the body.
Recovery: A light compression vest is worn after surgery. If the arms are included in the upper body lift, they are to be elevated for a period of time after surgery to reduce swelling. Patients are encouraged to move and function as much as they comfortably can. Most patients are functioning close to normal in a couple of weeks.
Brachioplasty: Upper arms
Hanging skin from the armpit to the elbow can be physically uncomfortable, aesthetically not pleasing, and can make it difficult to find clothing that fits. The upper arms are connected to the chest wall through the arm pits, which in most massive weight loss patients are loose and contain a lot of excess skin. To get the best results, we must reshape the arm pits as well.
We developed a brachioplasty procedure that includes the chest wall – an extra step many plastic surgeons avoid due to surgical complexity and potential for scarring. Today, our approach is among the most common techniques for this type of body contouring.
In the majority of patients, the incisions will run from the elbows through the armpits and onto the pectoral area. Excess skin and fat will be removed, and the skin and underlying tissues will be closed and tightened. All wounds are closed with internal sutures which will not need removal.
Recovery: For a period of time after surgery, the arms will need to be elevated above heart level. Patients who have non-physical jobs may be able to get back to work in 10 to 14 days. Most patients can return to driving within 10 to 14 days. We typically recommend wearing compression sleeves for a few weeks after surgery to aid in healing.
Most patients have some sagging skin or excess fat deposits around the thighs after massive weight loss. Surgeries in this region require expertise. The thighs help carry and move our body weight, and the area is also a hub for the lymphatic system, arteries, and veins.
We have created a safe, effective thigh lift procedure to remove skin excess while limiting disturbance of the delicate internal structures of the thighs. The surgeon makes an incision down the inner thigh, where the inseam of your pants runs. The surgeon will tighten the skin and remove the excess, bringing the 360-degree shape of the leg closer to the ideal.
Most patients will have some swelling with thigh reduction procedures, which in some may last an extended period of time.
Risks: The pelvic region tends to be a less hygienic body area, and surgeries near it may pose a higher risk of infection. Prolonged swelling may persist after thigh reduction surgery, and you will be given a fairly aggressive regimen to reduce it. Wound healing problems as well as fluid collections may occur after thigh reduction surgery, which fortunately can resolve with appropriate care.
The bottom line on body contouring
Many of our patients lose 100 pounds or more through safe and effective bariatric surgery techniques or our medically managed weight loss program. Their weight loss gives them a new lease on life. For some, however, the transformation isn’t complete until they shed the excess skin – the loose-fitting dress – that continues to remind them of how they used to feel.
Our body contouring techniques can help patients shed that stigma, but we are quick to remind them that these procedures are major surgeries that require motivation to achieve successful outcomes.
If you are ready to take the next step after massive weight loss, our body contouring experts will help you set reasonable, personally satisfying milestones.