Body contouring after massive weight losses/Post-bariatric surgery

Cosmetic surgical procedures

Lifting techniques involve removal of skin and fat. Fat can be removed with liposuction, which involves small, difficult to detect scars. However, skin removal requires a longer, more noticeable scar. The longer the scar, the more skin that can be removed. Also, the closer the scar is to the skin being removed, the more effective and accurate the removal will be. Esthetic considerations often modify the acceptable length and position of scars, so close communication between my patients and me is essential. Scars can be placed longitudinally down the thighs or arms, in the groin or armpit creases, or horizontally or diagonally along the upper, lower or middle buttocks. That is why I meet with my patients at least twice for 1 ½ hours each time before performing surgery. I spend a lot of time listening to their goals, and explaining benefits, limitations, and possible complications of treatment options.

I have performed liposuction since 1983, the year it was approved for general use in the U.S. I use the “superwet” technique for liposuction, rather than the “dry” or “tumnescent” techniques. This technique provides excellent reduction in bleeding, without risks of administering too much fluid. I do my procedures in surgery centers or hospitals, and only use board-certified anesthesiologists very familiar with liposuction to provide optimal comfort, monitoring and safety. Our body’s metabolism and immune systems work better if normal body temperature is maintained, so the operating room is warmed, a warming blanket is used, and all internal and external solutions are warmed. Sequential compression devices are used to move blood from the calves and prevent blood clots and pulmonary emboli. One innovative approach I have used for many years is to administer Epogen, a natural hormone that increases red blood cell production, to patients who have low red blood cell volumes (anemic). Since I have used this hormone, I have performed many large volume liposuctions without needing blood transfusions.

Benefits

• Removes folds of skin and fat
• Improves body proportions
• Improves mobility, hygiene, ease in finding flattering clothing, and comfort
• May improve sexual relations
• Reduces facial jowls and cheek hollowness; eliminates neck wattle
• For women, improves the shape, position and size of breasts; for men, reverses droopiness of breasts and enhances pectoral definition
• Eliminates abdominal folds, improves the shape of the belly button, and tightens stomach muscles
• Improves the shape, size and position of the buttocks
• Eliminates folds of the inner arms, mid-back, lower back, armpits, inner and posterior thighs, and upper and inner knees

Techniques

• These are described in the sections dedicated to different parts of the body.  Generally, folds are removed leaving long scars.  These scars are placed in body creases whenever possible, so they are less apparent.  Sometimes, implants (breast or pectoral), or volumizers (fat transfers, Radiesse or Sculptra) are used to fill in concavities or hollows.  This is most common in the cheeks, breasts or buttocks.
• Because the tissue strength and vitality is diminished by stretching from excess weight, extra care is necessary to preserve blood supply and to avoid tension to the wound edges.  This is done by not removing too much skin or fat.   It is essential to have a plastic surgeon who is very familiar with the characteristics of massive weight loss patients.
• Since large areas of the body are exposed during surgery, it is important to keep patients warm before, during and after surgery.  The body’s immune system and metabolism works better at a normal body temperature.

  Limitations

• Body contouring is not able to remove excess fat inside of the abdomen.   This can only be done with further weight loss.  
  Muscles and overlying skin have are thinned by excess weight.  There may still be some laxity of skin and muscles even after body contouring procedures.
• It is best not to do too many procedures at one time.  Prolonged operations lead to increased complications: pneumonia, blood clots/pulmonary emboli, anemia, and delayed healing. 
• Bariatric surgery and intensive diet and exercise programs do not guarantee persistent weight loss.  It is usually best to maintain to lost weight about one year before undergoing body contouring procedures.
• Since several areas would often benefit from plastic surgery, it is important to have an overall plan prior to having any surgery.  I enjoy providing patients with recommendations about different combinations, so they can reach their goals most rapidly, safely and economically.

In summary, I believe that cosmetic surgery should be performed in a setting that maximizes patient safety, comfort, and benefits. My results are enhanced and prolonged when patients practice many forms of self-improvement. Therefore, I work closely with endocrinologists, gynecologists, psychologists, nutritionists, dieticians, estheticians, trainers, acupuncturists, herbalists, and micro pigmentation experts.

Contact me today to schedule your consultation.

BARIATRIC SURGERY

Dr. Lavey is one of the few specialists in the Bay Area who are members of the American Society of Bariatric Plastic Surgeons.  He provides creative approaches to skin reduction and fat contouring.  For example, in 2005 Dr. Lavey presented a paper to the California Society of Plastic Surgeons on mid-back lifting.  Some of these patients had combination breast reshaping, buttock and thigh lifting, or abdominoplasties at the same time.  He believes that bariatric patients achieve optimal results through a multidisciplinary approach coordinating gastroenterologists, endocrinologists, nutritionists, nurses, physical and occupational therapists, psychologists, and exercise trainers.

Past Procedures