Body Lift or Tuck for Skin Tightening after Weight Loss

What is a Body Lift or Tuck?

A body lift or tuck is a term used that encompasses any combination of skin excisional surgeries meant to remove loose or sagging skin on the torso and also the buttocks and thighs. Body lifts or tucks are surgeries that used for people who have had massive weight loss and are left with significant saggy skin on the mid, upper, and lower body. A body tuck could include removal of a large abdominal skin fold (pannus) and or extend to sides and flanks. In some instances the tuck of the mid body could also include lifting of the sagging skin on the buttock and around the thighs also. This type of body lifting surgery is not always done in one procedure but can involve multiple surgeries to achieve the full restoration of all areas.

When to Consider a Body Tuck after Dramatic Weight Loss

• If you have experienced dramatic weight loss from bariatric surgery or diet and exercise.
• If you have sagging skin in multiple areas, including the face and neck, breasts, arms, abdomen, back and thighs.
• If your weight has stabilized following bariatric surgery or diet and exercise. This may be 18 months or more after your weight loss.

Pros and Cons of Body Lift Surgery

Pros

• Gets rid of loose skin so you can fit into your clothes better.
• Gets rid of overhanging skin that might be causing painful chafing, rashes and infections.
• Improves your appearance and self-esteem

Cons

• Surgery results are rarely perfect and may not meet your expectations.
• You will have permanent scarring some of which will be in exposed areas
• Your surgery results may be affected by weight gain, aging and lifestyle choices.

Candidates for Skin Tuck or Skin Tightening Surgery

Skin tuck or skin tightening surgery is major surgery which can have a great impact on improving a patient’s life. However, to have the best results and safe outcomes, a number of factors have to be considered to determine is a person is a good candidate. These are the factors that need to be in place:

• You are in overall good health without chronic medical conditions, such as diabetes or heart disease. People in poor health are not good candidates for body-contouring procedures. Get clearance for plastic surgery from your primary care physician or from doctors treating you for medical conditions.
• Your weight has been stable for at least six months with no further weight loss expected. This time allows your skin to shrink as much as possible and your nutrition to be stabilized and optimized, factors that will aid in your recovery.
• You have a healthy diet; problems such as protein deficiencies can interfere with healing.
• You do not smoke; smoking slows down the healing process and increases the risk of serious complications during and after surgery. If you smoke, you must quit at least six weeks before surgery.
• You have realistic expectations; surgery will lead to marked improvements in your shape, but it is impossible to restore the skin or body to what it would have been without the weight gain or to what it was in your teens or twenties. Even after body-contouring surgery, skin continues to sag over time as part of normal aging.

How is a Body Tuck or Body Lift Performed?

Your first step is to identify what you wish to achieve. We will then suggest the procedures that will help you reach your goals and give you a realistic picture of what those procedures can do for you. Sometimes multiple procedures can be performed at the same time, while, other times, a staged approach may be recommended. Because each procedure can impact the outcome of the next, careful surgical planning is required. Of the body contouring procedures, panniculectomy and lower body lift are the procedures most often performed following dramatic weight loss.

Tummy Tuck (Panniculectomy)

What it does
The pannus is the name for overhanging skin of the lower abdomen that typically occurs after major weight loss and/or pregnancy. A panniculectomy removes the hanging pannus, or apron of skin, from the lower abdomen below the belly button (excess skin and fat above the belly button are not removed). It is often performed on patients who are still significantly overweight, but have troublesome skin irritation from hanging skin. Some potential candidates have fat extending over their hips, around their backs or as low as their knees, which presents health hazards. After surgery, you will have fewer skin problems, but little improvement in your belly contour.

How it is done
Dr. Gruber makes a horizontal incision at the pubic area, where the excess skin and fat can be carefully removed.

The remaining skin is pulled closed and secured.

Sometimes a drain is inserted that requires home care for a while.

Tape is applied to all of the incisions to aid in healing and to prevent tearing.

