Body contouring after massive weight loss

Obesity has become a worldwide epidemic with major health implications.

Although it is more prevalent in more affluent societies, it is a multifactorial disease with environmental, genetic, social and biologic causes. There is major health risks associated with being overweight and a decreased life expectancy of 3-7 years compared to normal weight individuals. Health risks associated with obesity are hypertension, stroke, diabetes, osteoarthritis, sleep apnea, depression, decreased sexual function, acid reflux, infertility, bladder control issues, congestive heart failure and metabolic syndrome. This relates to waist circumference (35 inch or greater in females and 40 inch or greater in males) which correlates to intraabdominal fat content. This causes increased cardiac risks and diabetes which further leads to increased risk of vascular disease and atherosclerosis.

The amazing fact is that these pathologic pathways are reversible. Because there are many factors that contribute to obesity, a multidisciplinary approach focusing on diet, exercise, behavior modification, medications when needed and surgical intervention where it's applicable will prove to be most effective. There are many restrictive and malabsorptive procedures which lead to massive weight loss. It is beyond the scope of this monogram to describe these (see obesityhelp.com). Although patients who undergo these weight loss procedures have a lot of problems in common, they are different in their presentations. Weight loss proceeds at different rates, weight stabilizes out at different times, and weight loss is not uniform throughout the body.

This is the first step in taking charge and changing your life. After you lose the desired weight and your weight is stable for at least six months, you will need to consult a plastic surgeon to help reshape your body. Many people find that they end up with loose skin on the abdomen, pubic area, arms, thighs and buttocks, and sagging breasts. Even though you are healthier and feel better inside, you are not happy with your look on the outside. This is not the body image you had in your mind.  Psychologically this can be as depressing as the obesity was. You need to consult a board certified plastic surgeon with experience in these types of body procedures. You also have to prepare yourself that not everything can be reshaped at the same time. Often, body contouring after massive weight loss requires multiple procedures. What I find that works for me and my patients best, is an abdominoplasty and a lower body lift first. Occasionally, I liposuction the arms if they are not fully "deflated", because at the next stage I do the arm lift and breast lift/augmentation or reduction. The thighs I leave as the last stage with some additional touch ups. These are major life changing surgeries which help build your self confidence and make you feel better about yourself.