Massive Weight Loss

One of the fastest growing areas of plastic surgery is in the arena of massive weight loss. Lap band and gastric bypass patients routinely lose significant amounts of weight, and a determined few are able to accomplish this through hard work and determination. Frequently, after the weight has been shed, these patients are left with excess skin most commonly in their abdomen, but also in their arms, thighs, breasts and faces. An entire subspecialty of plastic surgery has emerged to help patients manage the excess skin and produce a body that better reflects the healthier and more attractive you.

Gastric bypass surgery has become almost commonplace in today’s society and is safer than ever before. Although the weight loss results have been dramatic, many patients aren’t appropriately counseled regarding some of the cosmetic consequences that can – and frequently do – result. The numbers of patients undergoing surgery are approaching 200,000 patients every year.

With weight gain, your skin must stretch to accommodate the excess fatty tissue. Sometimes, the skin must stretch beyond its capacity and “breaks” resulting in visible “stretch marks” or striae on the skin. Also, secondary to an unhealthy lifestyle and bad eating habits, overweight patients tend to have poor elasticity of their skin. This combination makes patient’s skin unable to contract or “snap back” after 100+ pound weight loss. When this happens, excess skin may result which obscures a newly toned and in-shape body beneath the excess skin. Patients can also suffer from skin irritation and rashes, an inability to find clothes that fit, and most commonly a need to continue to manage the redundant skin by wearing loose fitting clothes.

Fortunately, there exist numerous operations that are designed to treat and manage these issues wherever they arise, helping to recontour and reshape your body to more accurately reflect the hard work it took to achieve your weight loss goals.

Timing of Surgery

One of the most important factors to consider after a patient is able to lose a significant amount of weight is the duration that weight has remained off. It is also important to ensure that not only does the weight stay off, but also that we allow for enough time for the patient to lose all the weight they have intended. I want to be able to tailor the operation to your new “ideal” body weight to best achieve your cosmetic goals. Massive weight loss cosmetic surgery is much like going to the seamstress – you want to have your clothes tailored at a weight that you are going to be able to maintain.

Patients can lose weight over different time intervals than others and even in different areas on their body. As long as I feel that we can achieve your goals in the area to be operated on (but possibly not in other areas on your body), then we can usually proceed with surgery in the successfully “completed” area. However, if you have lost a significant amount of weight, but have a significant amount to lose, then I will routinely recommend waiting until all of your weight is lost in the areas of concern. Skin with less fatty tissue attached is more flexible and allows me to produce an even better result.

Plastic Surgery Procedures for Weight Loss

There are numerous procedures available for the weight loss patient and your particular circumstances and goals will dictate what options are available to you. All of this will be explained in detail at a complimentary in-office consultation with Dr. Marin. Call our La Jolla, CA office at (858) 638-9800 to see if massive weight loss surgery is right for you.

Abdominal Surgery

Either through diet and exercise or gastric by-pass surgery patients commonly lose the most significant amount of weight from their abdomen. The abdomen contains both extra-abdominal (outside the abdomen) and intra-abdominal (inside the abdomen) fat. Thus, when a patient gains weight, the skin is stretched, but so too is the abdominal wall and muscles as a result of the fat that is deposited internally on the inside of the abdomen.

To fully correct this problem, an abdominoplasty or “tummy tuck” is often the procedure of choice. This allows me to correct the stretch of the abdominal wall musculature in combination with the removal of excess skin and stretch marks.
Often, patients who have lost a significant amount of weight tend to have problems beyond just the anterior abdomen or tummy. I frequently will recommend more aggressive procedures based upon the degree of excess skin that needs to be addressed. An extended abdominoplasty or extended “tummy tuck” will help to remove excess skin and fat along the waist and “love handle” area. This also produces a secondary benefit by lifting the hip area and correct mild sagging that may exist.

The signature surgery for massive weight loss patients is a “body lift” procedure. This procedure was created to address the sagging skin that occurs in both the front and back of the patient. With a body lift, I am able to improve the abdomen in a similar fashion as a tummy tuck, the waist similar to an extended tummy tuck but also lift and tighten the lower back and elevate the buttock. This can help create a more defined waist and restore the buttock to a more elevated position and rounded shape. This creates a scar in a similar distribution as a belt and is usually easily concealed even in a bathing suit. Many patients who never, ever considered wearing a bikini or going shirtless to the beach can feel confident to show off their new figure, but not revealing any incision or obvious sign of surgery.

