Pregnancy, diet and exercise, and extreme weight loss can both result in excess loose, sagging, or projecting lower abdominal wall tissues. A tummy tuck restores abdominal appearance, resulting in a smoother, flatter abdomen.* Results may be enhanced by liposuction, breast lifts, or augmentation and thigh lifts.*
Procedure Before and After Photos
* Each patient is unique and individual results may vary.
Before your Major Weight Loss Surgery
Bariatric surgery and the weight loss that follows will result in many life changing issues. It will improve your health while normalizing your blood pressure and blood sugar, so you feel great, your activity level will increase and your appearance and self esteem will significantly improve. However, the loose skin and skin folds that result from your weight loss can be of significant concern. The sagging skin can cause issues with personal hygiene and with fitting clothing properly, even after you achieved your healthy weight.
Your appearance is dependent upon how your skin will react after your weight loss and its adherence to your new slimmer foundation. If your skin has an elastic property it will better conform to your new slimmer foundation. Another important factor is how much you lose weight in specific parts of your body. If you carry a significant amount of weight around your middle, then the skin in that area will have further to contract and will be most affected by your weight loss. The end result is that hanging skin can affect your self-confidence and become a constant reminder of your past obesity.
The most common area of concern is the overhanging apron of skin on the front of the abdomen, called a “pannus”. In addition to hygiene issues beneath the pannus (rashes and skin irritation) there is also a concern for the proper fitting of clothing. These symptoms and concerns tend to be worse in hot weather and may be a cause of chronic back problems. While the abdomen is definitely the area of greatest concern, excess skin on the upper arms and inner thighs are also problematic areas.
When is the Right Time to Consider a Body Contouring Surgery?
The timing of body contouring surgery is dependent on two main factors. First, is attaining a stable weight, which usually occurs 12 to 18 months after the weight loss procedure or medical weight loss program. A weight loss expert will usually prefer the patient to be at a stable weight for at least 3 months before your body contouring surgery. The most common problem that we see is that many patients feel that body contouring prior to attaining their stable weight will enhance their activity and provide an unrealistic way to reach their true stable weight. Second, after attaining your weight loss goals, it is highly advisable that you are also healthy (without any health conditions). The stress of these procedures dictates that all candidates be medically stable. Therefore, reaching a stable weight and being in good medical condition pave the way for a more successful body contouring outcome.*
Types of Major Weight Loss Procedures
Contouring of the Abdomen
Before committing to body contouring surgery you must ask yourself: Are you willing to accept a scar in return for your improved body contour?
There is one simple rule of body contouring surgery: you can’t take away excess skin without having a scar and these scars can be long and they can be permanent.* These scars will tend to fade with time, but they will always be there. The way the scar looks is mostly determined by your body’s natural healing process and the location of the scars. Some people make thicker heavy scars, while others make thin scars. In most procedures, the scars are hidden in places that are covered by clothes, such as along the waistline. In some procedures, such as an arm lift (brachioplasty), the scars can be visible.
Plastic surgery procedures commonly performed following medical weight loss include abdominoplasty/tummy tuck (panniculectomy), liposuction, arm lift (brachioplasty), thighs and buttock lift, breast reshaping, male breast reduction or lift, facelift/neck lift, and other special areas. It is possible that you could also choose to have a combination of procedures performed at the same time.*
Liposuction Procedure
This is a technique that uses hollow suction tubes to remove fat.* The tubes are narrow and can be placed through small incisions that are not very obvious. Lipectomy is rarely used as a sole procedure in patients who have lost a large amount of weight because it does nothing to tighten skin. In fact, removing fat from under inelastic loose skin only makes the loose skin worse*. This technique may, however, be used along with lifting procedures to get a better overall contour.*
Abdominoplasty (Tummy Tuck/Panniculectomy)
This is the most common procedure performed after a weight loss journey or strictly as a cosmetic procedure for contouring of the abdomen. I prefer to categorize this procedure as either a limited abdominoplasty, a standard tummy tuck in Wisconsin surgery or a circumferential abdominal wall contouring. The person undergoing abdominal wall contouring after excessive weight loss will require either the standard or the circumferential procedure.
