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Beverly Hills Surgery After Weightloss

What is weight loss surgery (bariatric surgery)?

Weight loss surgery, also known as bariatric surgery, is a group of procedures performed on patients who have difficulty losing weight. These procedures are frequently referred to as gastric sleeve or gastric bypass depending on what procedure is performed. Sometimes after a person has gained enough weight, it actually becomes difficult to lose that weight through diet and exercise alone because there may be some hormonal and metabolic changes that have occurred.

Bariatric surgery is used to reduce the number of calories that the body “sees” when ingesting and digesting a meal. Because there are less calories being absorbed, weight loss occurs over six months to a year. Depending on various factors, this weight loss can be very significant.

What is a plastic surgeon’s role in bariatric surgery?

Depending on the patient’s preoperative weight, and their response to the bariatric surgery, the amount of weight that could be lost can be stunning, even in the hundreds of pounds! This loss of fat under the skin and around the internal organs can have significant consequences for the patient’s body.

About Nicholas Lahar, M.D. – Lahar Plastic Surgery

Nicholas Lahar, M.D. - Lahar Plastic Surgery

Lahar Plastic Surgery

Nicholas Lahar, MD

Plastic Surgeon located in Beverly Hills, CA

While the patient’s health has improved significantly with this loss of weight, the weight gain and loss over the years has irreversibly damaged the skin, causing it to hang loose now that much of the fat that helped to suspend it is gone.  A plastic surgeon’s role is to safely remove this hanging skin, “tailoring” the skin to the body and restore the body contour that was lost.

What are common areas that a plastic surgeon addresses on someone that has had weightless surgery?

Weight gain occurs more commonly in certain areas and these areas tend to be addressed more commonly with surgery.  Some of the more common areas include excess skin in the abdomen through liposuction, breasts through breast lift or breast augmentation, arms, thighs, upper back.

Is a tummy tuck the same for a weight loss patient?

A ‘typical’ tummy tuck or abdominoplasty involves removal of excess skin below the belly button down to the pubic region.  The excess skin is discarded and the remaining skin is pulled tight to recontour the abdomen. In a patient who has lost a lot of fat, the typical excess skin below the belly button may extend further around the sides.

In order to contour this extra skin, the skin removed may need to extend into areas not usually addressed such as around the hips (extended tummy tuck), all the way circumferentially (belt lipectomy or body lift), or it may include central abdominal skin (a Fleur-de-lis tummy tuck).

This does result in a scar that is longer than typical and therefore you will need to have an understanding of where the scars will be so that you can make an informed decision for what procedure works best for you.

Surgery After Weightloss FAQs

Despite losing significant amounts of weight, many patients who are going to have plastic surgery after weight loss surgery will still have pockets of fat that may still need to be removed. In order to achieve the best results possible, these pockets of fat should be removed by liposuction during the procedure in addition to the skin removal. Not only does this make the results better, the removal of fat may actually help to bring more blood supply to the healing skin that remains.

Of course, not every single little deposit a fat needs to be removed and it is important to leave fat in certain areas to help keep the results smooth and the contours looking great.

Whatever can be done safely for your particular body and situation!  Body contouring after massive weight loss is highly personalized. Because there are frequently multiple areas of excess skin that need to be addressed, it is not a good idea to remove all areas in one surgery.  This is for a number of reasons. The more areas that you have surgery, the longer the procedure will be and it is not safe to keep operating on your indefinitely. Also, some of the procedures ‘work against’ other procedures in terms of how they are performed. For instance a posterior body lift will elevate the buttocks by removing skin from the lower back and a tummy tuck removes skin from the front.  By having incisions on the front and back at the same time, the amount of skin removed from both sides is a bit less that what can be removed if both procedures are performed separately. A consultation to evaluate your anatomy and goals is really the best option for creating a plan (and body) tailored just for you!

You will be given instructions both in your consultation as well as prior to surgery to get you completely set up to have the most successful and easy experience possible. Our team will help you through the process and answer any questions that you may have. Most of the time, I will want to have a medical clearance from your doctor, especially if you have had bariatric surgery in the past in order to lose weight. Occasionally, nutritional deficiencies occur because your body is not absorbing enough vitamins and minerals in addition to calories. You will actually usually be taking a multivitamin to minimize this risk so it is relatively uncommon. Your medical clearance will help me determine your ability to tolerate surgery.

I will also recommend a high-protein diet in the month before surgery in order to optimize your healing. Healing tissue requires protein to close the incision and you will want to be in a protein surplus to really help your healing. I recommend ingesting at least 0.5 g of protein per pound body weight per day for one month prior to surgery. I highly recommend beginning an exercise program or at least doing 10 to 20 minutes of walking three times a week prior to surgery. Anything more is all the better. Exercise will help your physiology and body tolerate surgery better and will make your recovery much easier and reduce the complications.

I do put my body contouring patients on a blood thinner to reduce the risk of deep vein thrombosis/clots. While extremely rare, they are found more commonly in patients who have a high body mass index and require body contouring surgery. Therefore in order to maximize your safety this blood thinner is administered for one week after surgery in almost all circumstances.

Usually skin removal after massive weight loss is quite significant and profound. The reason for this skin looseness is that the skin has been damaged and does not recoil to being tight the way it did when the person was younger. After surgery the skin is relatively tight but there can still be some looseness that develops over time. However it will never be as loose as it was prior to surgery. Occasionally an additional procedure may need to be done to remove minor skin excess that develops but this is generally rare and frequently a smaller procedure than the original procedure. I have added small revisions to a second stage surgery in order to help the patient if they have recurrent laxity.

Stretch marks occur when the elastic fibers in the skin are stretched beyond their tolerance and they actually break. This is very common in pregnancy but can also occur during growth spurts or for any reason that the skin is stretched. Stretch marks are quite common in patients who have had significant weight in the past. I will go over any skin that will be removed during surgery and will tell you what may remain such as stretch marks or even tattoos that may be partially removed during the surgery. Thankfully, the areas that are usually most stretched, and has the most stretch marks, are the areas that are frequently removed during surgery. It is not a guarantee that all of the stretch marks will be removed but I do my best. There are no great treatments for stretch marks at this time unfortunately other than surgical removal.

I recommend patient’s weight no less than three months and I generally recommend six months as a better goal time to have their next surgery. This allows you to heal after surgery and get your body ready for the next surgery.  This includes bringing your blood levels back to normal. After 3-6 months is also a time where your incision is no longer demanding intensive protein to heal.

Surgical technique is just part of the whole story when it comes to scar healing. A patient’s personal genetics will also play a role. I do my very best to carefully close the skin. I also recommend patients use silicone gel or silicone tape to cover the scar once it has healed, usually at about 2 to 3 weeks after surgery. Silicone therapy has been proven to improve scar appearance after surgery. I will also examine your scar during follow up exams to make sure that it is healing the best way possible and will make interventions if necessary.

If you’d like to learn more about what to expect in terms of the Surgery After Weightloss  process or anticipated results, set up a time to come in and meet with Dr. Lahar. He can explain the procedure in detail and help you understand how this approach can move you closer to your aesthetic goals.

Dr. Lahar has extensive experience with this complex procedure and was involved in research focused on enhancing the safety of Surgery After Weightloss. Online scheduling is available, or you are always welcome to call to set up your visit.

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