Many people who have lost a lot of weight very rapidly, either as a result of childbirth, bariatric surgery and/or good old-fashioned diet and exercise, often find their journey is only beginning when they get down to their ideal weight. Rapid weight gain and loss can lead to stretch marks, increased skin laxity and hanging skin in the areas where the gains and losses were most dramatic, as well as adjacent areas. In a recent Instagram Live video, Dr. Pane addressed this aftereffect of rapid weight loss in response to the following question, asked by one of the viewers: “When doing a tummy tuck, is there a technique you use to reduce the skin in the upper back? Also, how do you determine the cut with the incision? Do you use a V cut or does it depend on the person’s body?” Dr. Pane answered this compound question live on the air. Be sure to read on after the answer to learn how your question could be one of the next ones he answers!

With regards to the first part of the question, Dr. Pane noted the bra roll area [the area between and above the breast and below the shoulder] and/or the actual upper back is not part of a standard tummy tuck. Sometimes you can do a combination procedure which takes care of both areas. However, depending on where the scars are going to be, in most cases those procedures will get staged out to help reduce healing time, risk of complications and more effectively manage postoperative scarring. The tummy tuck is normally done first and the back skin is addressed later. If the skin is more on the side and flanks than toward the center of the back, the tummy tuck may address that. Another point to consider is that unlike a standard tummy tuck, the back tends to leave more visible scars and people don’t always want that. But for patients who have lost massive amounts of weight, the scar may seem like a better trade to do away with the looser skin.

Regarding the scars themselves, Dr. Pane says: “In terms of where the scar goes, I try to put it in the natural crease [typically just under the bikini line] if one is available so it’s where the body wants it to be. Sometimes the patient doesn’t have an obvious natural crease. In these cases, I go by measurements and margins to determine where to place it. In the natural crease gives patients a better chance of a nice, thin scar and makes scar aftercare easier. If you’re taking a lot of skin out, and the remaining skin is too tight, it can lead to slightly wider scars. People with lots of excess skin and lots of stretch marks will usually form thinner scars because the skin has been thinned out so drastically.”

Dr. Pane noted that in cases where wider scars are left after surgery, scar revision to help create a thinner scar is often an option. However, as with the techniques used to perform the skin excision, this will depend on the individual patient; how much loose or hanging skin is present; the overall skin condition; and whether the patient has natural crease lines which might serve to better conceal or camouflage the scars. An inverted V incision technique may work best for patients who have lost dramatic amounts of weight and have a corresponding amount of excess skin. In other cases, a lateral incision might be better.

The key point to consider in these cases, as Dr. Pane observed earlier, is going to be whether the patient is more comfortable with the scars or the excess skin. Obviously, whenever Dr. Pane and the staff of Atlantic Coast Aesthetics perform any procedure, we want to strike the best possible balance between patient health and the outcome the patient hopes for. It’s also important to keep in mind that there is currently no such thing as a completely scarless surgery, nor is modern medicine likely to come up with a methodology for one in the foreseeable future. Because of this, everything that can be done to help conceal postoperative surgical scars will be, but patients need to be realistic in their expectations. As of now, a skilled, double board certified cosmetic surgeon like Dr. Pane doing the procedure and diligent scar aftercare by the patient remain the best ways to help minimize the appearance and size of scars.

If you have a question about any aspect of cosmetic surgery, Dr. Pane and the staff of ACA are always happy to discuss your interests and concerns. Simply follow us on Facebook, LinkedIn, Twitter and Instagram; call us at (561) 513-4763; or click here to contact us via email. Also, be sure to tune in to Dr. Pane’s Instagram Live sessions, where he answers questions from the audience and those submitted through social media live on the air! It’s possible your question might be the next one he takes on, helping educate and inform others who share your interests while giving you the straight answers you need to make the best decisions possible about your needs and goals for your cosmetic surgery journey. Remember, at ACA, we believe the only bad question is the one you DON’T ask!