Over the last 50 years, we have seen obesity become a significant community health issue affecting an increasing numbers of patients. We also saw a large number of motivated people who have undertaken the difficult task of losing massive amounts of body weight to address their obesity and associated health issues. There were many patients who would do this with no specific assistance just a focus on the energy imbalance that has led to obesity: Reducing the caloric intake and increasing calorie expenditures through exercise/activity.
Other patients have achieved these goals with the assistance of bariatric procedures such as a gastric banding, gastric sleeve gastrectomy or gastric bypass.
Level of satisfaction gained by achieving a goal weight reduction and maintaining this can be marred by the realisation that the free weight loss body has not also magically reappeared and instead the areas of skin laxity that affects various parts of the body and the particular pattern will vary from person to person. There are reliable surgical options for addressing these concerns.
These procedures apply similar principles to different areas of the body affected by the weight gain and weight loss journey.
Broadly there are problems relating to 3 elements
It is usual for these procedures to be a combination of techniques to address these concerns and the desired outcome is an improvement in the skin tension, contour, and structural integrity.
When a bed sheet is pulled off the line it has lots of folds. When it is pulled tight over the mattress the lines are less evident. In a similar way, the skin changes associated with weight gain and weight loss such as stretch marks and laxity improved their appearance as much as possible by increasing tension with skin excision.
Fatty excess and localised fat distribution can lead to a thickening and concealment of shape or abnormal contours. When combined with skin laxity this can cause contour problems such as an abdominal apron which can go around the whole body, loose tissue hanging from the arms and similar problems in the thighs. A combination of excision and liposuction is used to contour these regions in combination with skin tension.
In some people, there is a paradoxical loss of volume and this is particularly evident in the breast and buttocks. In these circumstances, this leads to drooping, loss of firmness, skin looseness and loss of shape. The reconstruction of this problem requires a complex procedure to lift the breast and sometimes an implant for volume. In the buttock, this may involve physical lifting during a lower body lift but also the return of volume with fat grafting.
Depending on the site in the body, these procedures have common elements that tighten the skin, re-contour by reducing or repositioning fat and skin folds and repair the structural changes.
These are significant operations and all performed under general anaesthesia at an accredited hospital with a fully qualified anaesthetist.
If you have are having a day case procedure, he will be moved to the second stage area of recovery for another hour or so before leaving or alternatively you will go to the ward and any accompanying family can catch up with you at this time.
Patients who have lost massive amount of weight will frequently have concerns in more than one body area and it is common to combine procedures. It is important that surgery is safe and as a consequence the duration of the operations will be limited in depending on the general health of the patient. Many of these procedures taken around 2 hours although a lower body lift will take between 3 ½ and 4 hours. When conditions are optimised (young healthy patient in the normal weight category) it may be safe to increase the duration of surgery particularly if combining lower body lift and other procedures.
This type of surgery delivers a substantial outcome but is also is a significant operation with an early recovery period associated with reduced activities, a reduced ability to perform normal household chores and no driving.
The ideal candidate for surgery:
Dr Magnusson will then spend time educating you about the various elements of the surgery and what they are designed to do and how this could relate to you specifically.
The important elements that lead to the best outcomes from this surgery are having:
There are many factors that impact surgical outcomes and while good outcomes can be achieved in many different body shapes and sizes, it is important for the patient to appreciate which category they fit into and therefore what type of outcome they will individually achieve.
Patients present with different body shapes. There are curvy figures, apples, pears, those with central visceral fat depositions as well as different shapes according to body weight. In patients of each different type a procedure can be performed well with a good recovery and yet the results will still all differ.
Commonly there is more than one option to consider. The natural tendency is to choose the smaller and simpler option. A most important aspect in choosing a procedure is to have a clear goal and by understanding how the various elements of the procedure interact to lead to outcomes it will become clear which procedure or combination is going to get you closest to that goal.
Choosing an alternative procedure which won’t logically take you to your goal may be performed well, you may recover flawlessly and yet not be completely satisfied.
Dr Magnuson will guide you expertly through this process using images of patient’s he has already treated with similar body shapes to give you a good understanding of the outcomes that might be achievable for you.
Assistance: When you return home from hospital you will have a reduced ability to perform your normal activities and especially your normal household duties. You may also have a specific need for assistance with certain activities especially in the first week. The larger the procedure the more likely this will be the case. For those with children arrangements will be necessary to ensure that they are adequately cared for during this time.
