A significant risk factor for many chronic diseases that can cause an early death is obesity. Not to mention that obesity increases the risk of degenerative diseases of the knees, hips, and feet by exerting a great deal of pressure on all of the body’s joints.

The best strategy for helping patients lose weight safely and sustainably involves making lifestyle changes along with a sensible diet and exercise routine. Bariatric surgery can be an excellent way to help patients lose a lot of weight if they are unable to make changes in their lives or lose weight on their own.

As a plastic surgeon, I have the chance to see patients after they have shed a remarkable amount of weight and used this to promote new lifestyles that can eradicate conditions like diabetes, hypertension, sleep apnea, and frequently can stop all medications that they were previously taking with a doctor’s supervision. However, I become involved when the patient is currently healthy and active in all other respects but unhappy because they are detained inside their own fortresses made of hanging skin.

Because of all the excess skin hanging around their face, arms, breasts, abdomen, flanks, buttocks, and thighs, people feel better but do not look better. Plastic surgeons are uniquely qualified to give patients a “get out of jail free card” from their excess skin because they have additional training and experience in these surgical rejuvenation procedures.

Unfortunately, due to financial constraints, many bariatric surgeons attempt to perform many of these procedures themselves. Because they lack the training and crucial body contouring principles that can only be learned in a plastic and reconstructive surgical residency, this can result in less than ideal outcomes and even avoidable deaths.

Who will pay for the procedure is another issue that prevents patients from enjoying the benefits of post-bariatric surgical body contouring. First and foremost, any procedure that is eligible for insurance reimbursement needs to have a surgical code and a relative value scale attached to it. The American Medical Association, who created the coding, has never evaluated plastic surgery procedures in the context of extreme weight loss. The amount of time and effort the surgeon put into providing patients with this care would not be reflected in any way, even if an insurance company were to “cover the procedure.” Many procedures that are quite intricate and challenging to carry out are not considered when determining insurance reimbursement.

Numerous patients have expressed the opinion that this is unfair. Here is how I will respond to this: Patients who undergo surgical weight loss procedures are those who lacked the initial drive to lose weight. What is the patient’s motivation to maintain their new lifestyle if someone else is paying for their body contouring procedures? The patient is less likely to give up their lifestyle in order to maintain their expensive investment in themselves if they have had to save their money for several pricey operations that together cost as much as an expensive car. A costly new car loses value over time very quickly, but if you take good care of your new body, it can last a very long time. This is something I also tell my patients. When someone has something on the line, they always behave differently (pun intended).

What steps can I take to improve how I feel and look?
Three distinct procedures are typically used to rejuvenate the arms, breasts, abdomen, flanks, buttocks, and legs through surgery. Each one requires 6.5 to 7 hours to complete. These are complicated procedures that require a lot of work to remove and reshape the skin, as I mentioned in the previous sentence, but the results are worth it.

Lifting the lower body circumferentially while enhancing the glutes
The circumferential lower body lift with gluteal augmentation using vascularized flaps from the flank region is the first procedure I usually start with. Once this fundamental part of the body is fixed, I will be able to judge the legs and breasts more favorably in terms of appearance. A tummy tuck, a flank-plasty with lateral thigh repositioning, and gluteal augmentation using the skin from the muffin top and inserting the tissue into the gluteal region to enhance the buttocks are actually three separate operations done concurrently. Even though the surgery takes a long time and involves a complex number of procedures, I almost always discharge the patient that evening, and they actually recover much better than if they stayed in the hospital. No sutures are required to be removed because all incisions are thoroughly closed. Four drains are present and last for about a week. To block pain responses, we use a pain pump with a long-acting local anesthetic, and everyone receives a blood thinner for five days to avoid blood clots. I usually tell my patients that it takes two weeks or so for things to start feeling better, but then things get much better. All of the patients are extremely happy after this operation, which has changed their lives.

lift your upper body (bilateral brachioplasties with lateral chest wall reshaping and breast rejuvenation)
The combined upper arm and lateral chest wall contouring procedure typically constitutes the second stage (otherwise known as an extended brachioplasty). This is frequently combined with a breast lift, whether or not it includes implants. Despite the lengthy scar that runs from the elbow to the armpit and extends down the posterior lateral chest, the brachioplasty is a one-stage procedure with very few complications, and patients adore the results. However, breast surgery almost always involves two stages because the tissues after weight loss are extremely complex and have a lot of hanging tissue that cannot be corrected in a single step. In the second stage, an implant may be necessary to help give the remaining breast tissue shape and volume if it is very thin.

Anterior thigh lift
The lateral thigh lift is usually the final step. In the majority of cases, we perform aggressive liposuction in the medial thigh region, followed by resection of any remaining loose tissue. On the inside of the leg, the incision extends from the knee to the groin crease. As a result, the skin in this distribution can be transversely tightened, resulting in a much smoother, firmer leg. The surgery is not nearly as difficult to recover from as in the arms, and patients can return to relatively normal activities in a week. This can relieve patients of the burden of their extra hanging skin, allowing them to feel comfortable in shorts, dresses, and pants.