Unfortunately, sometimes cosmetic surgeries, particularly the larger ones, don’t necessarily deliver the results the patient was hoping for. This is the case with our Atlantic Coast Aesthetics Question of the Week this week. The patient asks, “What approach [do] you take when operating on massive weight loss patients? I have already had an abdominoplasty with very poor results. I think my issue is that when I’m laying flat my stomach looks flat but when I am sitting or standing there is loose skin! I’m thinking a surgeon would be best who could sit me up during the next abdominoplasty to make sure there are no bulges.” Dr. Thomas A. Pane, our founder and Chief Medical Officer, chose this question for the Question of the Week because it allowed him the opportunity to speak in more detail and depth about how and why abdominoplasty for massive weight loss patients should be addressed.
Dr. Pane started by observing that the patient did not include a picture, nor was an in-person consultation performed, so based upon self-reporting by the patient it is much more difficult to say exactly what went wrong or why the procedure didn’t deliver the required result. However, many people who experience drastic weight loss, as with bariatric surgery or some illnesses, are left with a large amount of loose skin after the weight is gone. In severe cases, even an abdominoplasty that goes all the way around to the back horizontally may not be enough to remove and flatten all the excess skin which remains.
The first step is to understand just how much skin was left over after the initial weight loss occurred and from there, evaluate how much skin remained after the first abdominoplasty. This is important because it will allow the surgeon to effectively determine what the next step should be in arranging a procedure that will remove the excess skin and deliver the results the patient wants. However, this would be something done with pictures at a minimum or during a clinical in-person examination for the best possible results.
Especially if the loose skin is gathered around the lower part of the abdomen, an “extended” abdominoplasty with a vertical scar may be the best option to treat the problem. Dr. Pane cautioned that this is not a common procedure and should be done only when absolutely necessary because of the larger area affected and the increased recovery time required. The surgeon who did the original surgery may have opted for a more conservative and less invasive procedure because of concerns about removing too much skin or to avoid the more obvious vertical scar. However, in this case, the more conservative route may not have been the ideal choice.
Another option may be a mini-abdominoplasty to remove a little more skin without having to perform another complete abdominoplasty. Dr. Pane observed that the patient notes that there is always at least a little loose skin at the lower part of the abdomen because of how our bodies work and the fact that gravity is always pulling on them. An abdominoplasty gives the illusion of more tightness, but most “tightness” occurs in the musculature underlying the abdominal wall. While this can be tightened to a degree during abdominoplasty, there will always be a little bit of loose skin, especially when the patient is lying down or the abdomen is otherwise relaxed.
The downside of answering questions on the Internet is that there isn’t an actual person to attach to the problem. While pictures are a good starting point, they cannot give the comprehensive overview of the patient’s condition and needs that an in-person clinical evaluation can. For this reason, while the mini-abdominoplasty and the vertical procedure are and remain options, an actual, definitive answer to this patient’s question would have to wait upon a full consultation and evaluation, so that the complete medical history of the patient is known and the problem can be assessed at close range.
If you would like to ask a question about cosmetic surgery, ACA’s staff is always happy to assist you with real answers, straight talk and the most up-to-date practices and procedures available anywhere. Simply email us at https://acplasticsurg.com, call us at (561) 422-4116 or follow us on Facebook and Twitter. Your question may be chosen by Dr. Pane to be answered live in an upcoming Google Hangout, meaning you can actually help us help other people who share your questions, comments and concerns. Remember, at Atlantic Coast Aesthetics, we believe the only bad question is the one you don’t ask!