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Plastic Surgery after Bariatric Surgery

Bariatric Surgery (especially the Gastric Bypass Surgery) are surging in popularity. With massive weight loss in a short time, skin often does not shrink well. Body contouring plastic (or cosmetic) surgery can help deal with this extra skin and give such individuals a new image after losing massive weight.

Whether a person loses weight through diet and exercise or through bariatric surgery, there are a few problems that arise as a result of the weight loss. One that will be most noticeable is the loose skin that remains after the weight is gone. When someone is overweight, the skin stretches to accommodate the increased volume of weight. After weight loss, the skin often fails to tighten, and so it sags. In many cases, it hangs (especially in the arms, stomach, thighs, breasts, and buttocks). It acts as a constant reminder of the weight you once carried around. Exercise WILL NOT tighten skin (exercise never tightens skin - only muscles). The only way to tighten loose skin is through plastic or cosmetic surgery.

Though tummy tucks, lower body lifts, and liposuction are not new to the cosmetic surgery world, performing these (and other) procedures on post-bariatric patients often requires a different approach. What makes body contouring, or body reshaping, more difficult after bariatric surgery is that the skin has usually been permanently damaged by being so extremely stretched. The result is that the patient's skin will loosen with age faster than a normal patient's. Bariatric patients desiring such reshaping after surgery should use a specialist with experience dealing with this type of situation.

A variety of surgical procedures are often necessary and performed at different times. Depending on which area bothers you the most, the surgery can be tailored to fit your needs, starting with the area of greatest concern.

Often an abdominoplasty (Tommy Tuck) is done first, though a circumferential lower body lift may be needed instead. Breast lifting surgery, arm lifts, face lifts and neck lifts are all additional procedures that can be done at separate times. A body lift is the combination of tummy tuck and a lower body lift (inner thigh lift, and outer thigh/buttock lift).

 

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Abdominoplasty (Tummy Tuck)
An abdominoplasty, or “tummy tuck”, is a surgical procedure which smoothes, or flattens, the abdominal area. Often, this is accomplished by removing excess skin and fat from the lower and middle portions of the abdomen and tightening the abdominal muscles. For some patients, who just have laxity of the lower abdomen, a partial or Mini-Abdominoplasty may be all that is required. For others, who have a wider area of laxity, or more loose skin, a full abdominoplasty may be a better choice. An abdominoplasty allows removal of redundant or lax skin and at the same time tighten the underlying abdominal muscles rejuvenating the appearance of the abdomen. To accomplish this, an incision is made across the lower abdomen at approximately the level of the pubic hair and extends towards either side of the abdomen. Normally used is a “bikini line’ incision which is well concealed by bikini bottoms or panties.
Following significant weight loss, it is common for the skin of the abdomen not to return to its normal contour and quality. Stretch marks may be present. When a significant amount of hanging skin results, this is called a pannis, or apron. Such a pannis can interfere with many of the normal activities of daily living, make exercise difficult and even become a hygiene problem. When an abdominoplasty involves removing a large amount of excess skin, it is referred to as a panniculectomy.

Arm Lift (Brachioplasty)
The soft tissues of the upper arm can become redundant as a result of gravity and aging. This redundancy can be particularly pronounced following significant weight loss. Once the tissue of the upper arm develops this laxity, the only method to improve it is by removing the redundant skin and fat. This procedure is called a brachioplasty, or arm lift. A brachioplasty is performed by removing skin and soft tissue from the inner aspect of the arm. This redrape the skin in this area and improve the support of the underlying soft tissue. The result is a much improved contour to the upper arm, especially when the arm is raised. There is a inconspicuously placed scar along the inner aspect of the arm, from just above the elbow to the armpit that fades over time.

Breast lift

For women, mastopexy (breast lift surgery) is a procedure to lift the breasts and may be performed with or without the addition of breast implants to improve shape, fullness and cleavage. For men, several breast reduction techniques are available, depending on the degree of correction required.
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Lower Body Lift
Often when there is laxity and redundancy of the abdominal wall soft tissue, there is also laxity and redundancy of the skin and soft tissue of the thighs and buttocks. This sagging of the buttocks, thighs and flanks can distort the contour of the body as well as produce skin irregularities or cellulite. A lower body lift is an extension of a tommy tuck. It removes excess skin and fat and lifts the soft tissues of the thighs and buttocks. Some have referred to this procedure as a “face-lift” for the body. It accomplishes more than just removing redundant skin. A lower body lift actually rejuvenates the appearance of the body by tightening the supportive soft tissues of the treated areas. It also improves cellulite.
A lower body lift is a significant surgery and produces some of the most dramatic improvements in cosmetic surgery. There is a permanent scar which fades over time and is easily hidden by bikini bottoms or panties.

Timing and Approach to Plastic Surgery
Plastic Surgery procedures should be considered only after ones weight has stabilized after a bariatric procedure. This is usually 18 months or more, depending on an individual's preoperative weight. Performing a skin tightening procedure prior to weight stabilization may result in the need for further skin tightening in the future. It is preferred to wait to at least three months between operations.
Plastic Surgery procedures following massive weight loss are usually extremely gratifying for both the patient and surgeon. The results are usually dramatic and provide a significant functional and aesthetic benefit to the patient.
 



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Dr. Roberto Rizzi multidisciplinary team is specialized in Laparoscopic Gastric Bypass Surgery as well as other Bariatric surgeries. Dr. Rizzi's team of professionals includes dietitian, psychologist, physiotherapist, anesthesiologists, physician and plastic surgeons, all specialized in obesity treatment
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