11 May 2021 Body Contouring after Massive Weight Loss
Body contouring is restoring the body to a more functional and aesthetic form after massive weight loss and is the final steps in a weight loss patients’ journey. It should not be considered as an alternative to weight loss nor a method of fat reduction.
The patient is to be congratulated for having done the hard work to lose the excess weight (with or without bariatric surgery). Due to the massive weight loss, the skin may be lacking in elasticity. It can be saggy, heavy and loose, and can form problematic folds. This is not only psychologically displeasing for the patients who have worked hard for their weight loss but also presents physical symptoms such as rashes, chaffing and difficulty in exercising and walking. Unfortunately, the only solution for this is surgical excision of the excess skin, however this is at the expense of surgical scars. The scars are often placed strategically in cosmetically inconspicuous places, although sometimes to remove the most stubborn of skin excess, they need to be placed in more visible locations.
I believe every patient is different and the treatment must be tailored to their individual physical requirements and wishes. I take the time to discuss the patients’ ultimate goals for their body in detail during their consultation. If multiple areas need addressing then surgical procedures need to be staged, based on the patient’s needs. For example, some patients might only want an abdominoplasty (tummy tuck) to correct abdominal skin redundancy and repair of the rectus divarication (muscle separation) where indicated. While others might need a Belt lipectomy (total body lift) to address the redundancy of the back and lift the buttocks, as well as deal with the front of the abdomen. Others may even want further procedures to deal with the redundant skin on the arms (brachioplasty), the thighs (thigh lift) or their breasts (breast reduction &/or lift).
The hospital stay is also variable between patients and between procedures. For example, abdominoplasty or body lift patients usually stay in hospital for around a week while brachioplasty (arm lift) may be done as day surgery. All patients are required to wear a surgical compression garment for 4-6 weeks after surgery to help with recovery and reduce seroma (bruising and fluid build-up) rates.
I always tell my patients that the more skin we excise, the better they will look; however, it can increase the risk of wound complications. This is most evident in buttock lift surgery, where the skin excision must be quite conservative to allow patients to bend over, otherwise they will have wound dehiscence.
To be eligible for Medicare item numbers for body contouring surgery, massive weight loss patients must satisfy some strict Medicare criteria. I will assess the patient at the consultation to determine if they meet the criteria. The criteria is quite in depth, however an indication of some of the points are:
- Patient must have lost the equivalent of 5BMI points.
- Patient must have stable weight for the past 6/12.
- Weight should be documented showing the weight loss as well as the 6 months of stable weight.
If patients do not meet the specific criteria, they are still able to have this surgery, however it will be classified as cosmetic surgery meaning there are no rebates available from Medicare or Private Health insurance.
By Dr Andre Safvat – Specialist Plastic Surgeon