If you have any abdominal hernias or torn abdominal wall areas, the surgeon

Lower Body Lift or Tuck – also known as belt lipectomy

What it does
This procedure reshapes the abdomen, waist, hips, thighs and buttocks through an incision made around the circumference of the body. It is designed for those who have loose skin in the buttocks, back of the thighs, hips, side of the thighs, front of the thighs, inner thighs, abdomen and relatively thin layers of fat below the skin in these areas.

How it is done
Incisions pass from the back around the hips to the front of the thighs.

The surgeon removes loose skin as well as underlying fat tissue from below the incision to allow suspension of the remaining tissues to stretch and smooth the lower body, especially the buttocks and thighs.

The surgery begins in the back, but you are repositioned during the surgery to address the hips, outer thighs and front of the thighs.

This surgery can be combined with abdominal skin tightening if needed.

If a previous abdominoplasty has been performed, or is not needed, the lower body lift can be extended to tighten the inner thighs.

Breast reduction, breast augmentation and gynecomastia (male breast reduction) are other procedures associated with plastic surgery following dramatic weight loss.

The following procedures are frequently incorporated in plastic surgery for dramatic weight loss, but are also undergone by people who have never been obese:

Liposuction – also known as lipoplasty

What it does
Liposuction can improve the contour of your flanks, hips, chest, thighs, neck, upper arms and knees. It is frequently used in conjunction with the skin excision of the body tuck.

How it is done
Dr. Gruber will make very small incisions in the area where fat will be removed.

A thin, hollow rod (cannula) is inserted through the incision to create tunnels through the fat.

The fat is sculpted by the cannula and removed with a high-vacuum hose.

After fat removal, you are placed in a compression garment.

Breast lift – also known as mastopexy

What it does
A breast lift treats sagging and uneven breasts, decreased breast volume, drooping nipples, and stretched areolas, returning a youthful shape and lift to your breasts. Women who desire larger, smaller, or more rounded breasts may want to consider a breast augmentation or breast reduction along with the breast lift.

How it is done
Mastopexy incisions vary, depending on the amount of excess skin, the position of your nipples, your preference and Dr. Gruber’s suggestions.

After making the incisions, the breast tissue is shaped and excess skin removed.

Your nipple and areola will be positioned to a more youthful height. (Nipples and areolas usually remain attached to underlying mounds of tissue, which may allow for the preservation of sensation and the ability to breastfeed).

If needed, we can reduce the size of the areola by excising skin around the perimeter.

The remaining skin is then tightened while closing the incisions, layering the sutures deep within the breast tissue to support the newly-shaped breasts.

Skin adhesives and/or surgical tape may be used to help close and support the skin.

What are my options?

After dramatic weight-loss, the goal of plastic surgery is to tighten loose and sagging skin. Your options include lower body lift, tummy tuck, facelift, liposuction, breast lift, breast reduction or gynecomastia, thigh lift, arm lift and panniculectomy. In many cases, it is wise to stage procedures at intervals. It is most important to create a plan, deciding what should be done first to give you the most surgical advantages.

Your initial consultation appointment

During your initial consultation, you will have the opportunity to discuss what you want to achieve. We will evaluate you as a candidate for plastic surgery after dramatic weight loss and clarify what procedures may benefit you most.  It is important to be completely honest during the consultation. Be fully prepared to answer these questions:

• Do you have any medical conditions or drug allergies? Are you being treated for any medical conditions?
• Have you had any previous surgeries?
• What are your current medications and vitamin and herbal supplements?
• What is your current use of alcohol, tobacco, and recreational drugs?
• What is your history with any noninvasive cosmetic procedures?
• What outcome do you expect from the surgery? What is your chief motivation in undergoing plastic surgery after dramatic weight loss?

We may also:

• Ask you to look in a mirror and point out exactly what you would like to see improved.
• Take photos for your medical record, using computer imaging to show improvements you can expect.
• Evaluate your health status, including pre-existing health conditions or risk factors.
• Evaluate the elasticity of your skin.
• Discuss your options and recommend a course of treatment.
• Discuss likely outcomes, including risks or potential complications.
• Discuss the type of anesthesia that will be used.

