Clinical Areas
Body Contouring After Major Weight Loss
Substantial weight loss changes the volume of the body, but it does not restore the skin that was stretched to accommodate it. What remains is an envelope problem rather than a fat problem, and it is treated by removing skin rather than by removing fat.
These operations are therefore excisional. Each one trades a scar for a change in contour, and the length and position of that scar is determined by how much skin has to come out and from where.
Why liposuction is not the answer here
Liposuction reduces localized fat where the skin retains enough elasticity to contract afterwards. After major weight loss that elasticity has usually been lost.
Removing further volume from an already loose envelope can make laxity more obvious rather than less. This is why the operations in this section remove skin, and why energy-based devices — whatever their other uses — cannot substitute for excision when redundancy is significant.
Which operation treats which area
The procedures are distinguished by the region of skin excess rather than by preference:
- Abdominoplasty — the front of the abdomen, with repair of rectus diastasis where indicated.
- 360° lower body lift — circumferential laxity involving abdomen, waist, flanks, lower back and buttocks together.
- Thigh lift — the inner thigh, by a groin-crease or vertical approach depending on how far the excess extends.
- Pantaloon lift — circumferential lifting whose dissection is deliberately carried into the lateral thighs, elevating the lower body upward as one unit.
- Brachioplasty — the upper arm, extending into the axilla and lateral chest when the deformity does.
Staging
Correcting every area in a single operation is not always the safest choice. Extensive excisional surgery places real demands on tissue circulation, operative time, blood loss and recovery.
Where the total burden would be high, staged procedures are more predictable — and the sequence is chosen so that treating one area does not compromise the result in another.
Before surgery is considered
Weight should be relatively stable. Operating during ongoing weight change risks a result that does not hold.
Nutritional status matters after bariatric surgery in particular, where deficiencies and anaemia are common and directly affect wound healing. These are assessed rather than assumed.