Patients who are unable to lose a significant amount of weight because of limitations with mobility or other medical conditions, may be a candidate for a “panniculectomy.” This is a surgery designed to remove excess skin and fat at the waistline to help patients with recurrent infections, skin irritation or to aid in patients overall activity levels. This procedure is designed to be more functional and less of a cosmetic nature, as our goals are to solve recurrent medical problems and remove skin bulk.

Breast Surgery

As women and men lose weight, the area of the breast often is left deflated with sagging skin. Obviously the goals are different, but the problems that result are remarkably similar. For women, I have three goals: restoring the volume of the breast usually with the use of a breast implant, removing the excess skin that did not contract, and repositioning the nipple and areola to a more youthful position, centered on the implant. These goals are accomplished in many different ways depending upon the particular needs of the patient. Both saline and silicone breast implants are options, along with the full range of lift or mastopexy techniques.

For men, the goal is to remove excess sagging skin that can even extend under the arm toward the back, to produce a more masculine chest.

Face

One of the things that can rapidly age your face is the loss of weight and a “youthful fullness.” Significant weight loss often results in a healthier, more athletic body, but a gaunt, hollow facial appearance with excess or redundant skin. This can be successfully managed with a face and neck lift procedure that will simultaneously restore the volume to its proper position and remove the unwanted excess skin.

Upper Arms

The upper arm can be one of the areas most dramatically affected by significant weight loss. The upper arm skin is particularly inelastic and can have a “saggy” appearance even without weight loss. This can be a source of concern for many patients who refuse to wear short sleeves or tank tops so that they can hide their upper arms. An “arm lift” or brachioplasty can be a wonderful solution to this problem. Scarring can be a concern with arm lift surgery, but I have found that most patients are very happy with more shapely upper arms, freely choosing to wear sleeveless tops.

Inner Thighs

Similar to the upper arms, the inner and outer thighs usually fail to tighten after significant weight loss. Both of these areas can be tightened and lifted to remove unwanted skin, with scars well hidden in creases that are easily concealed. If your circumstance is more significant, the procedure can be modified to accommodate almost any problem.

Combination Procedures

As with most of our surgeries, patients see a significant benefit to combining procedures to limit their postoperative down-time, the number of times they need to undergo general aesthesia and the overall cost. This is most evident in massive weight loss surgery. Many of the problems are directly related to other areas and it this allows me to produce a more “complete” result.

Scars are an expected consequence of massive weight loss cosmetic surgery. These scars, although significant, are much less of an issue for nearly every patient in light of the often “life-changing” transformations produced with these procedures. I make every effort to place these scars in locations that are easily concealed wherever possible. The majority of issues that arise with respect to scarring can be easily revised in the office under a local anesthetic.

Skin that has undergone significant stretch from weight gain followed by significant weight loss (either via surgery or diet and exercise) is frequently forever changed with respect to its elasticity. As an analogy, the rubber band has been stretched too far and the “spring” has been forever lost. Thus, we often expect a “secondary relaxation” of your tissues, even with maximal tightening, after many of these procedures. A secondary tightening procedure may be required after the procedure and, unfortunately, is related to the quality of skin that we are working with. We don’t see this as a complication, but more as an expectation. If we attempt to address this issue at the first surgery, your skin will stretch at its weakest point, and that has been proven to be at the scar itself. Thus, you will may develop widened, depressed or irregular/uneven scars – not a trade I am willing to make.

Overall, massive weight loss surgery is wonderfully successful means to rid you of the unwanted memory of your former self, and an opportunity to begin a new life where your exterior matches the health and vibrancy of the individual hidden beneath.

Contact Our La Jolla, CA Plastic Surgery Office

Please contact Dr. Vince Marin at our La Jolla, CA office to see if massive weight loss cosmetic surgery is right for you.

Marin Aesthetics
Dr. Vince Marin
1431 Camino Del Mar
San Diego, CA 92014

Phone: 858.638.9800
Toll Free: 888.638.9894
Fax: 858.551.9071

Dr. Marin provides plastic surgery services to the entire San Diego County community.