In regards to my interest in Body contouring post weight-loss surgery, I feel it encompasses both the cosmetic and reconstructive aspects of Plastic Surgery. Whilst the health benefits of massive weight loss are clear and the results for the patient are life changing, many patients suffer from the subsequent issues of excess skin laxity, essentially feeling as though they’re a deflated balloon.
Patients have skin overhanging their trousers, find it difficult to exercise or wear normal clothing, can have issues with recurrent rashes in their newly created skin folds, have deflated breasts, and age prematurely in the face and neck.
Last year alone there were over 5000 weight loss procedures performed in QLD alone, many on the Gold Coast, so there are a huge number of patients currently suffering, or will soon be suffering, from the massive weight loss and subsequent skin excess.
I enjoy working with these patients as they are usually – highly motivated people that have decided to make significant positive changes to their life and health, but need some ‘fine tuning’ operations to give them the body shape they’ve always desired.
Given the sharp rise in the number of weight loss procedures being performed, it’s also a quickly evolving niche in Plastic Surgery with adaptation of techniques to provide aesthetically pleasing results for these often challenging cases.
Surgical plans need to be individualised towards the patients’ needs and areas of concern, but may include:
Belt lipectomy – Massive Weight Loss (MWL) patients often are left with circumferential skin laxity and the ‘saddle bag’ deformity of the outer thigh. This is best addressed with a circumferential or ‘Belt’ lipectomy, combined with liposuction of the outer thigh area. This procedure also lifts the ptotic gluteal region to help create a normal gluteal curve.
Gluteal Auto-augmentation – MWL patients often notice that they have difficulty keeping their trousers up as they have lost the normal curve of the gluteal region. This procedure, typically paired with a Belt Lipectomy, uses the excess lumbar fat and soft tissue to be transposed into a pocket over the gluteal muscles, in order to help recreate the gluteal curvature. Fat grafting is also used in order to create a natural, smooth gluteal curve.
Thigh Lift – circumferential excess skin of the thighs, particularly of the inner thigh, can be addressed by performing a thigh lift, where excess skin is removed and the circumferential subcutaneous fat treated with liposuction. My preference is to perform a vertical thigh lift to address excess skin down the length of the thigh, with the scar concealed in the inside aspect of the thigh.
Brachioplasty – MWL patients may suffer from ‘tuckshop lady arms’, excess skin that cannot be treated without skin excision. I perform this as a poster-medial excision, which is more difficult surgically than the historical medial excision, but hides the scar in a such a way that is not seen from in from or behind with the arms raised. An extended brachioplasty continues past the axilla and onto the lateral chest wall in order to address skin laxity over the lateral torso or back. This is often combined with a back/bra reduction or with breast rejuvenation surgery.
Back/Bra lift- MWL patients often notice that there is excess skin that hangs over their bra strap on their back. This upper back skin is not effectively treated with any existing circumferential lipectomy or lower body lift, but can be excised directly or as part of a brachioplasty or mastopexy procedure.
Mastopexy or Augmentation mastopexy, or gynaecomastia surgery- Similar to patients after cessation of breastfeeding, MWL patients often have severe deflation and ptosis of their breasts, and feel that they have to ‘fold’ them into their bra. Patients that simply want their nipples back on the most projected point of their breasts may only require a mastopexy procedure. Those wanting more volume at the same time, or upper pole cleavage and projection may need to undergo mastopexy combined with an implant augmentation. Male patients often feel that MWL has accentuated their ‘man boobs’ as the nipples now sit lower and point downwards. Surgery for these patients needs to address the skin and soft tissue excess, as well as place the nipple back over the Pec Major muscle.
Face/Neck lift – MWL patients often feel as though they have aged prematurely in the face as their fat deposits decrease, and the skin wrinkles and hangs off their face and neck. They may notice new Jowls, deepened marionette lines, and loss of the angle from their neck to their chin. These patients may need a facelift, or neck lift in order to re-suspend the soft tissues, and may also need fat grafting back to the areas that have lost the youthful fullness they had previously.
I perform all of the above procedures for these patients. Obviously, patients do not require all of these procedures, and the decision about which of the above are required, which procedures can be combined, how many separate operative sessions and in which sequence they are performed is personalised for each patient depending on their individual circumstances.
Anyone wishing to book their consultation please contact reception.
Dr Drew Cronin
B.Biomed Sci, MBBS, FRACS (Plast)
Plastic and Reconstructive Surgeon