An unusual case of a nurse in her late 50’s with lipodystrophy of the flanks. She is 5’2” and 292 lbs, giving her a BMI of 53.40. Her maximum weight was 450 lbs and she has had a panniculectomy of the abdomen in 2001 and a gastric bypass in 2006. She was referred by her orthopedic surgeon because the flank skin oscillates when she moves and causes a disturbance of her gait.
She is shown before and again, 3 months after a posterior-lateral thigh/buttock lift with the removal of more than 10 lbs of skin from each side, for a total of more than 20 lbs. Despite her high risk for surgical complications with her highly elevated BMI, she healed uneventfully. Although our main goal was a functional improvement in her gait, which was achieved by her surgery, she also has a significant improvement in her appearance as well.
A mother of 2 who has lost 100 lbs with diet and exercise from her maximum weight of 260 lbs and is now 5’4” and 160 lbs. She is bothered by “ rolls of skin which make it difficult for her to tuck in her shirt”. She was motivated to lose weight so that she would be more fit to play with her grandchildren. She is shown before and again, 1 year after an extended abdominplasty with the removal of 8 lbs of skin. 680 cc of fat was removed from the upper abdomen with liposuction at the same.
She is thrilled with her new contour.
Discussion: Her improvement is dramatic. The results of abdominoplasty after significant weight loss depend on the amount of weight that was lost to get down to an ideal body weight. Patients that have lost 20 lbs look better than patients who have lost 50 lbs. Pts who have lost 50 lbs look better than patients who have lost 100 lbs, and so on. Despite adding liposuction to the “rolls” above the umbilicus, she continues to have some excess skin. When patients have gained significant weight they have expanded in a horizontal direction above the umbilicus. The contour can be improved further by excising this extra skin in a vertical direction, albeit at the expense of a visible scar in the midline. This would become a “Fleur de Lis” abdominoplasty. I find that unless a patient already has a midline scar in the upper abdomen from a prior abdominal surgery that they do not want the tradeoff of this scar for additional tightening.
A mother of 2 in her mid 50’s who has lost 80 lbs with diet and exercise. She is bothered by the “rolls of skin which make it difficult to tuck in her skirt”. Her impetus for losing weight was to be more fit to be able to play with her grandchildren. She is shown before and again, 9 months after an extended abdominoplasty with the removal of 8 lbs of skin. Although the best results with abdominoplasty are with patients who are thin and have not had decreased elasticity of the skin from significant weight loss, she has a significant improvement. Her scar is hidden in a “thong” position.