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Surgery After Massive Weight Loss

What Is Surgery After Massive Weight Loss

Dramatic weight loss, aging, or sun damage may result in loose and sagging skin. This excess skin can make it difficult to find clothing that fits well or cause rashes. A body lift can help remove excess skin and improve the contour of the body. A body lift can help lift and reduce the skin in the abdomen, thighs, groin, and buttocks. Body contouring can also be done on the back and arms.

Variations of the Procedure

  • Body Lift

    Excess skin and drooping of the buttocks, thighs, and abdomen can be treated with a body lift. In this procedure, a “belt” of skin is removed around the lower abdomen and extending around the back. The buttocks, abdomen, waist and thighs are tightened and lifted.

  • Abdominal skin

    The abdomen can be contoured through an abdominoplasty or a panniculectomy. Both an abdominoplasty and panniculectomy remove excess skin of the lower abdomen but the abdominoplasty also includes tightening of the area between the muscles. This tightening, also called a plication, helps give a more tapered appearance to the abdomen like an “internal corset”. Some patients will have extra skin that has to be removed on the lower abdomen and also vertically. Read more on about this on our tummy tuck page.

  • Arm Lift and Thigh lift

    Excess skin under the arms and on the inside of the thighs are treated with an arm lift and thigh lift, respectively. See our procedure pages on arm lift and thigh lift for more information.

  • Back lift

    Sagging skin below the area of the bra line can be lifted through a procedure called a back lift. In a back lift, the excess skin is removed horizontally across the back.

  • Breast lift

    The breasts may have a deflated and droopy appearance after weight loss. A breast lift can reshape the breasts so they have a more youthful and lifted appearance. For breasts that have good volume but the breast tissue is dropped significantly, an autoaugmentation procedure can be done. For breasts that need more volume, an augmentation with an implant can be done. See our breast lift and breast augmentation pages for more information.

Am I a Good Candidate?

Patients who have reached their ideal body weight, have maintained that weight for at least 6 months, and are in good general health are good candidates for these procedures. For patients who have had bariatric surgery, will need to have their nutritional labs checked prior to surgery.

How is the Procedure Performed?

Prior to surgery, the areas of skin to be removed are marked while you are standing up. The procedures are performed under general anesthesia in an accredited surgical center or hospital. The excess skin is removed and the tissues are tightened and repositioned. The incisions are closed with sutures and dressings. Drains may be placed. You will wear compressive garments after surgery.

Why Should You Choose the Surgeons at Hill Country Plastic Surgery?

Both Dr. Farber and Dr. Shah were fellowship-trained at the most prestigious institutions and their techniques for delivering patient results and satisfaction set the standard for plastic surgeons in the field. They use the most advanced techniques and consistently achieve superior results. Their warm demeanor, genuine care, and dedication to their patients are second to none. Ultimately however, patients choose Dr. Farber and Dr. Shah for the results. Their patients look and feel their best, and so can you. Discover the difference here in San Antonio!

Limitation, Risks, and Complications

Body lift procedures are not intended only for removal of excess fatty tissue. If there is good skin elasticity, liposuction can be done to remove the excess fat.

Thigh lifts are best for removing extra loose skin between the legs. It is not meant for reduction of a large amount of excess fat. If you have a lot of excess fat, you may benefit from a weight loss program, weight loss surgery, or liposuction prior to undergoing a thigh lift. Risks include poor wound healing, bleeding, infection, fluid collections, wound separation, asymmetry, deep fatty tissue may die (fat necrosis), skin discoloration and/or swelling, spitting sutures, poor appearance of scars, numbness or changes to sensation on the skin, and need for additional operations.

If you have swelling in one leg, pain in the legs, shortness of breath, chest pain, or abnormal beating of the heart, you should immediately go to the emergency room.

What to Expect During Your Consultation Visit

During your initial consultation with your surgeon at Hill Country Plastic Surgery, we will discuss your concerns and goals before recommending treatment options that are tailored specifically to your needs. Prior to your consultation, we recommend that you review the procedures on our website so you are familiar with the terms we will be using during our discussion.

Once we identify your concerns and surgical goals, we will discuss all of the treatment options that are available to you. Every patient is unique and we will develop a tailored surgical plan that addresses your specific goals. In addition, we will thoroughly review your medical history, surgical history, medications, allergies, family medical history, and other important details. It is very important that we obtain accurate information in all of these areas as it may impact the outcome of your surgery. Other information we will need to know is your current weight loss program if any, and how long your weight has been stable. If you had prior weight loss surgery, information from your bariatric surgeon will be reviewed. We will examine and measure your body to help with developing a personalized treatment plan.

While discussing different treatment options, we will perform a physical exam and take measurements that are necessary for planning for your surgery. Pre-operative (before surgery) photos will be taken either at your initial consultation, or during your pre-operative visit.

After your consultation, you will receive access to your notes on the patient portal in addition to information about your specific surgery. If you have not activated your patient portal, this can be done at your appointment by asking any of our staff to assist you. If you have questions after your appointment, you can contact our office or message us through the patient portal. Some patients will require medical clearance from their primary care physician or a specialist or additional tests before undergoing surgery.

