- Before Bariatric Plastic Surgery
- The Post Bariatric Plastic Surgery Procedure
- Post Bariatric Plastic Surgery Recovery
- Post Bariatric Surgery Costs
CONGRATULATIONS ON YOUR WEIGHT LOSS!
You have made incredible changes in your body and your life since your weight loss. The steps that you have taken to lose weight have required significant personal sacrifice and faith in yourself. You have worked hard to get to this point and you should be proud of your accomplishment. You may have even lost as much weight as 100lbs or more.
No doubt that this amount of weight loss had had some tremendous health benefits, such as the need for less medications for high blood pressure or diabetes. However, the amount of weight loss that you have achieved usually leaves an excess of sagging skin, often times from the neck to the knees. This skin excess not only causes personal embarrassment, but may pose problems with skin rashes as well. Unfortunately, changing this aspect of your body cannot be done through diet and exercise, no matter how hard you try.
PLASTIC SURGERY OPTIONS AFTER WEIGHT LOSS
Dr. Eppley, an Indianapolis Plastic Surgeon, provides Bariatric Plastic Surgery expertise that offers hope, and powerful options for body contouring surgery that can help you achieve these final physical goals. You want to make the outside of you feel as good as you do inside! A number of specialized plastic surgery procedures are available to help reshape many of these problematic areas. These include such options as:
- Abdominoplasty (tummy tuck)
- Brachioplasty (arm lift)
- Breast Reshaping (implants, lift, reduction)
- Face Lift and Neck Lift
- Thigh and Buttock Lifts
- Total Lower Body Lift
WHAT TYPES OF BODY CONTOURING PROCEDURES DO I NEED?
As the demand for body contouring procedures has dramatically increased over the past ten years, plastic surgery techniques have become modified and refined for the unique needs of the massive weight loss patients. But where do you start? Are you a candidate for bariatric plastic surgery? When should I have surgery after my weight loss? What is the right operation for me? What are my options? Only an in-depth consult and treatment planning session with a plastic surgeon can help you make these decisions.
Before Undergoing Bariatric Plastic Surgery
While some patients may be anxious to get on with the ‘final’ stage of their weight loss journey, it is important to wait at least several months after you have reached your weight loss goal. This allows your body a period to recover and adjust metabolically to the new weight and allows time for the skin to accommodate to your smaller frame. This also allows you to acquire new eating habits for long-term weight maintenance.
HOW LONG SHOULD I WAIT AFTER MY WEIGHT LOSS BEFORE HAVING PLASTIC SURGERY?
While there is no magic waiting period, most plastic surgeons would like their patients to have a stable weight for at least six months before considering elective body contouring surgery. A stable weight means minimal fluctuations of only a few pounds. Patients who have had gastric bypass, due to intestinal absorption changes, aren’t usually ready for body contouring surgery for a year or longer after the surgery. Patients who have had the Lap Band procedure lose weight at a much slower rate, and may need to wait even longer than a year to pursue body contouring surgery. Extreme weight loss patients who have done it on their own without surgery can be done within six months after they have hit a stable weight.
The most important reason to wait to undergo bariatric plastic surgery is to allow your body time to recover. Almost everybody contouring procedure requires a lot of nutrients and energy to heal properly. You want your energy stores and your immune function to be in the best shape possible. In short, you don’t want to be malnourished going into major surgery. With the stress of major body contouring surgery, even a mild nutritional problem may become apparent in the postoperative period, resulting in wound healing problems.
Ideal daily requirements for good healing after body contouring surgery include protein (70 – 75 grams), vitamin A (25,000 units), vitamin B12 (500 ug), folate (400ug), vitamin C (2 grams), iron (100mg), and zinc. (20mg) To achieve this level of supplementation, multivitamins and protein drinks and bars may be adequate in some cases. For many patients, however, this oral approach may not be sufficient. For this reason, there are available formulated supplements unique to the needs of the bariatric patient including ProMend (Bariatric Advantage, Irvine, CA) and ProCare Surgical Formula (NutrEssential, Wilmington, CA) These formulas bring to the table the necessary vitamins as well as protein, free amino acids, arginine, and glutamine which are essential building blocks for new tissue formation. ProCare is preferred as it comes in a powder form which is better absorbed in the gastric bypass patient as opposed to pills.
The post-bariatric patient is a unique surgical patient because of the magnitude of the procedures and the patient’s often compromised nutritional situation. Oral vitamin and protein supplementation should be started one month before most body contouring surgeries and continue for one month after. While this will not eliminate all wound complications, it will decrease the risk and the length of time that any wound complications will take to heal.
Bariatric Plastic Surgery – The Procedure
Body contouring surgery, also known as bariatric plastic surgery, includes a long list of operations that can be done from the neck down to the knees. Bariatric plastic surgery is unique in that many of the operations are long. Removing and reshaping loose hanging skin is tedious. Or, to put it more graphically, there is a lot of cutting and sewing to be done in most body contouring surgeries.
While patients almost always ask how long surgery can take (you can argue you are asleep, what does it matter), this is still an understandable question particularly for the waiting family members who are not asleep. In most cases, the length of surgery is fairly predictable. The importance of accurately predicting the length of the operation also has economic impact. Since most body contouring surgeries are not covered by insurance, there is a fee-per-time cost for the use of the operating room and the anesthesiologist. You need to know the amount of time for the operation and the cost, upfront.
Surgery time will certainly vary based on the plastic surgeon. A longer or shorter operative time doesn’t make one plastic surgeon better or worse than another. Every plastic surgeon operates at their own speed and comfort zone. So don’t compare plastic surgeons by time. A longer or shorter operative time doesn’t necessarily mean a better or worse result. As I always say…I don’t get any rewards for being fast…I only get rewards (and patient happiness) from a good result, regardless of the time it took to get there. Nobody has yet to tell me….’Doc, the result is terrible but it was really fast!’
