LOST A SUBSTANTIAL AMOUNT OF WEIGHT RECENTLY?

Losing a large amount of weight through exercise or bariatric surgery is a great achievement. However your next challenge might be what to do with all that leftover excess skin that can be unsightly, inconvenient under clothing, and can cause skin irritations and infections.

Dr Alex Phoon offers a range of surgical solutions to improve your body contour and to address your post weight loss concerns. These are highly technical, complex and often multi-staged procedures, tailored to address your concerns in the most effective and safest manner possible.

Common Post Weight Loss SURGERIES

Belt Lipectomy

A belt lipectomy is a comprehensive procedure designed to remove excess skin and fat from the lower body, with the incision going circumferentially around the body.

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This surgery addresses the abdomen, waist, hips, pubic region and buttocks all in one operation. In addition to removing excess skin, the surgeon will also perform liposuction to enhance the body’s contour further. The result is a more defined waistline and a smoother, tighter lower body appearance. The loose skin is removed from both the front, side and back and is very common for those that have lost more than 25kg of weight loss.

FLEUR DE LIS ABDOMINOPLASTY

Fleur de Lys abdominoplasty, also known as an inverted-T abdominoplasty, is a specialized procedure that targets individuals with significant excess skin and fat in the midsection.

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This surgery involves an incision from the top of the abdomen, down the middle, and extends horizontally to the hips and most frequently around the body circumferentially as with the belt lipectomy. This technique allows the surgeon to address excess skin in both the vertical and horizontal directions, resulting in a more comprehensive abdominal contouring. Fleur de Lys abdominoplasty is especially effective for those who have experienced massive weight loss and is closely related to the corset abdominoplasty.

EXTENDED TUMMY TUCK (ABDOMINOPLASTY)

An abdominoplasty is a very powerful technique for removing loose skin and stubborn fat with liposuction.

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If you have lost a significant amount of weight (such as more than 40-50kg) this operation is often not powerful enough to address all the loose skin around the back of your body. As such it is usually reserved for younger patients whose skin has bounced back well or those who have had children and who have minimal skin and mostly muscle weakness.

CORSET ABDOMINOPLASTY

A corset abdominoplasty is a procedure specifically designed to accentuate the waist. This procedure has a significant reduction centrally so has a vertical scar in addition to a horizontal scar under the chest/breast as well as in the abdomen.

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This surgery involves a combination of vertical tightening of the abdominal muscles and the removal of excess skin and tissue from the waistline. A feature of the operation is the minimal undermining of the skin edges and minimal liposuction to encourage healing post-operatively. It is rare to combine another procedure such as a breast lift at the same time doe to the higher risk of healing issues.

BUTTOCK GRAFT LIFT

A buttock graft lift is a powerful procedure that is usually performed in combination with a belt (360) lipectomy.

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In the front of the body, the overhang or ‘pannus’ is removed whilst at the back, the buttock is lifted whilst at the same time your own excess fat is used to help revolumise the buttock area. Less volume is needed with fat grafting when the skin of the buttock is lifted at the same time. The scar is hidden in a g-string afterwards.

UPPER ARM LIFT (BRACHIOPLASTY)

Brachioplasty, commonly known as an arm lift, is a surgical procedure that targets excess skin and fat in the upper arms.

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This surgery aims to reshape the arms by removing loose skin and fat deposits, resulting in a more toned and defined appearance. Brachioplasty always involves liposuction at the same time. If the arm has lipoedema, it may rarely be done as a two-stage procedure such as a thigh lift. The scars run down the inside of the arm from the elbow to the armpit and are visible. When they go down the chest wall as well, they are called extended brachioplasties.

THIGH LIFT (LIPECTOMY)

A thigh lift is a procedure that removes the excess skin and stubborn fat from the inner thigh after massive weight loss. It is important to remember that it is not a magic wand for those who have not lost the weight first.