Once you have determined that you would like to have surgery and have completed any clearances and tests that were requested, contact our office at (210) 658-3555 to schedule a pre-operative appointment with one of our surgeons.

Pre-operative Appointment

On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.

During your pre-operative visit, we will provide you with all of the after-care instructions as well as necessary medication prescriptions. You will also be provided with a post-operative appointment for follow up after your surgery.

Before the Day of Surgery

Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. Please stay away from second hand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and then you will need to undergo a cotinine test prior to surgery to ensure that the nicotine is out of your system.

Please do not drink alcohol before or after your surgery (until cleared by your surgeon). In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life threatening side effects.

Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.

Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.

You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.

The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.

Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.

Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.

Do not eat or drink anything after midnight the night before your surgery.

Please call our office if you have an infection of any kind prior to your surgery.

Day of Surgery

On the day of surgery do not take the following blood pressure medications with generic names that end in “-pril”, “-sartan” before your surgery. If you are on metformin, you will be asked to not take it on the day of surgery.

On the day of surgery, your plastic surgeon will meet you in the pre-operative area to go over any last minute questions or concerns you may have. Your plastic surgeon may make some preoperative markings and will perform extensive checks with careful attention to detail, ensuring high quality care and safety. You will meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.

Throughout the procedure, your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for care on these will be given to you in your preoperative paperwork.

Aftercare

In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:

  • Prepare a sleeping area that is easy to get to. For example, set up a couch downstairs instead having to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.
  • You may receive your post-operative medications at your pre-operative appointment. You should pick up these medications prior to your surgery.
  • If you’re having an outpatient same-day procedure you will be released to go home the same day and will need someone to drive you home.
  • Review your post-surgery instructions given to you at your pre-operative appointment

If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery.

When undergoing general anesthesia, you will need to have someone drive you home. You will not be allowed to undergo surgery if there is no confirmed designated driver.

Medications:

After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.

You may resume your home medications after surgery except blood thinners and as determined by your surgeon. We will give you a prescription for a pain medication. If you are prescribed medications that contain acetaminophen (tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (tylenol) per day.. Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.

Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as Miralax or Colace once or twice daily.

You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day. Take ibuprofen with food to protect your stomach from irritation.

If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.

Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.

We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.

Surgical Site Care:

You may shower 48 hours after your surgery. Do not scrub the incisions, just let the water run over them and gently dab them dry afterwards. Apply gauze over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery.

Drain Care:

Sometimes it is necessary to place a drain after surgery. The purpose of a drain is to remove excess fluid from the surgical area. Empty the bulbs and measure the output whenever the bulbs are half full or at least twice a day. You will be given a sheet to record how much is coming out of the drains. Bring this sheet to your follow-up appointment. In general, drains remain in place until there is less than 30mL (1oz) out of the drain for two days in a row.

Please Call Immediately if:

Please call if you have the following signs/symptoms:

  • temperature greater than 100.5 F
  • bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes
  • increasing pain that is not controlled on oral pain medications
  • increasing redness or size at the surgical site
  • your drain is not holding suction
  • if your wounds come apart
  • Any other concerns

For non-emergency questions:

During business hours (8 AM – 4:30 PM): call (210) 658-3555.

After hours and on weekends/holidays: call (210) 658-3555 and you will be forwarded to the on call surgeon.

If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.

Activity restrictions:

No vigorous activity: no pushing, pulling, bouncing, housecleaning, yoga, running, heavy lifting greater than 5 lbs until your follow up appointment. Avoid activities that raise your blood pressure or heart rate. You are encouraged to walk around and you can climb stairs after surgery. You should not lay in bed and not move.

Clinic appointment:

Your clinic appointment will be scheduled at your pre-operative appointment before surgery. If you need to change your appointment time or date, please contact our clinic at (210) 658-3555.

The surgeon may adjust any of the above guidelines and instructions based on the patient and type of surgery performed.

Surgery After Massive Weight Loss FAQs

On average, patients can return to full activities, including working out at the gym, 6 weeks after surgery.

You will be able to return to light duty at 2 weeks and to full activities at 6 weeks. We recommend that you wear your compression garments at all times for the first 6 weeks except when showering.

Results are visible immediately after surgery but the full results will not be seen for many months. For the first three days after surgery, you will be swollen and after that, the swelling starts to resolve. You won’t see a significant amount of the swelling go down until around 3 weeks. It may take years to see the results of the surgery and up to two years to see the final outcome.

The price of a body lift is dependent on how much skin and fat need to be removed. Sometimes, liposuction is recommended to remove excess fat from the treated areas.

A cosmetic thigh lift is body lift is not typically covered by insurance. Sometimes removal of only the abdominal skin is covered by insurance but tightening of the abdominal muscles is not covered. We recommend you call your insurance carrier for more information.

Interested?

Are you interested in learning more about this procedure? To schedule a consultation, please contact us. Hill Country Plastic Surgery is the premier plastic surgery center in the San Antonio and Austin area, and our friendly team members are here to help you and will reach out promptly.

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