Patients who have lost a large amount of weight either after bariatric surgery or through diet and exercise have specific concerns relevant to their situation. Dr. Downey has over 15 years experience with this unique patient population and will address patient's individual needs. Each patient is different and some questions can only be addressed during your consultation but here are some of the most frequently asked questions.
Q. When should I come in for a consultation?
For most people the best time to consider plastic surgery is when their weight loss has stabilized. Usually this is approximately one year following bariatric surgery and weight loss. Most patients come in for a consultation at this time of their abdomen (including hernia), arms, thighs, back/buttocks and breasts.
Q. How many procedures can be done at one time?
Many patients who have lost over 100 lbs want to consider plastic surgery for several areas of their bodies (example abdomen, breast, arms, and legs). Often procedures can be combined but usually up to a maximum of about six hours in the operating room.
Q. Are these procedures covered by insurance?
Patients who have developed a hernia after open bariatric surgery will usually have the repair of the hernia covered by their insurance. Some patients who have developed a very large overhanging panniculus (skin and fat of the abdomen) will also have insurance coverage for the removal of this skin and fat, especially if there has been documentation of rashes and skin irritation. In general most other procedures (arm lifts, thigh lifts, breast lifts, and facelifts) are considered cosmetic by insurance companies and not covered under the insurance plan.
Q. Which procedures should I do first?
When you come in for your consultation you will be able to discuss with Dr. Downey the various areas that you want to have addressed. For most patients the abdomen is the first priority and then other areas follow. Each patient is different and which areas are addressed first depends on the patient's preference. The areas which bother you most should be the first areas addressed!
Q. How much does surgery cost?
When you come in for your consultation you and Dr. Downey will discuss which procedures will be done first. Once this is decided then a full quote will be given to you for the procedures. The quote will depend on which procedures are done, whether any procedures are covered under your insurance policy and other factors such as whether a hospital stay is required.
Aesthetic Surgery After Massive Weight Loss
For many patients who have lost a lot of weight, the abdomen is an area of great concern. Excess skin may interfere with wearing clothing and ashes may develop below the folds of skin. The problem can be aggravated in women who have had children; if the muscles are stretched, no amount of exercise is going to put them back to their pre-pregnancy shape. At first glance, it may seem easy to say that a tummy tuck is the answer, but as one starts to learn about the procedures available, more questions arise. What is a mini tummy tuck? What is a panniculectomy? Can I have liposuction, or should I consider a lower body lift or a tummy tuck?
First, let's define the terms. A panniculectomy removes only the apron of skin and fat that hangs below the pubic area. In general, this is considered a reconstructive procedure and is performed for patients who have large aprons. This can be done before weight loss surgery to increase a patient's mobility, or after weight loss surgery when the patient has a large apron that makes hygiene difficult.
After large amounts of weight loss, most patients want to consider an abdominoplasty, not a panniculectomy. An abdominoplasty (in lay language, a tummy tuck) not only removes the skin and fat of the lower abdomen, but also tightens the underlying muscles. This is usually considered a cosmetic operation and is not covered by insurance. A mini–tummy tuck only addresses the skin and fat of the lower abdomen (below the belly button) and does not involve tightening the muscles.
For most patients who have lost significant amounts of weight, liposuction will not be the answer. Liposuction only removes fat; it does not remove excess skin. Loose skin may actually be worse after liposuction, and this should be a topic of discussion with your doctor before surgery. Sometimes liposuction is done on the sides or end of the incision at the same time as an abdominoplasty for patients with fullness in this area, but again this may not be needed for some patients.
Although the lower body lift is ideal for some patients, it is not for everyone. If patients only have laxity in the anterior abdomen or tummy area, then a tummy tuck would be the best option. It is very possible to do a tummy tuck first and then later do the back part of a lower body lift. This is an option many patients have chosen for a variety of reasons, including time off work, financial concerns and other priorities. The most important criterion in deciding which procedure to do first is what matters to you most. Some patients might eventually wish to have a lower body lift, but their arms bother them the most. For these patients, an abdominoplasty and an arm lift (brachioplasty) would be the first surgery, with the posterior part of a body lift done at the second stage. An abdominoplasty usually takes about three hours.
The surgery can be done either as an outpatient procedure or with an overnight stay in a hospital or aftercare facility. I prefer patients to spend a night in an aftercare facility so that I can check on them the next morning before the drive home. I would encourage patients to consider spending at least one night in a monitored facility for safety's sake as well as their own comfort.
The most painful part of an abdominoplasty is where the muscles are tightened up. I have found a pain pump, such as the ON-Q system, very helpful in minimizing post-operative discomfort. Drains are used and are generally in place for a week to 10 days after the surgery. They are a very necessary evil; patients do not like them, but they drain fluid that can accumulate and possibly disrupt the healing process. Most patients are back to a light schedule within two weeks of the surgery, and it usually takes about six weeks before they can resume all of their regular activities, including strenuous exercise.
The results of a tummy tuck can be very striking, especially for patients who have lost a lot of weight around the abdominal area. The flatter contour will quickly be apparent, although it may take several months for the final results.