Body Contouring after Weight Loss

By Dr Andre Safvat, Specialist Plastic Surgeon

Body contouring is restoring the body to a more functional and aesthetic form after massive weight loss and is the final steps in the massive weight loss patients’ journey. It should not be considered as an alternative to weight loss nor a method of fat reduction.

Abdominoplasty before and 10 weeks post op.

The patients are to be congratulated for having done the hard work to lose their excess weight (with or without bariatric surgery). Majority have lost the adiposity but because the skin is lacking in elasticity, it is saggy, heavy and loose, and forms problematic folds. This is not only psychologically displeasing for the patients who have worked hard for their weight loss but also presents physical symptoms such as rashes, chaffing and difficulty in exercising and walking. Unfortunately, the only solution for this is surgical excision of the excess skin at the expense of surgical scars. The scars are often placed strategically in cosmetically inconspicuous places, although sometimes to remove the most stubborn of skin excess, they need to be placed in more visible locations.

I believe every patient is different and the treatment must be tailored to their individual physical requirements and wishes. If multiple areas need addressing then surgical procedures need to be staged, based on the patient’s needs. For example, some patients might only want an abdominoplasty to correct the anterior abdominal wall skin redundancy and repair of the rectus divarication where indicated. While others might need a Belt lipectomy (total body lift) to address the redundancy of the back and lift the buttocks, as well as deal with the front of the abdomen. Others may even want further procedures to deal with the redundant skin on the arms (brachioplasty), the thighs (thigh lift) or their breasts (reduction mastopexy).

The hospital stay is also variable between patients and between procedures. For example, abdominoplasty or body lift patients usually stay in hospital for a week while brachioplasty may be done as day surgery. All patients are asked to wear a surgical compression garment for 4-6 weeks after surgery to help with recovery and reduce seroma rates.

Brachioplasty before and 5 months post op.

I always tell my patients that the more skin we excise, the better they will look; however, it can increase the risk of wound complications. This is most evident in buttock lift surgery, where the skin excision must be quite conservative to allow patients to bend over, otherwise they will have wound dehiscence.

To be eligible for Medicare item numbers for body contouring surgery, massive weight loss patients must satisfy the following strict criteria

• They must have lost the equivalent of 5BMI points.

• They must have stable weight for the past 6/12.

• Weight should be documented showing the weight loss as well as the 6 months of stable weight.

• The patient’s skin redundancy must present a significant functional disturbance (both physical or psychological). These include intertrigo, chaffing and difficulty with walking, exercising or other activities; discomfort and pain. It may also cause difficulty with micturition or sexual activity and generally low self-esteem.

If patients do not meet the criteria as above, they are still able to have this surgery, however it will be classified as cosmetic surgery meaning there are no rebates available from Medicare or Private Health insurance.