Plastic surgeons are treating a growing number of patients after massive weight loss. This is likely due to the prevalence of obesity in America and greater public awareness of this problem and the health consequences. Newer surgical techniques such as lap band procedures have gained popularity.

After successfully losing a great deal of weight, people are disappointed to find that the skin does not contract as much as they would like, leaving folds of redundant skin. The face, neck, arms, breasts, trunk, thighs, and knees may all be affected. The breasts deflate. The buttocks appear flattened.

Patients learn that now that they have lost the weight, there is a whole new set of issues to deal with. Because loose skin is a major problem, they need excisional techniques that leave long scars. And because so many areas are affected, they usually require more than one operation.

Patients accept the trade-off of scars for getting rid of loose folds of skin, which are more embarrassing than scars.

The results are never quite as good as the surgeon would like, because of the compromised skin tone. Touchups are to be expected. Because numerous procedures are done, the chance of having a complication is high. Counting delayed wound healing, seromas and asymmetry, the likelihood of a patient encountering some type of complication approaches 100%!

Sometimes insurance pays for bariatric surgery, because of the medical problems associated with obesity. However, insurance dose not typically pay for treatment of the skin deformities that result from massive weight loss. For patients that just paid for their lap band surgery or gastric bypass, the thought of paying much more for their plastic surgery can be disappointing.

A trusting patient-physician relationship is key, along with the understanding that treatment will be ongoing over a period of months to years. Patient satisfaction can be high.

The major issues are discussed at the first consultation. A "battle plan" is developed. It is usually best to treat the patient's priorities first. An abdominoplasty is usually the first order of business. This is done with simultaneous liposuction. If the outer thighs and buttocks are saggy, a lower body lift is recommended, which is a tummy tuck and outer thigh/buttock lift. done at the same time. Sometimes an inner thigh lift is done as well, either at the first operation or a subsequent one. It is more common today to use a longitudinal incision down the inseam of the inner thigh, rather than an incision in the groin crease, to remove the greatest amount of excess skin and get the best result.

We recognize the importance of augmenting the buttocks, which usually appear flat after major weight loss. Fat injection may be done, or flaps developed at the time of the outer thigh lift may be transposed to help fill out the buttocks.