The obesity epidemic across the United States and the rest of the world has led to many programs centered on lowering Body Mass Index (BMI) for the well-being of the individual. However, significant amounts of weight loss cannot ignore the physics of the real world. Bodily entities like the skin and fat deposits that have made huge changes in tension and size from the loss of volume do not always adjust themselves accordingly after weight loss. Bariatric (weight loss) surgery has caused many individuals to meet their BMI goals and develop healthier life s, but it has also created the need for much of the body contouring necessary from weight loss.
As individuals metabolize their fat, they begin to not only weigh less but also occupy much less physical space. This loss of volume, especially when rapid, is not responded to by the body. In most cases, severe and swift weight loss results in loose skin and fat that literally hangs off the body because the mass upon which it rested has been suddenly removed.
The aim of body contouring is to rearrange and excise this surplus tissue for both cosmetic and functional purposes. Aesthetically speaking, large surface areas of skin hanging off a conversely small frame could be considered just as unsightly as the taut surface of a morbidly obese individual. Daily activity can be hampered by this misshapen body due to frequent chafing between the functional skin and excess skin. This can cause significant discomfort and possible skin infections from excessive irritation. The patient’s hygiene also becomes an issue because of the ease at which moisture is retained between flaps of loose skin; this moisture presents an ideal breeding ground for bacteria.
Although it is possible to perform a full body lift in one lengthy session, most doctors prefer to break up body contouring surgeries for the safety and comfort of the patient. This is an extremely risky surgery and keeping a patient under anesthesia for more than six hours is only going to exacerbate the situation. The body contouring procedures are split up into a few of the most common areas operated on:
- Arm Lift (Brachioplasty)
- Breast Lift (Mastopexy)
- Abdominoplasty (Tummy Tuck)
- Lower Body Lift (normally thighs and buttocks)
Most of these surgeries result in heavy scars that respond minimally to reduction procedures. Therefore, the incisions are situated in normally covered areas of the body, such as under the arms or below the waist line.
The arm lift (or brachioplasty) procedure attempts to procure a more natural and youthful look by removing the fat and excess skin hanging down from the underarms. This is more commonly seen in women, but can also occur in men who have lost significant weight. The incision is made beneath the arm and can extend from the elbow to the armpit, depending on how much skin must be removed. However, most patients are satisfied with the results and believe trading “skin for scars” is worthwhile, especially when scars are efficiently hidden by the surgeon.
The breast lift (or mastopexy) reshapes the breasts and repositions the areolas. The skin below the breast is generally removed and the nipple is moved higher while skin above the breast is pulled around to create a swell. This procedure is usually combined with breast augmentation (enlargement) so as to better fill the empty space vacated by the fat loss. The areolas can also be resized if necessary. Most of the scars associated with this procedure are hidden by a normal bra.
The tummy tuck (or abdominoplasty) tightens the abdominal walls and removes excess skin to create a flatter contour of the abdomen. This procedure is performed under local or general anesthesia and begins with an incision along the bikini-line and the removal of the navel. Once the abdominal walls have been repositioned, the skin flap is pulled down, stretched and cut for the new naval fixture. The procedure is moderately invasive and requires around two to three weeks before exercise can be attempted.
A lower body lift consists of both a thigh lift and a buttock lift, both aimed at resecting as much excess skin as possible. The thigh lift is performed similar to an arm lift, with the surgical incision varying in position based on where most of the skin lies. The butt lift does not make use of implants at all, although some can use fat harvested from other parts of the body to “fill out” the shape. In most cases of body contouring relating to bariatric surgery though, the simple cutting and repositioning of the skin produces satisfactory results.