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Indeed, some patients have naturally strong thighs, and a thigh lift will not change your underlying shape in this situation. Rarely the procedure may need to be performed in two stages with initial liposuction to debulk the thighs and a secondary procedure to remove the excess skin to minimise nerve and lymphatic injury. Thigh lifts have a high revision rate because of the loose skin involved. The scars run vertically down the inside of the leg and are visible. Just like the brachioplasty scar, you need to want to trade off the scar from the lift more than you want the loose skin as this trade-off is unavoidable.

BRA STRAP EXCISION

This operation is reserved for the most significant weight loss patients. Patients whose weight loss is characterised by significant loose folds of skin in the upper back after their weight loss.

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It is rarely performed in isolation and usually combined with a corset abdominoplasty. It can be thought of as the upper equivalent to a belt lipectomy.

FREQUENTLY ASKED QUESTIONS ABOUT POST WEIGHT LOSS SURGERY

WHAT OTHER PROCEDURES CAN BE PERFORMED AT THE SAME TIME AS AN ABDOMINOPLASTY?

The most common procedure combined with an Abdominoplasty would have to be a breast procedure. This might be a breast augmentation, a breast reduction or even a lift with an implant (augmentation mastopexy). Like the tummy, the breast undergoes a remarkable amount of changes following Massive weight loss and or breastfeeding, once the breastfeeding has stopped. It is best to wait at least six months from the end of breastfeeding before considering any kind of breast surgery. Some people like to refer to this combination as a Massive weight loss procedure combined with a breast procedure.

Liposuction is exactly the same thing as liposculpture and there is a lot of marketing spin out there that can make this area a particularly tricky one to understand. It really isn’t. It usually involves the use of a special device that breaks up the fat (either with a mechanical action or with ultrasound) followed by the suction process that follows it.

There is always a small amount of liposuction that is performed as part of an Abdominoplasty. This is included in the price of the Abdominoplasty. For some people, the ‘gold standard’ for an Abdominoplasty might also involve some additional liposuction over the lower back, flanks, and ‘muffin top’ area as this is the most effective way to accentuate the waist and works wonders when combined with an Abdominoplasty. It is a separate procedure, however, as we have to turn you over during the procedure (whilst asleep of course) and it can take about 45 minutes to perform.

CAN YOU DO ALL THIS IN A SINGLE OPERATION?

Generally no. This is due to the substantial nature of the surgery and recovery required. The other factor is that Medicare limits the surgeries which may be performed together so a tummy tuck, arm lift and/or thigh lift may not be performed in a single operation.

If you do not want to claim the Medicare rebate (or health fund coverage), it is technically possible to combine them, however it is unwise given the health risks and possible extended self-funded stay in ICU and hospital.

Risks and complications of cosmetic surgery

Cosmetic surgery is still surgery and as such always has potential risks and complication. It is important for anyone considering cosmetic surgery to be well-informed and aware of the possible adverse outcomes. Dr Alex Phoon is a fully qualified Australian specialist plastic and cosmetic surgeon who operates with an experienced team in leading public and private hospitals in Sydney Australia.
In this article, we will dive into the various risks and complications associated with cosmetic surgery, providing insights into each aspect.

Scarring

One of the most common concerns among patients undergoing cosmetic surgery is the potential for scarring. While skilled surgeons strive to minimize scarring, it is an inevitable part of the healing process.

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The severity of scarring varies depending on the individual and the procedure performed. Certain factors, such as genetics and skin type, can also influence how prominent scars may be. However, it is worth noting that in many cases, scars fade over time and can be further improved through scar revision techniques.

Scarring is a natural part of the body’s healing process. When the skin is injured, whether through surgery or trauma, the body responds by forming new collagen fibres to repair the damage. This process can result in the formation of a scar, which is a visible mark on the skin that differs in texture and colour from the surrounding tissue.

