Body contouring is a procedure that alters the shape of the human body. It includes procedures that eliminate or reduce excess skin and fat that remains after previously obese individuals have lost a significant amount of weight, in a variety of places including the torso, upper arms, chest, and thighs.
Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who have obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouch (gastric bypass surgery). Long-term studies show the procedures cause significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a mortality reduction from 40% to 23%. The U.S. National Institutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with BMI of at least 35 and serious coexisting medical conditions such as diabetes. However, research is emerging that suggests bariatric surgery could be appropriate for those with a BMI of 35 to 40 with no comorbidities or a BMI of 30 to 35 with significant comorbidities. The most recent American Society for Metabolic & Bariatric Surgery guidelines suggest the position statement on consensus for BMI as an indication for bariatric surgery. The recent guidelines suggest that any patient with a BMI of more than 30 with comorbidities is a candidate for bariatric surgery.
Potential risks and side-effects
Body lifting is not lightly undertaken. The process requires a commitment on the part of the patient who must stay with the program through bariatric surgery, during the 18 months required for weight loss, then the body contouring procedures and recovery. Often, beginning to end takes three years. A single body lifting operation can require seven to 10 hours under general anesthesia, blood transfusions and often, another surgeon to assist. Plastic surgeons advise patients that body shaping is not an obesity operation. A patient who is more than 50 percent over his or her ideal weight must first drop as many pounds as possible before proceeding. Other medical considerations the plastic surgeon must take into account include scars already present on the body, current medical conditions like heart disease or bleeding disorders, and if the patient smokes. Other possible risks include infections and reactions and complications due to being under anesthesia for longer than six hours. The patient may also experience seroma, a buildup of fluid; dehiscence (wound separation) and deep vein thrombosis (blood clots forming in the legs.) Rare complications include lymphatic injury and major wound dehiscence. The hospital stay for the procedure can require from one to four days while recovery can require about a month for a total body lift. Essentially, the patient trades "skin for scars". But skin relaxation is always a risk and may not be stopped with a single procedure. Reputable plastic surgeons will explain all the risks and complications in full to their patients and even encourage a second or third consultation visit with other plastic surgeons to get additional views on such a major undertaking.
Body lifting surgical procedures
While body shaping can be done in one marathon session, it is usually broken into one to three surgical stages, with the patient under general anesthesia. But if the patient is a smoker, has a history of deep venous thrombosis or clotting disorders along with a high BMI and other medical risk factors, the surgeon will probably insist on doing several short procedures in a hospital setting to insure maximum safety for the patient.
The following are the individual components of body contouring:
Arm lift or brachioplasty. The extra flesh on the arms of bariatric patients virtually always appears on the underside of the upper arm and is sometimes referred to as "bat wings". Surgeons make incisions made from the armpit to the elbow to remove the skin. A brachioplasty procedure can employ some liposuction after the incision is made. With the arm opened, the surgeon pulls the skin tight and then trims away the excess skin which, depending on the patient, can be a pound of skin per arm or more.
Breast lift or mastopexy. By trimming excess tissue from the upper breast, the surgeon can move breasts which usually droop to the umbillicus to a more upright and full position. The procedure also often requires an implant to make up for lost fat and tissue inside the breast. Scars on women are almost always hidden inside the area covered by the bra.
Stomach lift or abdominoplasty. Excess skin hanging down over the pubic region is often the distorting feature that most concerns and bothers patients. The stomach pannus retains moisture, and causes rashes due to skin rubbing against itself which usually leads to poor hygiene. While the surgical procedure to remove it is known as a panniculectomy, there is often more work to be done for patients who suffer from large amounts of hanging skin. To provide improved contours on the waist, back and flanks, surgeons sometimes perform a belt lipectomy, (also known as a torsoplasty or a circumferential liposuction). The incision goes all the way around the patient's midsection at the level of the lower waist. The surgeon uses more liposuction on the stomach and flanks while trimming excess skin from the patient's back and sides as well. The abdominoplasty and belt lipectomy incisions are placed so that the resulting scar is hidden within most underwear and swimsuits.
