Body Contouring
Body contouring procedures include surgery to the abdomen (tummy), back, arms, thighs, or any part of the trunk or limbs. Abdominoplasty (or tummy tuck) is the most common type of body contouring surgery. Some women choose to have it after pregnancy when they find it very difficult to lose the excess skin and fat at the lower abdomen despite changing to a healthier lifestyle.
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) or with the help of drugs like Ozempic, 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.
Pre-surgery requirements:
- 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.
Please refer to the other section on liposuction for more information.
How about breast augmentation?
If you have lost a lot of breast volume after losing weight, your breasts will have likely changed. 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.
Belt lipectomy is similar to body lift but is more commonly performed on males.
Fleur-de-lis (FDL) abdominoplasty or FDL body lift involves an additional vertical skin removal from the central abdomen. It is performed when you have a lot of skin overhanging at the upper and central abdomen.
*Disclaimer: The results of brachioplasty vary from person to person. The ‘before and after’ images shown are specific to the individual depicted. It is critical to understand that surgical outcomes are unique to each individual, influenced by genetics, lifestyle (e.g. diet, exercise, history of sun exposure, and smoking), and tissue quality after weight loss. Therefore, your results may not mirror those depicted.
The patient has provided consent for photo sharing. Dr. Beryl Tan (FRACS Plastic Surgery; AHPRA MED0001806513) is a certified medical professional specialising in plastic surgery. Surgical procedures carry inherent risks and necessitate recovery periods. The information provided is general and should not replace specific medical advice.
Prior to committing to surgery, consider obtaining a second opinion from a suitably qualified medical professional such as a plastic surgeon. The term ‘plastic surgeon’ is regulated and exclusively used by surgeons who have undergone specialised training in plastic surgery and are fellows of the Royal Australasian College of Surgeons (FRACS).
**As with any surgical procedure, body lift surgery involves risks. Potential complications can include infection, scarring, changes in skin sensation, and dissatisfaction with the cosmetic results. It is important for individuals considering this procedure to discuss all potential risks and benefits with Dr Tan. Scroll down for more information on the general and specific risks of body contouring surgery.
Photos- Above- Before; Below- After 2 years
Photos- Above- Before; Below- After 2 years
What is brachioplasty/ upper arm reduction?
Brachioplasty (Arm Lift):
Brachioplasty is a surgical procedure designed to remove excess skin and fat from the armpit (axilla) and upper arm area. This procedure can help patients who have experienced significant weight loss or have excess skin due to ageing. Extended brachioplasty means further skin (and some fat) is removed beyond the elbow, or extending across the axilla (armpit) into the side chest wall. This is often performed in conjunction with breast surgery and the scars often join together.
*Disclaimer: The results of brachioplasty vary from person to person. The ‘before and after’ images shown are specific to the individual depicted. It is critical to understand that surgical outcomes are unique to each individual, influenced by genetics, lifestyle (e.g. diet, exercise, history of sun exposure, and smoking), and tissue quality after weight loss. Therefore, your results may not mirror those depicted.
The patient has provided consent for photo sharing. Dr. Beryl Tan (FRACS Plastic Surgery; AHPRA MED0001806513) is a certified medical professional specialising in plastic surgery. Surgical procedures carry inherent risks and necessitate recovery periods. The information provided is general and should not replace specific medical advice.
Prior to committing to surgery, consider obtaining a second opinion from a suitably qualified medical professional such as a plastic surgeon. The term ‘plastic surgeon’ is regulated and exclusively used by surgeons who have undergone specialised training in plastic surgery and are fellows of the Royal Australasian College of Surgeons (FRACS).
**As with any surgical procedure, brachioplasty involves risks. Potential complications can include infection, scarring, changes in skin sensation, and dissatisfaction with the cosmetic results. It is important for individuals considering this procedure to discuss all potential risks and benefits with Dr Tan. Scroll down for more information on the general and specific risks of body contouring surgery.
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.
What are the risks of surgery?
ALL Surgery is associated with some risk. There are general and specific risks related to the operation.
Understanding the Risks of Surgical Procedures: Every surgical procedure involves inherent risks, and it’s crucial for patients to be well-informed about these before deciding to proceed. Here, we outline not only the general risks associated with surgeries but also emphasize that specific procedures have their own unique risks.
General Surgical Risks: All surgical procedures can potentially lead to complications such as:
- Bleeding or hematoma formation
- Infection
- Healing issues, including slow/delayed healing or separation of the incision (wound dehiscence)
- Excessive or abnormal scarring, such as keloid formation
- Seroma (accumulation of tissue fluid)
- Deep suture extrusion that could lead to infection
- Fat necrosis (death of fat tissue)
- Pain- acute post-surgical pain; sometimes chronic pain
- Change in sensation (usually temporary but may be permanent)
- Allergic reactions to drugs or local anesthesia
- Deep vein thrombosis (blood clots in deep veins) that could lead to pulmonary embolism (clots travelling to the lungs)
- Pressure effect- excessive, unrelieved, or prolonged pressure on tissues can cause temporary or permanent damage. The risk of these complications is increased in lengthy operations and in the obese (BMI 30 or more), smokers, diabetics, and medically compromised patients. Great care is taken to minimize these risks during operations.
- Unsatisfactory result and need for revisional surgery
Informed Consent: Before any surgical operation, it is mandatory for all patients to read and sign informed consent forms. These documents are essential as they ensure that you have been provided with comprehensive information about the risks associated with your procedure. Dr. Tan and her team are committed to ensuring that you feel informed and confident in your healthcare decisions.
The risk of surgery for body contouring after massive weight loss is much higher (up to 30% in some reported studies). However, the risk is lower for others. In general, inner thigh lift carries a higher risk compared to abdominoplasty, or brachioplasty.
Abdominoplasty/ Fleur de Lis Abdominoplasty/ Lower or Upper Body lift/Brachioplasty/Inner thigh lift
- Asymmetry of scars and umbilicus (belly button) and uneven skin contours (there is always some difference between 2 sides of our body and even after surgery, they will not be mirror-image)
- Fluid accumulation (seroma) under skin flaps
- Permanent numbness of lower abdominal skin
- Fat necrosis (dead fat)
- Scarring- brachioplasty and thigh lift scars take longer (16-24 months) to fully mature
- Skin loss / necrosis at the umbilicus (belly button/naval)
- Wound breakdown which includes wound separation, skin and fat necrosis and may be associated with infection
- Abdominoplasty has a higher risk of deep vein thrombosis (explained in the Blog section)
- Smoking significantly increases the risks of post-operative complications, such as chest infections, as well as compromises the skin circulation, leading to an increased risk of wound breakdown.
- Obesity (Body Mass Index greater than 30) is also associated with increased complications, such as wound breakdown.
- Long term effects- Subsequent alterations in body contour may occur as the result of aging, weight loss or gain, pregnancy, or other circumstances not related to abdominoplasty.
- Pain- Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue after abdominoplasty.
- Intra abdominal organ injury (rare)
If liposuction is used- Fat or air embolism to lungs or brain (rare; ~8% in large volume liposuction); death ~1 in 5000 (mainly due to DVT/PE)
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 her work as a plastic surgeon. 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 at Donvale.