With that thought in mind, here are some approximate operative times based on some of the most common body contouring procedures.
- Abdominoplasty/Panniculectomy 2 – 4 hours
- Arm Lift 1 – 1.5 hours
- Back Lift 1 – 2 hours
- Body Lift 4 – 6 hours
- Breast Lift/Reduction 2 – 3 hours
- Facelift 2 – 3 hours
- Thigh Lift 2 – 3 hours
Also remember that operative includes other events than actual surgery. The measurement of operative time starts the second you walk into the operating room and doesn’t stop ticking until you are wheeled out on a stretcher. So events such as prepping and draping, positioning and turning you during surgery, and the application of dressings all counts as surgery time.
Post-Bariatric Plastic Surgery – After the Procedure
Body contouring surgery usually involves removing large segments of skin which are then closed by bringing the two sides together. What is not obvious is that the skin is closed over a ‘space’. As the skin is more elastic or flexible than the deeper tissues (such as fat) that lie underneath, closure of the skin when large segments of tissue have been removed leaves an open area beneath. As the body abhors a space, it will fill it with fluid. Thus, the need for drains is an important part of the post-operative phase.
The reason fluid accumulates in this space is that wounded tissue weeps. Much like a brush burn that you had on your knee as a child, fluid comes leaking out from the wounded tissue. In the spaces left behind after big skin removals, a large surface area of wounded tissue lies underneath. This will weep fluid for weeks after surgery. Drains are inserted into these spaces to prevent fluid build-up. A soft tube is inserted under the skin through a small opening near the main incision. This drainage tube is then attached to a suction bulb which pulls fluid out by vacuum pressure. This is known as a closed suction drain. The drains are quite long, up to 18 inches in length. Usually one or more drains are used for surgical site depending on the procedure. (An arm lift needs one drain, a tummy tuck needs two drains, a body lift may need four drains) Some procedures such as breast surgery may not need a drain at all.
The removal of this fluid is of critical importance. While the body can absorb a certain amount of fluid, large amounts that occur after major body contouring surgery cannot be absorbed. If allowed to build up, it may be a source of infection but will also not allow the sides of the wound inside to heal together. Therefore, the drains keep most of the fluid out so that adequate internal wound healing can occur. The drains serve as a safety valve until the internal weeping stops.
How long does this internal seeping persist or more pertinently, how long will you have to have these drains? It varies by the area and type of surgery. For arm lifts 2 to 3 days, thigh lifts one week, tummy tucks seven to ten days, and body lifts as long as two weeks. Some plastic surgeons use the amount of fluid coming out as the measure of how long they stay. Generally, less than 25 to 30 ccs per day per drain means they may be able to be removed.
How long will it take me to recover? It is best to think of surgery recovery as three phases based on what you will experience during each specific phase. How you feel, what you can do, and what is happening with your surgical incisions make up each phase. When talking about body contouring surgery, we need to be specific as to what procedures we are talking about. For the sake of this discussion, I am referring to the procedures of circumferential body lift, thigh lifts, or a combination of other body procedures which may add up the size of a procedure such as a body lift.
The first phase of recovery from body contouring surgery is right after the operation. It is a phase of pain, dressings, drains, and more limited physical activity. Surprisingly, body contouring surgery is not acutely pain but has more of a dull discomfort and some stinging along the incisions. In my practice, I glue on tapes over the incisions so there is no care needed. One can shower after 48 hours and feel free to get the incisions and drains wet, it will not hurt them. You can do whatever you feel like doing but most patients will be fairly limited to sitting around and walking about the house. Phase one is obviously the most difficult, generally lasts from 7 to 10 days, and is what most patients envision it to be.
Phase two in body contouring surgery recovery is when the drains come out, the tapes are removed, and you are getting back to some normal activities of daily living, including driving and some out of the house events. You are still sore but no longer in any severe pain. Some external stitches are removed, if present, as well. This phase is from 10 to 21 days. You may return to work if your job is a sit down one with minimal strenuous activity. You are not ready to return to any physical activity, particularly any form of working out. Your incisions may start to turn redder by three weeks after surgery as they start to heal. The red color is normal.
Phase three is what I call the nuisance phase of recovery and it is between 3 and 8 weeks after surgery. During this phase, you are really recovering, feeling much better, and by the end of this phase are almost or are back to all of your pre-surgery activities. This is also the phase when small ‘problems’ will develop at your incisions which will surprise patients as they think they should be completely healed by now. This includes extrusions or reactions to dissolvable sutures, known as ‘spitters’, which the body is pushing out as they dissolve. It is also the time when seromas or fluid collections may occur after the drains have been removed. These are minor problems but are common delayed issues that will occur in most body contouring patients.
In summary, recovery from body contouring surgery takes longer than most patients think. Complete recovery, including the full healing of all incisions, can take up to two months. Patients should be aware and prepare accordingly for their work and lifestyle. Body contouring surgery is a big change and usually with a big recovery as well.
Body Contouring Costs
These are approximate costs for different body contouring procedures, including operating room and anesthesia costs.
- Abdominoplasty (tummy tuck) $ 5,500 – $ 8,000
- Brachioplasty (arm lift) $ 4,500 – $ 5,5000
- Breast Reshaping (implants, lift, reduction) $ 5,250 – $ 8,250
- Face and Neck Lift $ 4,500 – $ 7,500
- Thigh and Buttock Lifts $ 4,750 – $ 8,500
- Total Lower Body Lift Cost $ 6,500 – $ 8,250