There are different types of scars that can occur after cosmetic surgery. One common type is a hypertrophic scar, which is characterized by raised and thickened tissue. These scars may be red or pink in colour and can be itchy or uncomfortable. Another type of scar is a keloid, which is an overgrowth of scar tissue that extends beyond the boundaries of the original wound. Keloids are more common in individuals with darker skin tones and can be more challenging to treat.

Fortunately, advancements in surgical techniques and post-operative care have greatly improved the management of scars. Surgeons take great care in placing incisions in inconspicuous areas and using techniques to minimize tension on the wound, which can help reduce the risk of visible scarring. Additionally, patients are often advised to follow a specific scar care regimen, which may include keeping the incision site clean, applying silicone gel or sheets, and avoiding sun exposure.

In some cases, scar revision techniques may be recommended to further improve the appearance of scars. These techniques can include laser resurfacing, dermabrasion, or surgical excision. Laser resurfacing uses a laser to remove the top layers of the skin, promoting the growth of new, healthier skin cells. Dermabrasion involves using a rotating brush or diamond wheel to gently remove the outer layers of the skin, revealing smoother skin underneath. Surgical excision involves removing the scar tissue and rejoining the edges of the skin to create a more aesthetically pleasing scar.

It is important for patients to have realistic expectations when it comes to scarring. While surgeons strive to minimize scarring, it is impossible to eliminate it. However, with proper care and the use of scar revision techniques, the appearance of scars can be significantly improved. Patients should discuss their concerns and expectations with their surgeon prior to undergoing any cosmetic procedure to ensure they have a clear understanding of the potential for scarring and the available treatment options.

Infection

Infections are another risk associated with any surgical procedure, including cosmetic surgery. Despite stringent sterilization protocols followed by healthcare professionals, there is still a possibility of infection.

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To mitigate this risk, surgeons prescribe antibiotics pre- and post-surgery, adhere to aseptic techniques, and closely monitor patients for signs of infection. It is crucial for patients to follow their surgeon’s aftercare instructions to minimize the risk of infection.

When it comes to cosmetic surgery, infection is a concern that cannot be ignored. Surgical procedures, no matter how minor, create an entry point for bacteria and other microorganisms. Although healthcare professionals take every precaution to maintain a sterile environment, the human body is naturally teeming with bacteria, making it impossible to eliminate the risk entirely.

Fortunately, surgeons are aware of this risk and take proactive measures to minimize the chances of infection. One such measure is the prescription of antibiotics. Prior to surgery, patients are often given a course of antibiotics to help prevent any potential infection from taking hold. These antibiotics are carefully chosen based on the patient’s medical history and the specific procedure being performed.

Post-surgery, patients are usually required to continue taking antibiotics for a certain period. This helps to ensure that any bacteria that may have entered the body during the procedure are promptly eradicated. By adhering to the prescribed antibiotic regimen, patients can significantly reduce the risk of developing an infection.

In addition to antibiotics, surgeons also follow strict aseptic techniques during the surgical procedure itself. This involves maintaining a sterile environment, using sterile instruments and equipment, and wearing appropriate protective clothing, such as gloves and masks. These precautions help to minimize the introduction of bacteria into the surgical site, further reducing the risk of infection.

Despite these measures, it is important to note that infections can still occur. The human body is a complex system, and sometimes even the most stringent precautions cannot completely eliminate the risk. However, by closely monitoring patients for signs of infection, surgeons can detect and treat any potential infections early on, preventing them from becoming serious complications.

Patients also play a crucial role in minimizing the risk of infection. Following the surgeon’s aftercare instructions is of utmost importance. This may include keeping the surgical site clean and dry, avoiding certain activities or behaviours that could increase the risk of infection, and promptly reporting any signs of infection, such as redness, swelling, or discharge.

In conclusion, while the risk of infection is present in any surgical procedure, including cosmetic surgery, healthcare professionals take numerous precautions to minimize this risk. From prescribing antibiotics to following aseptic techniques, surgeons prioritize patient safety and strive to create the best possible outcome. However, it is essential for patients to actively participate in their own aftercare and follow the instructions provided by their surgeon to further reduce the risk of infection.

