Body Contouring / Significant Weight Loss Patient #10
Details: A woman in her later 50s lost 140 lbs after a gastric bypass through an open upper abdominal midline incision. She is shown before and again, 15 months after a fleur de lis abdominoplasty. The improvement in her contour is dramatic. Her results are somewhat limited by the decreased elasticity of her skin which is typical after significant weight loss of 140 lbs.
A woman in her mid 40’s who is bothered by back rolls and looseness of the skin. She is shown before and again, 15 months after a bra line back lift combined with liposuction of the posterior shoulders. The bra line back lift trades a permanent scar that is hidden under the bra for better contour of the back. She is able to hold her arms at her side after the surgery.
A woman in her early 50s who has lost more than 50 lbs with HMR medically supervised weight loss plan and is bothered by loose skin of the lower abdomen that is difficult to hide with clothing as well as drooping and the size of her breasts. After discussions, we performed an extended abdominoplasty 2 years ago, with the removal of 5 ½ lbs of skin from her abdomen. Her abdomen was improved but she was still bothered by loose skin of the upper abdomen.
So one year ago, we performed a breast reduction/mastopexy and at the same time performed a vertical excision of the upper abdomen. She is thrilled with her new contour, and finds the upper abdominal midline scar is a worthwhile tradeoff for the additional tightening of the upper abdomen.
Discussion: When patients have significant weight loss the upper abdomen has horizontal excess that is not completely corrected with the direction of a traditional abdominoplasty. A “Fleur de Lis” abdominoplasty has a vertical component that has the tradeoff of a vertical scar that is visible in the upper abdomen for more tightening in this area. If someone is not certain that they want the vertical scar of the upper abdomen, an excision can be done at a second stage, as we have done here. When there are “rolls” of skin above the umbilicus, a vertical component is often needed for complete correction.
An early ( 6 week ) follow-up on a woman in her later 50’s who is bothered by the weight of her 38 D cup breasts as well as looseness of the skin in her back. She had grooving and irritation of her shoulders from her bra straps, back pain and difficulty with her posture. She did not have enough breast tissue to be removed to be covered by her insurance company but decided to proceed on a cosmetic basis. She is shown just 6 weeks after bilateral breast reduction combined with a bra-line back lift. She had 219 gms of tissue removed from her right breast and 313 gms from her left breast to bring her down to a c cup. Her shoulder and back pain have resolved, and she loves her new shape and size. A bra-line back lift places the scar directly under the bra strap area. Scars are at their reddest and thickest at 6 weeks and will now start to fade and improve over the next 2 years or longer. I have recommended topical silicone to help the scars fade.
A woman in her early 70’s who is bothered by laxity of the back skin. She asked about liposuction but this does not tighten loose skin and as we age the skin becomes less elastic. The most reliable way to tighten loose skin is to remove a piece. She is shown before and again, just 6 weeks after a bra-line back lift. With a bra line back lift, the back skin is lifted and the scar is hidden under the bra line. The skin in the flank area is pulled up as well.
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.