The number of people who are undergoing bariatric procedures to lose weight has increased dramatically over the last decade. The safety of these procedures has also improved significantly.
This has been possible because Lap Band and gastric bypass procedures are being performed via an endoscope. This increase in safety has led to more patients willing to undergo weight loss procedures. At the same time there is growing evidence that many chronic illnesses including diabetes, hypertension and sleep apnea are reduced significantly in those who undergo these procedures.
As the number of patients undergoing these procedures has increased, patients are left with extensive loose and sagging skin over the tummy, breasts, arms, thighs and over the buttock. Over the last decade many plastic surgeons have developed techniques to improve the outcome following these procedures.
After a significant weight loss, many patients are elated that they have reached their weight goal but when they look in the mirror they are not happy. They do no know what to do about the sagginess and whom to turn to for help.
This Web page hopefully will give you an overview as to what is the latest and the best available to help you cope with your problems. If you have questions, please don't hesitate to call us at: 405-340-9949.
When Is the Best Time to Have Surgery?
Most patients continue to lose weight for a year after bariatric surgery. It is therefore best to wait for a year when your weight loss has stabilized and you are not losing any more weight before undergoing a body contouring procedure.
How Many Surgeries Can Be Combined?
It is best not to have a surgery that lasts over 5-6 hours. After this time complications from surgery including blood loss and low body temperature add significantly to the overall risks of the surgery. Generally it is best to combine adjacent areas together.
Here are some combinations that Dr. Panchal performs:
- Tummy tuck and inner thigh lift
- Tummy tuck and outer thigh lift
- Belt Lipectomy (tummy tuck and buttock lift)
- Breast surgery and arm lifts
- Tummy tuck and breast surgery
Check out before-and-after photos of body contouring surgery after weight loss.
Which Area Does Dr. Panchal Operate on First?
Dr. Panchal will typically ask you what bothers you most and then listen to you before he will plan the surgeries for you. It depends on a variety of factors: how much time you can take off work at a single time, your profession, who can take care of you, your general health and your current weight. The most common areas to begin are the tummy and the breasts.
Typically the abdomen or tummy has mild to moderate fat and significant loose skin with poor abdominal muscle tone. Thus a tummy tuck with a liposuction of the tummy, love handles and lower back is needed in every patient.
Many patients have loose and sagging buttocks and may benefit from a buttock lift to create a harmonious shape between the front sides and the back. Typically fat that is saved from liposuction can be re-injected in to the buttocks to create a more fuller rounder look.
The breasts typically lose fat with weight loss and start sagging. One breast nearly always sags more than the other. Most patients seek breast lift so that the nipples point forward and not downward. Typically most women seek to have the lost volume replenished with a silicone gel implant. This procedure is a breast lift (mastopexy) and augmentation (enlargement).
A few patients have minimal volume loss or do not wish to have volume increased. They just settle for a breast lift without the implant. If you have significant sagging following weight loss, Dr. Panchal may perform a breast lift only as the first procedure and then place breast implant at a second surgery to reduce the risk of nipple blood supply complications.
Typically there is excessive loose skin over the inner arms post major weight loss. Most patients benefit from an arm lift with or without a liposuction. Rarely Dr. Panchal can perform a liposuction only if you have minimal laxity of the skin.
Massive weight loss can lead to loss of fat and significant sagging of the thigh both over the inner (medial) aspect or the outer aspect (lateral). These sagging areas need to be elevated and corrected to create a smooth contour.
Lateral or outer thigh lift: Dr. Panchal commonly passes a long instrument over the outer thigh when he is performing the extended tummy tuck and elevates or lifts the outer thigh skin and fat. He sutures and fixes this lifted tissue on to the deep tissue around your hip area and thereby creates a smooth contour over the outer aspect of the thigh. This smooth convex contour of the outer thigh merges beautifully with the concave contour in the region of the love handles. This creates an hour glass figure.
Inner or medial thigh lift: The thigh is no different than the rest of the abdomen and unfortunately it sags with some lose skin and fat collections too. Inner thigh lifts have undergone a significant improvement in its technique. Dr. Panchal adopts only the latest techniques. Depending on the extent of the skin required to be removed, you may need an incision that is only in the groin crease. If you have more laxity of the skin you may need an additional incision over the inner side of your thigh. Dr. Panchal limits the length of the incision so that it is only over the upper half of the thigh so that you can still wear shorts. He also attaches the deeper tissues to the inner aspect of your groin so that your results last longer and there is no alteration in the shape of your genital area. This attention to details is critical to create an excellent result. It is not uncommon to add some liposuction to the area undergoing thigh lift so as further enhance the outcome following surgery.
It is not uncommon that massive weight loss is associated with loss of fat from the buttock area and this leads to a significant sagging of the buttock. A buttock lift procedure allows an incision to be placed over the area where your buttock starts from the back. The excess sagging skin and the fat from the area in the small of the back and the upper buttock is then removed and the buttock is then lifted. Unfortunately this leads to a lifted but a completely flat buttock which has no projection whatsoever.
Here is how Dr. Panchal differs from other surgeons:
Dr. Panchal places the incision in the same area but lifts the buttock in an inner and upward direction (butterfly lift). This is allows the buttock to maintain its shape. Additionally he does not remove and discard the buttock skin and fat. He may either turn the excess skin and fat as a flap and place it back into the inner aspect of the buttock so that it dramatically improves the projection of the buttock. He may additionally inject some of the fat that was obtained during the liposuction and re-inject it back into outer aspect the buttock (Brazilian butt lift) so as to further enhance the shape of the buttock.
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A belt lipectomy is used if you have a pannus on your tummy and have sagging of your buttocks and outer thighs. This procedure involves placement of the incision above your pubic area and then extends in an outward direction onto the hip and upper buttock area so that the entire incision goes around like a low belt and at the same time keeps it along the bikini line and therefore well hidden.
A belt lipectomy procedure is a long procedure as it involves placing the patient on the back first to perform the tummy tuck and then turn you onto your tummy so the surgery on the buttock can be accomplished. It commonly takes five to six hours to perform and therefore done only if the patient is young and fit and can withstand the long surgery and recovery.