Your treatment plan

Based on your goals, physical characteristics, we will share recommendations and information with you, including:

• An approach to your surgery, including the combination of procedures.
• The outcomes that you can anticipate.
• Your financial investment in the procedure.
• Associated risks and complications.
• Options for anesthesia and surgery location.
• What is needed to prepare for the surgery.
• What you can expect to experience after surgery.
• Show before-and-after photos of cases similar to yours and answer any questions.

Preparing for Your Body Lift

We will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery.

You should be at a stable, dependable weight before you undergo body contouring. It is a good idea for your plastic surgeon to consult with your bariatric surgeon before surgery to determine if you have achieved your final weight plateau.

Procedures are most commonly performed under general anesthesia, although local anesthesia with sedation may also be used in some cases. If your body surgery is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

What to Expect the Day of Surgery

Your surgery will be performed at the outpatient surgery center. We will give you an estimate of how long your surgery will last based on the procedures you will undergo.

You will receive medications to keep you comfortable during the surgical procedure. Local anesthesia, combined with sedation, may be an option or you will receive general anesthesia. An anesthesiologist will be present to administer sedatives or general anesthesia and assist in monitoring you during surgery.

For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

Your surgical dressings will depend on the procedures you undergo and may include surgical drains.

After surgery, you will be taken into a recovery area where you will continue to be closely monitored.

Before leaving for home, you (or someone looking after you) should feel comfortable emptying and resetting your drains.

We will discuss how long it will be before you can return to your normal level of activity and work following liposuction. After surgery, you and your caregiver will receive detailed instructions about your postoperative care, including information about:

• Drains, if they have been placed
• Normal symptoms you will experience
• Any potential signs of complications

What to Expect with Recovery

Immediately after body tuck surgery
Generally, you can expect to be bandaged, wearing compression garments, and you may have some surgical drains.

When the anesthesia wears off, you may have some pain. If the pain is extreme or lasts long, contact your physician. You will also have some swelling after the surgery. In some cases, this swelling will remain for weeks or even months.

Follow all postoperative instructions. This will include information about wearing compression garments and the level of activity that is safe for you. Your doctor will alert you to the signs of problems to watch for, such as signs of infection. It is important to realize that the amount of time it takes for recovery varies based on what your surgery entails.

Arrange for someone to help you get around the house and help with your medication for at least the first 24 hours after surgery.

Make sure you continue to have help at home—this cannot be stressed enough. You’ll be tempted to try to help around the house quickly, but you won’t feel like yourself for one or two weeks and you still shouldn’t do anything strenuous, including lifting, for four to six weeks. If you have small children, you must put someone else totally in charge of their care for two weeks.

Recovery time frame
Your recovery will depend on the specific procedures you undergo. When procedures are performed together, the benefit is a single recovery time. The first week will be the worst, and you will still feel like you are recovering for approximately two to three weeks.

You may experience discomfort, swelling and numbness. You may be up and walking within hours of surgery, but you will require recuperation for several weeks or longer, depending on how much surgery you undergo.

The recovery period is significant and can be intense the first few days. You can speak with your surgeon about using a pain pump as well as medications to control pain and discomfort so that you can move about and sleep as needed.

You will likely go back for follow-up within five to seven days. During this visit, your doctor can remove the drainage tubes. Swelling should subside within five weeks and the results are apparent within three months.

By the end of the first week, you should be walking around the house frequently, but you will still be unable to drive. You may be comfortable enough to drive a car in two or three weeks or when all of your sutures and drains are removed.

Swelling and numbness may take months to resolve. Fading and flattening of scars take three months to two years.
You will probably need to wait six weeks after surgery before attempting any strenuous activities.

How Long Will the Results Last?

Barring pregnancy or significant weight gain, your results should be permanent, though plastic surgery cannot stop you from normal aging. However, if you underwent a breast lift in conjunction with your plastic surgery after massive weight loss and have received breast implants, these are not permanent and it is likely there will come a time when you will have to replace them.

Limitations and Risks

Fortunately, serious risks are rare and the satisfaction rate with these procedures is high. The overall complication rate is small.

All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures

Risks and potential complications of surgery should be discussed during your consultation. Being under heavy stress or having nutritional deficiencies might lead to slow healing.