After significant weight loss, patients are ready to purchase clothes for their new body and are frustrated with the excess skin around the belly or abdomen. Depending on the amount of weight loss, there can be a large amount of loose skin that may extend over the pubis and down to the thighs or even to the knee. A standard abdominoplasty is a technique used when there is a minimal amount of extra skin. The removal of this tissue involves an incision from hip to hip with excision of almost all of the tissue between the pubic area to just above the belly button, or umbilicus. This tissue weighs only about two to eight pounds and sometimes more, but makes a huge impact on how the trunk looks. The pubic area gets treated as well with either liposuction or direct excision of skin and fatty tissue. The stretched out abdominal muscles underneath are surgically tightened, creating a flat, toned abdomen. While skin removal is important, the repair of the muscle separation or abdominal diastasis is probably more significant in achieving the best look possible. If there is a large amount of skin to be removed, patients will need a more extensive procedure called a circumferential abdominoplasty, also known as a lower body lift.
With massive weight loss – whether by diet or bariatric surgery – patients desire the removal of sagging excess skin around the abdomen and trunk. Often, the amount of skin and tissue to be removed is so excessive that it exists not just in the front of the abdomen, but tends to extend around the sides of the trunk and even across the back. These patients will require a circumferential abdominoplasty or lower body lift. During this procedure, an incision is made all the way around the trunk, and skin and tissue are removed from the front, sides and back. This truly is a transformation that occurs right before the surgeon’s eyes as he sees excess pounds of skin removed. Usually five to 20 pounds of tissue is removed and the abdominal muscles are surgically tightened. This effectively elevates the outer thigh tissue and buttocks to eliminate the redundant saggy skin and results in a monumental change in how your body looks.
Circumferential abdominoplasty is also called a lower body lift, and it may improve the appearance of the outer thighs as it elevates the outer thigh tissue and buttocks; however, it does not treat the inner thighs. The inner thighs require a special procedure called a thighplasty (or thigh lift) to remove the excess skin and fat from that area.
The circumferential abdominoplasty takes 5-6 hours in the operating room, and requires an overnight stay at a full service hospital because of the extensive nature of the surgery. Recovery takes 2-4 weeks depending on one’s job description. Full results are not seen until 6 months post-operatively – although almost immediately, you will start shedding your old wardrobe and will fit into smaller sizes, perhaps even a size you have never experienced. Dr. Holzman shares the joy as his patients enjoy their new bodies, revive their better personal lives, exercise without discomfort, fit into new clothes, and become more confident.
Another type of abdominoplasty after massive weight loss is the fleur-de-lis abdominoplasty. This procedure is very similar to the standard abdominoplasty except that it incorporates more aggressive resection of the abdominal tissue in the upper abdomen. This results in a more defined abdomen, but requires the use of a longer incision and leaves a vertical scar on the abdominal wall. With the fleur-de-lis approach, the flanks and lateral abdominal tissue can be better contoured, a waist can be more defined, and there is lower risk of a “dog ear” – however, the surgical scar will extend from the bottom of the sternum down to the pubic area. A thorough pre-operative consultation and evaluation is required to determine whether you are a good candidate for this procedure, and Dr. Holzman can help guide you to the right choice for your body.
After abdominoplasty, Dr. Holzman will follow you closely in the post-operative period to see that you are healing well and are medically stable. Generally there will be a weekly visit for the first 3-6 weeks and then less frequently after that until you are completely healed and are satisfied with your results.
A personal consultation with Dr. Holzman is essential to determine the best procedure for you whether it be a standard abdominoplasty, circumferential abdominoplasty, or fleur-de-lis abdominoplasty. Many factors go into the decision making such as: body type, amount of weight loss, elasticity of skin, social factors such as job description, available time off, other planned procedures, and patient preferences. Other procedures that patients choose to have after massive weight loss include: arm lift (brachioplasty), thigh lift (thighplasty), and a breast lift. Dr. Holzman has extensive experience acquired from doing these procedures for many years. He will help you make safe decisions individualized for your needs and desires.