Pain

Pain and discomfort is a common experience following cosmetic surgery but can be mitigated with modern analgesic strategies.

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The extent of pain can vary depending on the procedure, the individual’s pain tolerance, and the body’s healing response. Surgeons typically prescribe pain medications to manage any discomfort during the recovery period. It is important for patients to communicate their pain levels with their healthcare providers, as proper pain management is crucial for a smooth recovery.

Undesirable cosmetic outcome

While cosmetic surgery aims to enhance aesthetics, there is always a risk of an undesirable cosmetic outcome.

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Factors such as unrealistic expectations and the biological unpredictability of healing can contribute to suboptimal results. It is essential for patients to have open and honest discussions with their surgeons about their desired outcomes, potential limitations, and realistic expectations. This helps ensure that both parties are on the same page and reduces the chances of disappointment. Revision surgery might be an option should this be an issue.

Nerve damage

Another potential complication of cosmetic surgery is nerve damage.

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Surgeons take great care to avoid damaging nerves during procedures, but it is not always possible to eliminate this risk entirely. Nerve damage can cause numbness, tingling, or loss of sensation in the operated area. In most cases, nerve function gradually improves, but it may take some time for complete resolution. Patients should be aware of this potential risk and discuss it with their surgeon before proceeding with the surgery.

Bruising and swelling

Bruising and swelling are common after cosmetic surgery, particularly in the early stages of recovery.

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These symptoms are part of the body’s natural response to trauma. Surgeons may recommend compression garments, elevation, and cold compresses to help minimize these effects. While bruising and swelling are temporary, they can cause discomfort and can affect the recovery timeline. Patience and adherence to post-operative guidelines can aid in reducing the duration and severity of these side effects.

Bleeding

Bleeding during or after surgery is a potential complication that can occur in any surgical procedure, including cosmetic surgery.

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Surgeons take measures to control bleeding during the operation, but occasionally, some post-operative bleeding may occur. It is crucial for patients to inform their healthcare providers if they experience excessive bleeding or if they are unable to control bleeding with gentle pressure. Immediate medical attention is necessary to address this complication. If there is major bleeding, you might require a blood transfer or transfer to a hospital for additional treatment.

Seroma

A seroma is a pocket of fluid that can accumulate under the skin after surgery.

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It forms as a result of the body’s inflammatory response. Seromas are more common in larger surgical procedures and can lead to swelling and discomfort. Surgeons may drain seromas through aspiration or place drains to prevent their accumulation. A surgical drain can be used to minimise this risk. Close monitoring by healthcare providers is crucial to ensure the timely detection and management of seromas.

Anaesthetic complications

Although rare, complications related to anaesthesia can occur during cosmetic surgery.

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Anaesthesia is administered to ensure patient comfort and safety during the procedure. Factors such as individual reactions, allergies, or underlying health conditions can increase the risk of complications. Anaesthetists are highly trained professionals who monitor patients closely throughout the surgery to minimize any potential risks.

Death

While the risk of death from cosmetic surgery is extremely low, it is essential to acknowledge that any surgical procedure carries inherent risks.

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Every effort is made to prioritize patient safety and ensure favourable outcomes. The preoperative assessment, careful surgical planning, and adherence to appropriate protocols help minimize this risk. Patients should discuss their specific concerns with their surgical team and feel confident in the expertise and experience of their chosen surgeon.

In conclusion, cosmetic surgery offers individuals an opportunity to enhance their appearance, but it is essential to recognize that it is not without its risks and complications. By understanding and discussing these potential outcomes with their surgeons, patients can make informed decisions and take necessary precautions to optimize their safety and overall surgical experience. With proper expectations, diligent aftercare, and open communication, the risks associated with cosmetic surgery can be minimized, and the goal of achieving desired aesthetic improvements can be realized.

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