Photo Credit: Anatoliy_gleb

A recent review in Cureus outlines surgical cosmetic procedures after weight loss, educating clinicians in counseling patients on cosmetic and functional goals.

A review published in Cureus provided an overview of cosmetic surgical procedures that patients may be interested in after massive weight loss.

“This guide serves to educate patients about the surgical options they can elect after bariatric surgery in order to achieve their cosmetic and functional goals,” wrote corresponding author Kandace Kichler, MD, and colleagues. “Physicians or other medical staff may also use this guide as an aid for counseling patients.”

Abdominoplasty

Procedure Goals:

• Remove excess skin and fat, tighten abdominal muscles, and achieve a natural, aesthetically pleasing abdominal contour.
• Ideal outcomes are a natural-looking umbilicus, enhanced abdominal musculature, preserved skin integrity, and a well-defined waistline.
• Liposuction can help define the waistline, particularly for patients with a blunted or cuboid abdomen.
• Markings mimic post-operative skin tension to prevent high-riding scars.

Candidate Criteria:

• Best suited for patients with significant skin laxity, excess fat deposits, and weak abdominal wall muscles.
• Commonly performed on patients post-massive weight loss, who may have additional challenges like pre-existing scars and a higher BMI.

Risks & Complications:

• Common complications include seromas and hematomas (which occur in approximately 33% of cases), which can lead to necrosis or infection if untreated. They also include superficial wounds, infections, and wound dehiscence due to high suture tension.
• Patients with massive weight loss have a higher likelihood of back pain, intertrigo, and nutritional deficiencies. Elevated BMI increases the risk of complications such as soft tissue deformity.

Outcomes & Satisfaction:

• High patient satisfaction rates:
  • 98% overall satisfaction with abdominoplasty.
  • Combined liposuction-abdominoplasty procedures achieve the highest satisfaction at 99.2%.
• QOL improvements include enhanced self-esteem and body image.
• Discomfort levels are similar for abdominoplasty alone and the combined procedure.

Average Costs:

• Abdominoplasty: $6,173.
• Liposuction: $3,382.

Liposuction

Procedure Goals:

• Remove adipose tissue from the subcutaneous space to enhance body contour.
• Most frequently performed between the inframammary and gluteal folds.
• Often combined with abdominoplasty, breast augmentation, gluteal fat transfer, and reconstructive procedures for the breast and face.

Liposuction’s Role in Massive Weight Loss:

• Critical for improving body contour, though rarely sufficient as a standalone procedure.
• Often combined with excision surgeries for optimal results.

Procedure Staging:

• Simultaneous liposuction and rejuvenation can treat an area without additional surgeries, but they may increase the risk of edema and vascular compromise.
• A staged approach (liposuction followed by excision after six months) minimizes complications and allows for better contouring.

Risks & Complications:

• Common complications include seromas, infections, hematomas, and vascular compromise.
• Higher BMI and percentage of excess weight shed are correlated with increased postoperative complications in patients with massive weight loss.

Outcomes & Satisfaction:

• Liposuction has a 67% satisfaction rate among post-bariatric patients undergoing body contouring.
• Liposuction is essential for body contouring, but it requires adjunct procedures to achieve the desired aesthetic results in patients who have lost significant weight.

Average Cost:

• $3,300.

Body Lift

Overview:

• Circumferential body lift that combines buttock lift, abdominoplasty, and often thighplasty to address functional and aesthetic concerns in patients with massive weight loss.
• Restores volume and shape to affected regions, catering to patients with atonic, lax skin requiring tissue resection.
• Increasingly preferred for comprehensive reconstruction in patients who underwent bariatric surgery.

Procedure Goals by Region:

• Abdomen: maximal skin and fat reduction; muscle contouring for abdominal wall definition; waist trimming with subcutaneous fat excision and horizontal (fleur-de-lis) tissue resection.
• Flanks: vertical tissue resection to restore contour.
• Gluteal region: case-specific approaches to improve volume and shape.

Risks & Complications:

• Common risks include pulmonary embolism (PE), deep vein thrombosis (DVT), paresthesia, numbness, seromas (most commonly in the abdominal area), and wound healing complications, particularly in patients with massive weight loss.
• PE/DVT risks are managed with prophylaxis. Smokers and oral contraceptive users are advised to stop these habits/medications four weeks pre-surgery.
• Total body lifts reduce infection, thrombophlebitis, and transfusion risks compared with multiple staged surgeries.

Outcomes & Satisfaction:

• Combines multiple contouring procedures in a single stage, enhancing efficiency.
• High satisfaction rates due to comprehensive correction and minimized need for repeated surgeries.

Average Cost:

• Ranges from $7,000 to $30,000, depending on scope (lower, upper, or total body lift).

Brachioplasty

Overview:

• A surgical procedure to improve arm contour by addressing severe deformities, such as excess and loose skin extending from the posterior axillary fold down the arm.
• Liposuction may precede or accompany brachioplasty to optimize skin tone, contour, and proportions.

Patient Considerations:

• Arms may appear over-inflated, even post-weight loss.
• It is recommended that liposuction is performed first, followed by an excision after six months for better outcomes.

Risks & Complications:

• Common complications include infection (14.6%), hematoma, seromas, sensory nerve injury, recurrent laxity, and asymmetry. Hypertrophic scarring occurs in 24% of cases, with 8.3% requiring revision surgery.
• Patients with massive weight loss often have thin skin, making them prone to open wounds and scarring.

Outcomes & Satisfaction:

• Optimal candidates are patients with stable weight for six months.
• There is a high risk of scarring, and careful attention is needed to manage range-of-motion issues at the elbow.
• Brachioplasty achieves significant improvement in arm contour, especially when paired with liposuction.

Average Cost:

• $4,680.

Watch for part 2 of this series, in which the review authors describe considerations for thighplasty, flankplasty, mastopexy, and facelift procedures.