Dr Beryl Tan - Body Contouring After Massive Weight Loss
If you have lost weight after gastric band/sleeve/bypass surgery, well done! If your weight loss is solely due to lifestyle changes (diet and exercises), a big pat on the back to you! These are significant and positive achievements. Losing weight means you will feel better overall, and often, medical problems such as diabetes and hypertension may resolve.
The tricky part of losing a lot of weight is that it is only the beginning of a long journey. Keeping the weight off is one hurdle. After that, you have to maintain the hard work with a well-balanced, preferably low carb diet, along with regular exercise. If you don’t, the weight can creep back!
How can body contouring help?
Everyone gains and loses weight differently. As a result, the pattern of excess, saggy, and stretched skin can vary. Dr Tan’s body contouring procedures can manage these skin excess issues, but the surgical results can also vary.
In many cases, more than one surgery is needed. For example, the combination of body contouring with an abdominoplasty or body lift. There is also the breast lift, arm reduction, with or without an upper body lift for the trunk, or inner thigh lift, as some of the more common combination procedures. It is also important to note that your weight must be stable for at least six months before considering body contouring surgery.
In some cases where a person has lost a lot of weight (>50kg) but still has a high body mass index, you may have hit a brick wall in your weight loss journey. This is due to physical and functional restrictions caused by the extensive overhanging lower abdomen tissue. Such cases may benefit from an apronectomy or panniculectomy procedure.
What is the Body Mass Index (BMI)?
BMI = weight in kg/height in m2; a helpful indicator that tells us if you are within the healthy weight range for your height.
- Below 18.5: Underweight
- 18.5-24.9: Normal weight
- 25- 29.9: Overweight
- 30- 34.9: Obese
- 35-39.9: Morbidly Obese
- 40 or more: Super Morbidly Obese
The BMI guide is not applicable for everyone, especially those of Asians or Polynesians descent or some older adults. It is best used, in conjunction with your waist circumference, as the fat distribution on your body is more important than the amount when assessing your disease risk. However, it is a helpful tool to determine the surgical risk of complications.
All the body contouring surgeries mentioned above come with a high risk of complications (up to about 30%). The higher the BMI, the higher the risks. Diabetes, malnutrition, and smoking can further increase the risk. Therefore, extra care and plenty of pre-surgery preparation are required.
- Medical optimisation: E.g. diabetes should be under control; absolutely NO smoking for a minimum of 4 weeks.
- Nutrition: Seek help from a dietitian to ensure you are eating the right food and are not deficient in nutrients, such as iron or vitamin 12. Absorption may have been depleted after weight loss surgery. See your GP for regular blood tests to monitor the level of the nutrients, your blood count, kidney, and liver function.
- Aim for at least 10,000 steps per day! Maximise physical activities as you will need a break from exercises about 4-6 weeks after surgery as it is a critical healing period.
Which areas of the body should be addressed first?
This depends on the individual; however, it is important to note that Dr Tan often limits the surgical time to around six hours to reduce the risk of complications. The following are popular areas of focus:
- Most people prefer their abdomen/trunk attended to first through abdominoplasty, extended abdominoplasty, or sometimes a 360-degree body lift or belt lipectomy.
- Next, people tend to focus on the upper arms (extending to the sides of the chest), +/- upper body lift/upper back lift/with or without a breast lift.
- Inner thigh lift with or without monsplasty.
– I tend to limit surgical time to about 6 hours, to reduce the risks of complication.
Please note that these operations are not performed as ‘weight loss’ procedures. If you are obese and plan to lose weight, you should put off any surgery that will change your body shape till you have reached your weight loss goal.
Is liposuction enough for me?
Liposuction is often used as an adjunctive tool, e.g. as ‘touch-up’ tool to the major procedures such as abdominoplasty, upper arm reduction and inner thigh reduction. It is not effective on its own to treat massive weight loss patients, unless you want more saggy skin. Liposuction only produces satisfactory or good results if you have relatively normal weight, good skin tone, and have fat only in certain areas.
How about breast augmentation?
If you have lost a lot of breast volume after losing weight, your breasts are likely very droopy and deflated. For men, there may also be saggy skin around the chest.
For women, augmentation is sometimes performed with a breast lift, but the latter is more important. Dr Tan cautions against the use of heavy implants, as your tissue is often not strong enough to hold the implants long term. Additional prostheses like a matrix may be used for additional support. Alternatively, those who desire more volume (as opposed to projection) may consider a fat graft. You can find more information on these procedures via the breast augmentation page.
Do I need to stay in the hospital after surgery?
A stay of at least 2-3 nights may be applicable, longer for some surgery.
This is for pain and drainage management, and in some cases, for dressing changes and help from physiotherapy to get you up and moving.
What scarring should I expect?
Unfortunately, body contouring surgery comes with long scars as skin excision is key for treating saggy skin. The more we cut, the longer the scar.
Dr Tan will provide scar management advice, but a general rule is that scars along the limbs take longer to mature, often around 14-24 months. This means they appear red and ‘lumpy’ (hypertrophic) for a longer period.
What is a body lift?
A body lift is a type of surgical procedure to remove extra skin and fat tissue from the belly, hips, outer thighs, back, and buttocks, i.e. circumferential or or 360° around the body.
What is brachioplasty/ upper arm reduction?
Brachioplasty (arm lift) is the surgery to remove extra skin and fat from the armpit (axilla) and upper arm.
What is medial or inner thigh lift?
In a medial (inner) thigh lift surgery, excess skin and fat from your inner thighs is excised, with or without liposuction.
After surgery care
The following will be recommended post-surgery:
- Postop compression garments (usually to be worn for six weeks)
- Maintaining a quality diet with plenty of protein, lots of vegetables and a moderate amount of fruits and carbohydrates
- Plenty of rest and sleep
- Regular movement of your ankles with short walks regularly at home during the day. After two weeks, you may be able to take slightly longer walks outdoors. One step at a time! You can use a pedometer or your iPhone to count your steps… start with 1000 steps, and increase 500 more steps incrementally every 2-3 days.
- Regular painkillers for the first 1-2 weeks (constipation may be an issue, and help will be offered for that)
- Depending on the type of surgery, a blood thinner may be prescribed for the first two weeks after surgery
- You may benefit from lymphatic massages from week three onwards
- You will likely need at least four weeks off work or longer if your work involves manual labour
Dr Tan will give a post-surgery advice sheet with details of the above list and more to ensure your full recovery.
Book a consultation for a body contouring review with Dr Tan today
Dr Tan is passionate about helping you achieve a look that you feel comfortable with, boosting your confidence in the process. She applies over fifteen years of experience, in-depth skills and knowledge to each case to achieve this. Book an appointment with Dr Beryl Tan today at Brighton, Cabrini or PRSM in Donvale and Drouin, and find out if body contouring can help you achieve an aesthetic you’ll love.