It is a two hour procedure, requires a general anesthetic and may also require an overnight stay in the hospital. The scar is usually placed low along the waistline and around the belly button. In those patients who have a lot of excess skin or have under gone previous abdominal wall surgeries, they may require an “up and down” scar. In some patients, the scar may completely circle the waist so as to ensure a contouring of not only the front, but also the back. The choice of procedure might be influenced by your current weight, medical condition, and financial issues.
During the procedure, a tightening of the abdominal muscles is often done in order to give a better overall contoured result.* Plastic drain tubes, about as thick as a pencil, are placed during the surgery to drain fluid from the surgical site.
* Panniculectomy cost range from $1,000-$3,500 for outpatient surgeries, and $5,000-$10,000 for hospital stays. Costs are typically covered by insurance companies, although some patients pay out of pocket.
Recovery from Abdominoplasty
These stay in for about a week and you’ll need to empty them at home twice a day. We remove them in the office afterward, when the amount of drainage is below a certain point. I advise patients to avoid heavy lifting (more than 10 pounds) for six weeks after the surgery. Patients who do light work can return in as little as two weeks, although many will allow four weeks. Risks of the procedure include bleeding, infection, and seroma (a harmless collection of fluid beneath the skin). The surgeon will treat Seromas in the office by draining them with a small needle. More serious complications, such as blood clots that form in the legs, can also occur but are very rare.*
Patients who have hernias from previous abdominal surgery can often have them fixed at the same time as the panniculectomy (abdominoplasty, or tummy tuck Wisconsin). Our office will work with your insurance company to ensure coverage for this procedure. The hernia repair can lengthen the procedure by about one-half hour, but will not prolong your over-night stay in the hospital.
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Contouring of the Arms
Arm Lift (Brachioplasty)
This procedure is one of the most requested after excessive weight loss. It must be stressed during the consultation that contouring can be attained, but the trade off is the presence of a scar. The scar, in mild cases, can be hidden beneath the armpit, but in more severe cases it will run along the inner upper arm to the elbow. This scar can be situated so that it can’t be seen from the side or back, but will be noticeable with the arm up.
Many patients who would never show their arms before the brachioplasty are quite comfortable wearing sleeveless clothes after this operation. The operation averages two hours, and the recovery involves about one to two weeks out of work for light jobs and four weeks for jobs that require lifting.* This popular procedure can be combined with other operations such as breast lift or abdominoplasty. Drains are used, and risks specific to this operation include patchy numbness on the upper and lower arm. The numbness does not interfere with function, may disappear over time, and is rarely bothersome to patients.
Contouring the Thighs and Buttocks
Thighs and Buttock Lift
We usually refer to the combination of these two procedures as a lower body lift. The surgeon will customize these procedures for each patient. What actually dictates the scar placement is the laxity of the skin and a desire to hide the scar beneath clothing. As a matter of fact, the surgeon can use the same scar for the outer thigh lift for the abdominoplasty as well, and concurrently, extended the same scar around the back as a buttock lift. We can treat the inner thigh by lifting the skin and placing the incisions along the groin crease. In severe cases, the doctor might require to make a long vertical scar along the inner thigh.* The lower body lift procedure requires more time and has a longer recovery than the abdominoplasty. Dr. Ewings will then use drains and the risks are similar to the tummy tuck procedure.
Chest Wall Contouring
Breast Lift
In general, a breast lift raises and firms the breasts by removing excess skin and tightening the surrounding breast to reshape and support the new breast contour.* With an excessive weight gain the breast skin stretches and the areola becomes enlarged. However, subsequent weight loss, will make the breast lose its elasticity resulting in a significant sagging of the breast mound, and the nipple-areola may also become enlarged. The goal of the breast lift is to improve the shape of a female breast that:
- Sags or is pendulous, but is proportionate with the body frame
- Has lost firmness and skin elasticity
- Show a flatter elongated shape
- Has a nipple and areola that point downward
- Has stretched skin and an enlarged areola after weight loss or after pregnancy
The Mastopexy Procedure
The Breast lift is an outpatient procedure that we can do under a general anesthetic or with mild sedation. The operative time is one and a half hours. Your surgeon will make an incision around the areola and may also extend down from the areola to beneath the breast. In general the greater the sagging of the breast, the longer the incision will be. For security reasons, we do not detach the nipple to avoid any loss in sensation to the breast (fig 1 ). We then, redrape the skin envelope around the newly formed breast mound to give a more rounded and perky appearance (fig 2). At that time, we discharge the patient home on the same day of surgery with a support bra in place. Dr. Ewings often perform this procedure in conjunction with other body contouring procedures including tummy tuck or the upper arm lift.