Lower body lift trims excess skin on the buttocks and thighs. For an inner thigh lift, the surgeon makes an incision high on the inner leg, starting near the groin and continuing down to the knee. Some fat may be removed with liposuction. The surgeon then removes excess skin and redrapes the remaining skin before closing the long incision, leaving the patient with tighter and more attractive thighs.
The outer thigh and buttock can be lifted through a hip-to-hip incision across the back, above the buttocks.
Nonsurgical body contouring is a rapidly growing field. Common methods used include low-level laser therapy (LLLT), cryolipolysis, radiofrequency energy, suction massage, and high-frequency focused ultrasound.
- Robinson MK (July 2009). "Editorial: Surgical treatment of obesity—weighing the facts". N. Engl. J. Med. 361 (5): 520–1. doi:10.1056/NEJMe0904837. PMID 19641209.
- Fajnwaks P, Ramirez A, Martinez P, Arias E, Szomstein S, Rosenthal R (May 2008). "P46: Outcomes of bariatric surgery in patients with BMI less than 35 kg/m2". Surgery for Obesity and Related Diseases. 4 (3): 329. doi:10.1016/j.soard.2008.03.107.
- Chandawarkar, RY (2006). "Body contouring following massive weight loss resulting from bariatric surgery". Adv Psychosom Med. 27: 61–72. doi:10.1159/000090964.
- Borud, LJ; Warren, AG (2006). "Body contouring in the postbariatric surgery patient". J Am Coll Surg. 203 (1): 82–93. doi:10.1016/j.jamcollsurg.2006.01.015. PMID 16798490.
- Aly, AS; Cram, AE; Heddens, C. (2004). "Truncal body contouring surgery in the massive weight loss patient". Clin Plast Surg. 31 (4): 611–24, vii. doi:10.1016/j.cps.2004.04.004. PMID 15363914.
- Mulholland, RS; Paul, MD; Chalfoun, C (2011). "Noninvasive body contouring with radiofrequency, ultrasound, cryolipolysis, and low-Level laser therapy". Clinics in Plastic Surgery. 38 (3): 503–20. doi:10.1016/j.cps.2011.05.002. PMID 21824546.
- Soldin, M; Mughal, M; Al-Hadithy, N (2014). "National Commissioning Guidelines: Body contouring surgery after massive weight loss". Journal of Plastic, Reconstructive & Aesthetic Surgery. 67 (8): 1076–81. doi:10.1016/j.bjps.2014.04.031. PMID 24909630.
- Hasanbegovic, E; Sørensen, JA (2014). "Complications following body contouring surgery after massive weight loss: A meta-analysis". Journal of Plastic, Reconstructive & Aesthetic Surgery. 67 (3): 295–301. doi:10.1016/j.bjps.2013.10.031. PMID 24211118.
- Azin, A; Zhou, C; Jackson, T; Cassin, S; et al. (2014). "Body contouring surgery after bariatric surgery: A study of cost as a barrier and impact on psychological well-being". Plastic and Reconstructive Surgery. 133 (6): 776e–82e. doi:10.1097/PRS.0000000000000227. PMID 24867737.
- Hurwitz, Dennis J. Total Body Lift: Reshaping the Breasts, Chest, Arms, Thighs, Hips. Waist, Abdomen & Knees after Weight Loss, Aging & Pregnancies. New York: M.D. Publish.
- Capella, Joseph; Rubin, Peter; Sebastian, Jeffrey. Body Contouring Surgery After Weight Loss. Omaha, NE: Addicus Books.
- Jalian, HR; Avram, MM (2012). "Body contouring: The skinny on noninvasive fat removal" (PDF). Seminars in Cutaneous Medicine and Surgery. 31 (2): 121–5. doi:10.1016/j.sder.2012.02.004.