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Part 2 of a series outlining surgical cosmetic procedures after weight loss to assist clinicians in counseling patients on cosmetic and functional goals.

In a recent paper published in Cureus, Kandace Kichler, MD, and colleagues outlined cosmetic procedures that patients may be interested in after experiencing massive weight loss post-bariatric surgery.

Part 1 covered the review authors’ guidance on abdominoplasty, liposuction, body lift, and brachioplasty. Part 2 of this feature offers quick hitters to facilitate patient counseling on flankplasty, thighplasty, mastopexy, and facelift procedures.

Flankplasty

Overview:

• Flankplasty is a body contouring surgery often combined with liposuction to address excess skin and fat in the flanks, lower back, and abdomen.

Procedure Goals:

• Improve both aesthetic and functional outcomes.
• Lower Body Focus: Flatten the abdomen, excise lower back rolls, relocate the navel, redefine the waistline and buttocks, reduce the mons pubis, and elevate the anterolateral thigh.
• Upper Body Focus: Eliminate mid and upper back folds, reshape arms by removing loose skin, and recreate the inframammary fold.

Candidate Criteria:

• Patients who have undergone bariatric surgery commonly experience soft tissue laxity from the neck to the lower back due to excess adiposity.
• Patients typically have inferior migration of back skin and flank deformities.
• Overhanging pannus in the lower abdomen and pubic area can cause discomfort and irritation.

Benefits:

• This procedure contours the soft tissue from the upper back to the lumbar area, removes soft tissue folds in the middle and upper back, corrects flank deformities, and deepens the waist when combined with lipoabdominoplasty.
• Flankplasty improves physical function and aesthetic appearance, which can enhance overall QOL.

Complications & Risks:

• Common risks include wound dehiscence, particularly in the lower back; seroma and hematoma development; and risk of lymphoedema and improper appearance or loss of the navel.
• Perioperative tobacco use and higher BMI (>30 kg/m²) correlate with increased complication rates.
• Patients may experience infections, hematomas, and delayed wound healing in areas with thin or lax skin.

Outcomes & Satisfaction:

• Patients have high satisfaction rates (98%), with outcomes ranging from pleasing to excellent.

Average Cost:

$7,768.

Thighplasty

Overview:

• Thighplasty is a surgical procedure to reduce skin laxity and remove excess skin from the thighs. It is often combined with liposuction for enhanced contouring.
• The extent of the procedure depends on the severity of skin laxity. A horizontal excision is sufficient for laxity confined to the upper third of the thigh.

Procedure Goals:

• Improve thigh contour and lower torso tightness while minimizing visible scarring.
• Correct deformities, such as sagging medial thighs, stacked anterior skin, and “saddlebag” lateral thighs.

Procedure Details:

• Approach:
  • Requires a lower body lift followed by skin excision.
  • Incorporates medial thigh excisions, liposuction, and prone/supine operative positions for optimal results.
• Targeted Areas:
  • Loose skin in the upper posterior thigh, medial sagging, and stacked anterior and lateral skin.

Complications & Risks:

• General risks include wound dehiscence due to thin and atrophic skin; scar-related issues such as enlargement, migration, and retraction (potentially deforming the labia majora or vagina in the inguinal area); seroma formation if closed-suction drains and compression garments fail; infection risk due to proximity to the anus and genitals; lymphedema caused by lymphatic channel injury; and suture granulomas and slow wound healing due to the humid environment of the inner thigh.
• Major complications can include infection, hematoma, fluid overload, and venous thromboembolism. There are higher complication rates in hospital settings than in ambulatory settings.

Outcomes & Satisfaction:

• Most patients (72%) report complete satisfaction, with 8% partially satisfied with their results.
• Despite higher complication rates, patient satisfaction remains high due to effective contouring and correction of deformities.

Average Cost:

$5,030.

Mastopexy

Overview:

• Mastopexy is a surgical procedure designed to restore and reshape the breasts in patients with severe ptosis and asymmetry after bariatric surgery. It helps lift and center the nipple-areola complex and improves breast symmetry and contour.

Procedure Goals:

• Remove excess skin, lift the nipple-areola complex, and restore fullness to the breasts.
• Correct ptosis (sagging) and restore symmetry using excess tissue from the epigastric or lateral thoracic regions.

Candidate Criteria:

• Post-bariatric changes can include severe ptosis, asymmetry, reduced upper pole volume, loose inframammary folds and lateral chest wall rolls, and lack of skin elasticity.

Complications & Risks:

• Common complications include ptosis relapse, reduction of upper pole volume, and upward migration of the nipple-areola complex; implant malposition; and thromboembolic events, seromas, hematomas, and nipple necrosis.
• Scar location and extension can affect aesthetic outcomes.
• Age is linked to post-operative ptosis, while smoking, alcohol, or drug use can increase the risk of nipple necrosis or loss. A higher BMI is associated with complications like implant malposition.

Outcomes & Satisfaction:

• A 2019 study showed that 100% of patients reported satisfaction with their mastopexy results, ranging from somewhat to extremely satisfied.

Average Cost:

$4,864.

Facelift

Overview:

• A facelift is a cosmetic surgery that addresses soft tissue deflation, excess skin, and sagging in the face and neck, which are common after significant weight loss. It aims to improve the cervicofacial appearance by restoring volume and tightening the skin.

Procedure Goals:

• Eliminate drooping skin, deepened nasolabial folds, and malar descent.
• Define the jawline and facial contours.
• Often combined with fat compartment augmentation, especially for midface deflation.

Candidate Criteria:

• Post-bariatric surgery changes can include significant deflation of the face and neck, with excess skin around the central neck and deepened facial folds; persistent skin laxity due to soft tissue deflation; and loss of facial volume, particularly in the midface.

Complications & Risks:

• Common complications include soft tissue deflation, hematomas, seromas, and hypertrophic scarring.
• Greater tissue loss due to more significant skin removal increases the risk of hematoma. Smoking is also linked to increased hematoma development.
• Persistent skin laxity may lead to the need for a revision facelift.
• Patients with massive weight loss often require longer incisions and repositioning of skin flaps, especially in the lower neck region.

Outcomes & Satisfaction:

• A 2010 study reported 97.8% patient satisfaction with facial appearance one year after surgery.

Average Cost:

$9,127.

Missed Part 1 of this series? Read it here!