Recovery*: The doctor will give detailed, written postoperative instructions and prescriptions for antibiotics and pain control to all patients. During the first week, you’ll be able to tolerate some light activity. Most patients can usually take care of their own basic needs. We see you again in one week after your procedure. At that time, the surgeon will carefully remove all your dressings and your sutures. After that, we’ll discuss Your post-operative recovery and activity levels again as well as an anticipated date for your return to work. You’ll be able to tolerate light employment after two weeks, with heavy lifting and regular activity in 3 to 5 weeks*. You will also receive detailed instructions for the care of your suture lines so as to help prevent excessive scarring. The final consultation usually occurs 5 months after your procedure.
Male Breast Lift or Reduction
Obesity in men often leads to breast enlargement, a condition referred to as Gynecomastia. We treat this with a combination of Skin Removal and Liposuction Wisconsin. The pattern of scars varies with the amount of correction needed, but we often leave them well concealed by chest hair. Risks of the procedure are bleeding and infection. Recovery time is about one week.*
Why Choose Dr. Ember Ewings
For over a decade, Dr. Ember Ewings has taken pride in delivering excellence in plastic surgical care. She earned her medical degree from the University of Wisconsin-Madison School of Medicine and completed her surgical residency training in plastic surgery at Saint Louis University. Additionally, she gained extensive experience in pediatric and craniofacial surgery during her fellowship at the University of Tennessee – Memphis, and Hôpital Necker-Enfants Malades in Paris, France. Dr. Ewings is also Board Certified by the American Board of Plastic Surgery.
Dr. Ewings has enjoyed caring for patients of all ages from across the upper Midwest, and performs both cosmetic surgical, non-surgical, and reconstructive procedures, and is delighted to be able to provide outreach services in Durand, Wisconsin.
She owns and operates the Plastic Surgery Clinic of Eau Claire in Eau Claire. Prospective patients can reach Dr. Ewings through her online Consult Form, or at her practice, Plastic Surgery Clinic of Eau Claire – 715.833.2116 or 800.456.8222.
Facial Contouring
Facelift/Necklift
We can correct loose skin on the neck and face with a variety of face and necklift procedures.* The common feature of these procedures is that we hide the scar along the front of the ear and in the hair. Dr. Ewings might do this procedure the same day surgery or with an overnight stay. Bruising and swelling is worst during the first two weeks.* Risks include bleeding and, rarely, injury to facial nerves.* For a more detailed description of this procedure refer to our Facelift Procedure under cosmetic surgery.
Combination Procedures for After Major Weight Loss
Combination Procedures (Breast Lift, Tummy Tuck, Arm Lift)
There are patients who want to have as much done as possible in a single surgery. Your surgeon will advise you about what combinations of procedures are reasonable to do at one time.* For example, breast reshaping and tummy tuck is a common procedure offered to many patients. Some patients may be candidates for multiple procedures that will provide a “total body reshaping.” Only patients who are close to their goal weight, are in very good shape and have no underlying medical problems (like heart disease) should consider such big operations.* Most importantly, your surgeon should have experience with these types of procedures and plan to do the surgery in a hospital setting. Remember, more surgery means bigger results, but also a bigger recovery and possibly more risk. For that reason, several procedures may be staged so as to offer a safer and more recovery-friendly environment.
Remember to make an effort to find a surgeon who gets you, who is open and honest about what to expect, who genuinely listens, and who can help you achieve your desired results. Call us at 800.456.8222 or email us and schedule a consultation! Our staff is happy to help you!
Frequently Asked Questions About After Major Weight Loss Procedures
*Individual results may vary. Plastic Surgery Clinic of Eau Claire DisclaimerRead more.
Breast Lift
Dr. Ewings customizes each breast lift to match her patient’s unique aesthetic goals for beautifully-shaped, perky breasts and lifted nipples.
Liquid Rhinoplasty
Dr. Ewings can fill in indentations, subtly improve the shape of the nose, and even enhance facial balance by making small adjustments to the nose.
Skin Cancer Treatment
Skin cancer is the most common form of cancer in the United States. More than 600,000 new cases are reported each year.
