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Body Contouring Surgery
After Massive Weight Loss


Obesity is defined as accumulation of fat that leads to body dysfunction. This medical illness can lead to a variety of severe medical conditions such as hypertension, diabetes, heart disease, strokes, sleep apnea and joint dysfunctions.

Unfortunately, obesity has become a major public health problem in the USA. It has reached epidemic proportions. According to the National Health and Nutritional Survey, 65% of adults are overweight and the rate is increasing. The cause of obesity is not only overeating, but is much more complex. Inefficient caloric utilization, reduced metabolic activity, high set point for body weight, genetics, environment and psychological issues all contribute.


The goal of bariatric surgeries, over 60% of which are performed laparoscopically, is to improve the overall health of morbidly obese patients. The outcome of the surgery is a significant reduction in the absorption of calories consumed.

Patients who have had bariatric surgery have undergone a major life-changing event. His/her overall body shape has drastically changed, his/her health has improved and his/her life expectancy has been extended.


The post-bariatric patient has a new issue to address. How does one deal with the abundance of loose, hanging skin? Body contouring for massive weight loss patients is the answer.

Body contouring for massive weight loss is performed in two or more stages if the patient’s goal is to reshape multiple areas.

The advantages of staging are:

  • Less anesthesia time
  • Less blood loss
  • Less surgical fatigue
  • Avoidance of opposing vectors of pull
  • Second chance to correct areas

The disadvantages:

  • Multiple exposures to anesthesia
  • Increased time off work
  • Increased expense for the patient

Dr. Delgado and the anesthesiologist will discuss the different options with the patient. The patient can then make an informed choice of the plan that is best for his or her needs and optimal results.


The approach for body lifting is to separate the procedures into upper and lower body lifting. The upper body lift is composed of breast surgery, arm surgery, axilla surgery and lateral chest surgery. This would complete the upper body lifting and tightening of the anatomic structures in this location. The lower body lift is composed of an abdominoplasty, the flank or back excision, also termed a belt lipectomy and often a medial thigh lift. When both upper and lower body lifts are done, the procedure is called a total body lift.


For women, breast deformities after massive weight loss are very different than those seen in women needing the traditional breast lift. The deflation of the skin can cause severe asymmetries and flattening of the breasts. A short-scar lift is usually not a good choice, but an inverted-T technique, which can excise the armpit roll and use it for auto augmentation of the breasts, is a nice choice. This technique was developed by Dr. J. Peter Rubin at the University of Pittsburg. It is a wonderful technique that resuspends the breast tissue on the chest wall and uses the lateral armpit tissue to enhance the breast volume.

As for men who need chest contouring after massive weight loss, Dr. Delgado is particularly skilled in sculpting the male chest as well, with many hundreds of successful cases of gynecomastia reduction (male breast reduction) to his credit.


The upper arms, axillae and adjacent chest of a patient after weight loss or aging can be exceptionally problematic. Women, especially, can develop challenging arm deformities extending to the axilla (underarm or arm pit) and to the lateral chest. The draping of the skin can be awkward to cover up, even in long-sleeved clothing.

An arm lift can solve this problem. The incision goes from the elbow to the axilla. Extra skin that is present in the axilla and the upper chest can be excised at the same time. This will tighten the entire area. The incision often blends, or fuses, the breast incisions to achieve a tapered and tailored appearance.


Circumferential body lifting has been developing since the 1960’s to address the laxity of tissue occurring around the torso. Since the incision follows much of the line where a belt might be worn, it is called a “belt skin reduction.” This approach incorporates a tummy tuck and wide waist excision of tissue extending around both sides to the buttocks crease in the back. This will excise a substantial amount of tissue from the mid-torso region, additionally lifting the anterior-lateral thigh and buttock region.

This is a significant surgical procedure and it is sometimes done in two stages. Patients are very pleased with the results of this procedure.


Massive weight loss that causes the body to deflate can affect the face as well. While a sagging body can be hidden under clothing, but it is not so easy to conceal loose skin on the face. Massive weight loss can cause slack skin in the forehead, drooping of the upper eyelids, bags under the eyes, new lines in the cheeks and a sagging jaw line and neck. Although the patient feels younger and more energetic than ever, he/she looks tired and older after the weight loss. For these patients, a facelift or neck lift is a good solution. For a balanced and natural appearing result, an eyebrow lift and upper and lower eyelid lifts may be indicated as well. All these procedures can be done at the same time. Recovery is approximately two weeks.


A skilled plastic surgeon has much to offer a patient who has undergone bariatric surgery and/or massive weight loss. Reconstructive plastic surgery allows the patient to complete his/her transformation and to enjoy his/her new shape and healthier life to the fullest.

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