Q: Dr. Eppley, After my multiple body contouring procedures, just checking in to see if what I’m feeling right now is normal. I can’t seem to muster up any amount of energy and I’m feeling very lethargic and the overall discomfort is quite exhausting. Also the backs of my hands where the fat was injected appear to be still quite swollen and the pain seems to be the same as it was when I initially had the surgery done. Should I be limiting the use of my hands more so than what I have already been? I’m taking my meds as prescribed and I have no fever or signs of infection.
A: None of this surprises me after major body contouring surgery. (breast augmentation, tummy tuck, buttock lift, fat injections to hands) When you have a lot of surgery, it takes tremendous energy to heal and that is where your body is putting its efforts. Thus any normal activities suffer a result and are deprived of their normal energy needs. While it seems like an eternity, it is only less than one full week after surgery so this is really a short period of time in the context of the overall recovery. In short, I consider what you are describing as very common and expected. I do not believe you will start to feel like yourself again for a few more weeks.
It is very common for the hands to be just as swollen at one week after surgery as it is the first few days. There is the volume added by the fat and then the swelling sets in. Together it takes a few weeks to lose the mitten look and for the hands to get supple again. While hand elevation and limiting their use helps, there is also the practical side that you have to used them for many activities. In the long run (6 to 8 weeks) the issue will likely be the opposite. (I wish more of the fullness had stayed)
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in multiple bariatric plastic surgery procedures. I had a gastric bypass done two years ago and have lost 140lbs. I now weigh 170 lbs, down from 310. I need a lot of work and want an arm lift, back lift, tummy tuck, thigh lift and liposuction with fat transfer to my buttocks and hips. Can this be done all in one surgery> It is safe to do all of these at once? Also, how long should I stop smoking prior to major body contouring surgery like this so I can heal properly?
A: While all of these bariatric plastic surgery body contouring procedures can be done in one surgery, that is not advised nor would any plastic surgeon do it. This is why too much trauma to your body and it increases the risk of major affter surgery complications llike DVT, infection and wound separations. As I counsel every extreme weight loss patient, you simply can not fix all of your body concerns in one surgery.
Every extreme weight loss patient needs to draft a complete list of their body concerns and then prioritize them. This will then allow you to create a series of two or three separate surgeries, spaced three to six months apart to get every body area addressed, It is more reasonable and common to do in the first stage the tummy tuck and arm lift and then do the back and thigh lifts in a second stage. It would be uncommon in a severe weight loss patient to have enough fat to harvest by liposuction to be able to do buttock or hip augmentation. It may be possible but not usually likely.
Regardless of how you sort and stage your body contouring procedures you must have stopped smoking months before. You need to stop once and for all at least 6 to 12 weeks before these surgeries. Otherwise, you are at high risk for major wound healing problems even if you ‘cheat’ on your smoking before and during the healing process.
Dr. Barry Eppley
Q : I had gastric bypass surgery about six months ago and have already lost 65 lbs. At the pace I am going, I will reach my goal of 100 lbs within one year after surgery. While the weight loss is fantastic, the amount of loose hanging skin that has developed is disgusting. I want to get this loose skin removed as soon as I can. How soon once I reach my weight loss goal can I have plastic surgery?
A: It is understandable that most extreme weight loss patients want to enjoy the benefits from their efforts as soon as possible. While the weight loss is the first step, most patients will require some skin removal through a second stage body contouring surgery to really see the body that they had hoped for.
Despite the enthusiasm of pressing forward as soon as possible, it is important to wait until some point after you have reached your weight loss goal. Your body needs time to recover and adjust to the new weight. This also allows you to learn new eating habits that will help keep the weight off but also have you become more nutritionally sound.
Body contouring surgery places major stress on one’s body and requires a lot of nutrients and energy to heal properly. You also want your immune function to be functioning as best as possible. In short, you don’t want to be malnourished going into major surgery. It has been that many post-bariatric surgery patients have protein-calorie malnutrition as well as various vitamins and mineral deficiencies.
While there is no standard waiting period after bariatric surgery, it is best that one have a stable weight for at least three months before considering elective body contouring surgery. Patients who have had gastric bypass, due to intestinal absorption changes, aren’t usually ready for body contouring surgery for six months or more afterwards. Lapband patients lose weight at a much slower rate and it may be much longer than a year after their procedure before they are ready. Extreme weight loss patients who have done it on their own without surgery can be done sooner because their intestinal absorption of nutrients has not been altered.
Dr. Barry Eppley