Meals: prepare with simple meals that are easy to reheat and healthy snacks with lots of available water.
Accessibility: think of those things that you will need to wake toiletries, medications, tissues/wet wipes, phone/charges/computer/TV remotes. These items should be readily available at hip height so that they don’t require bending or reaching.
Accessibility: Written instructions: keep information about your medications, their timing and your post-operative recovery instructions handy for regular reference as required. Consider a medication organiser so that regular medications can be taken at the right time of the day.
There are various stages of the recovery from surgery and especially from a significant procedure such as these.
Immediately after the surgery it is common to feel a little dizzy, discomfort and a bit disorientated in association with the medications from your anaesthetic and for managing pain.
The various stages include managing discomfort and the activities of daily living, managing more general household responsibilities, returning to activities including driving and exercise and finally the full maturation of the outcome and scar. These aspects all occur at different speeds.
For procedures that are in visible areas such as facial surgery, there is also a “social recovery” which means the effects of surgery have settled sufficiently to feel comfortable outside the house. The immediate post-operative swelling significantly resolves over the first couple of weeks, bruising is usually gone or coverable by 10 days to 2 weeks and a more relaxed appearance by about 3 weeks but changes will still be recognisable to those that know you best. The recent surgery is not obvious to most observers at 6 weeks and the appearance is natural at about 3 months.
You will remain in hospital until you are able to manage your discomfort and perform all the necessary routine activities of daily living with the level of support that you will have available at home. This may be as a day case for some procedures or after one or two nights in hospital for larger procedures or when there is limited help at home.
While in hospital you will be taught how to manage your medications and drains if you have have them. You will remain in contact with the clinic following discharge so that you will know when the drain is ready for removal.
You will be commenced on a medication called Clexane for some of these procedures (abdominoplasty, lower body lift and thigh plasty) and taught how to administer it at home. Clexane thins your blood and is administered by injection once a day. Abdominoplasty surgery does increase the intra-abdominal pressure and reduces blood flow from the legs and theoretically increases your chance of clots. This medication helps reduce the risk of clots during the initial early stage of your recovery during which your mobility is most affected and therefore this risk is increased. This is a very effective precaution and is continued for a total of 10 days for most patients unless there is additional risk.
In the short term when you get home there will be no driving and no significant exertion. You may require some extra pillows for support depending upon the procedure under your knees to keep them in a slightly bent position for comfort or under the arms with brachioplasty surgery.
At about one week you are well in control. You can return to driving after most procedures at this time. You know what makes the discomfort worse and therefore you avoid it. Medications are becoming far less necessary to remain comfortable. A relatively moderate discomfort during the day can be ignored when you are busy or thinking the other things that may become more noticeable when you are trying to clear your mind for sleep. Consequently many patients will still take a stronger pain tablet at night.
Patients with a sedentary job and need to be back at work may be able to go back on light duties if they are no longer requiring strong painkillers and especially if they are able to have shortened hours. Most patients will prefer to wait until two weeks if their circumstances permit. If the level of exertion at work can’t be controlled then six weeks off work will be required in uncommon circumstances.
By three weeks you are performing gentle exercise such as walking quietly without hand weights. You are in control of all aspects of your recovery and many patients are completely off painkillers. At this stage you will be performing most of your normal activities, they will just be a little slower and more deliberate than usual. You will still be avoiding significant exertion and not moving quite as freely as usual to avoid exacerbating any discomfort.
At six weeks you are liberated! You can return to all activities even exertion at the gymnasium however it will take a while to build back up to normal speed. You will have both good days when you do a bit more and bad days when you feel the results of those activities.
At six weeks your scar will appear as a relatively fine pink line. From this point it will actually become pinker and reach its most obvious point between three and five months.
At about three months most patients feel that they are not reminded daily about the surgery and are back to their normal activities. The majority of post-operative swelling have largely stabilised and resolved. There will be further improvements particularly in areas of liposuction over the next 12 months but these won’t be occurring at a appreciable rate from day-to-day.
At six months the scar will have usually peaked in terms of its visibility and already be improving but the full improvement of the scar is slow and takes 18 to 24 months.
Following your consultation you should understand and have answers to the following questions: