Q: Dr. Eppley, I had gastric bypass surgery two years ago. I lost 90 lbs and my weight has been stable over the past year. I am now ready to get rid of my loose skin around my waistline. I want an adominoplasty that is extended to lift up the thighs a little, as demonstrated in some photos that I have attached. I don’t know if that will be enough skin removed though so a belt lipectomy / body lift may be necessary. What do you think?
A: Thank you for sending your pictures. They are well detailed and I have reviewed each one. There is no question about the need for a complete abdominoplasty in the front. Ideally the most abdominal tightening would come from a combined horizontal and vertical cutout pattern. (fleur-de-lis tummy tuck) But the addition of a midline vertical abdominal scar may not be worth the transverse tightening that it provides. You are correct in assuming that a circumferential body lift is really needed to get the type of lifting in the upper thigh and buttocks that you have illustrated. Compared to many extreme weight loss patients, you actually have less excess skin around the waistline and into the back than most. Some such patients may consider the scar goiing across the back as undesireable in order to gain a buttock lift. That is a personal decision and it is just a question of the amount of scar created vs the amount/extent of lifting that one desires.
While a circumferential body lift will provide some upper thigh lift, it will not deal with much of the loose skin in the thigh that extends nearly down to the knees. This requires an independent thigh procedure which should not be performed at the same time at the body lift due to concerns about the vascularity of the intervening skin.
Dr. Barry Eppley
Q: Dr. Eppley, Over the last two and a half years, I have lost 225lbs naturally through better eating and exercising. I am now stable at this weight and in need of surgery to remove a lot of thet excess skin, specifically around my midsection and groin. I couldn’t be happier with where am I today, but know that I am still not myself with all this excess. While there is a lot of extra skin now, where do you recommend surgically to start the process of remaking this thinner but saggy body?
A: Thank you for your inquiry and congratulations on your weight, loss all on your own efforts. Not many people could have made that much progress and sustained it on their own. With that amount of weight loss comes the expected skin excess throughout the trunk region. This is a very common issue that I see, in both men and women, after bariatic surgery where this amount of weight loss is more typical. Your pictures shows that a circumferential lower body lift is a good place to start to remove a lot of this excess skin. Tightening the waistline and getting rid of most of the redundant skin and overhang is always a good starting point on the body makeover process. This is the largest surface area of skin to be removed and needs to be done first before any procedures are considered above or below this area.
Dr. Barry Eppley