Surgery After Massive Weight Loss for Toowoomba, Brisbane & the Gold Coast

surgery after weight loss - Dr Magnusson

 

Surgery after massive weight loss

Over the past 50 years, we have seen obesity become a significant community health issue affecting an increasing number of patients. We have also seen a large number of motivated people across Toowoomba, Brisbane and the Gold Coast undertake the difficult task of losing massive amounts of body weight to address their obesity and associated health issues. Many patients have managed this without medical assistance, focusing simply on correcting the energy imbalance (calorie intake and expenditure) that led to their obesity. Other patients have achieved their weight loss goals with the assistance of bariatric procedures, such as gastric banding, sleeve gastrectomy or gastric bypass.

Whichever way weight loss is achieved, the level of satisfaction gained by reaching your goal weight can be marred by the realisation that your pre-weight loss body has not also reappeared, instead you may be affected by loose skin on various parts of your body. These loose folds will vary from person to person and may become affected by infections or rashes due to rubbing and irritations with movement and exercise. This can also interfere with daily hygiene and routine activities.

There are reliable surgical options for addressing these concerns, which A/Prof Magnusson can provide.

Weight loss procedures available

In his Gold Coast and Toowoomba clinics, A/Prof Magnusson offers a range of procedures for patients who want to change the shape of their bodies after weight loss. These include:

  • Abdominoplasty
  • Lower body lift
  • Brazilian butt lift (BBL)
  • Brachioplasty (upper arm lift or arm reduction)
  • Breast implants
  • Breast reduction surgery
  • Mastopexy or breast lift (with or without breast implants)
  • Upper body lift combination
  • Thighplasty (thigh reduction)
  • Face and neck lift
  • And others
What are these procedures for?

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

  • skin laxity which requires the excision of skin and consequently there is a wound and a scar
  • fat excess or distribution problems which can be managed with a combination of liposuction and excision
  • structural problems of the underlying fascial and muscle structures or droop particularly of the breast and buttock

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 are improved as much as possible by increasing tension with skin excision. However the irregularities such as stretch marks will still exist to a degree.

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.

What happens at operation?

These are significant operations and all performed under general anaesthesia at an accredited hospital with a fully qualified anaesthetist.

  • The surgical markings for the procedure or combination of procedures will be made prior to the surgery by Associate Professor
  • The anaesthetist will look after your comfort and breathing during the surgery.
  • The surgery will be performed with you fully asleep with the help of an experienced plastic surgery theatre team.
  • Compression garments or bras will be fitted over the dressings along the wounds from surgery before you wake up.
  • Your initial recovery will be close to the operating room for the first 45 minutes to an hour.

If you have are having a day case procedure, you 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.

Surgical options and additional procedures.

Patients who have lost a 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 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.

Common combinations:

  • Lower body lift or abdominoplasty with circumferential trunk liposuction and buttock fat grafting/Brazilian butt lift
  • Lower body lift or abdominoplasty and breast surgery
  • Brachioplasty and breast surgery
  • Brachioplasty and thighplasty
Who is a good candidate?

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:

  • Has good general health with a positive attitude and realistic goals.
  • Is close to or in the normal body weight range and has achieved their goal weight if weight loss is required and has remained stable at this weight for more than 6 months.
  • If the patient is a woman, she has completed her family and waited at least 12 months firstly to be sure and secondly because there are significant changes to the body that occur during this period of time.
  • The chemicals in cigarettes reduce the blood flow in the skin and have the ability to impact wound healing.
  • While many of the associated goals of this surgery are for an improved appearance, wound healing problems would be a substantial concern. This surgery is not performed by Dr Magnusson on current smokers. Every patient who smokes would be required to stop smoking for at least six weeks prior to surgery and remain off cigarettes for at least 4 weeks following surgery.
  • The best outcomes from any procedure involve three aspects: selection of the correct proceeded to reach the goal, are technically well performed and safe operations, diligently following the post-operative management plan. Deviation from this path at any step may alter the outcome and importantly that also includes not following the post-operative instructions.
The consultation

A/Prof 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.

  • Medical history: When you attend for your consultation with A/Prof Magnusson you will initially be seen by a nurse who will check your medical history. Information that is important includes past surgical procedures, medications, allergies and adverse reactions to medications.
  • Clinical photographs for your record will be taken. These images are a private and confidential part of your medical record and are not shared in any way without your consent and prior approval. Clinical photographs greatly assist the consultation process as we can look at photographs of the body from angles that you would not normally see to help explain relevant points of the examination and treatment decisions that may be considered.
  • You will be seen in a lengthy consultation with A/Prof He will want to determine your goals, expectations and motivating factors.
  • Your body mass index will be assessed as there is a differential rate of risk and different outcomes associated with different levels of body weight and different body shapes. A/Prof Magnusson will have a frank discussion about your weight and your goals in this regard.
  • This surgery has many forms and in some patients additional procedures are indicated.
  • An examination will be performed that will focus on your areas of concern but also assess adjacent areas:
    • The assessment of skin laxity
    • Fat distribution and volume all the way around the body
    • Muscle and fascial integrity and droop (breast and buttocks if these are part of your concern)
    • The presence of any additional problems such as and apron which may be troubled by skin irritations.

Realistic expectations of surgery after weight loss

The important elements that lead to the best outcomes from this surgery are having:

  • A clear goal
  • Selecting an operative procedure that is designed to get you as close to this goal as possible
  • Adhering to the post-operative guidelines and restrictions

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.

Preparing for the return home after surgery

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.

Surgery After Weight Loss – Recovery

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 thighplasty) 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.

  • Are you a good candidate for this surgery?
  • What procedure types are you going to need to achieve your goals?
  • What treatment options are there and how will the results differ?
  • Are your goals realistic and achievable?
  • The length, quality, duration and location of scarring.
  • The important aspects of your recovery.
  • The timing of your return to work and other activities.
  • The risks of surgery and the likelihood of complications and what is required to manage them.
  • What is required of you to achieve the best outcome from surgery both in preparation for the procedure and the recovery from surgery.

Arrange a consultation for surgery in Toowoomba or on the Gold Coast

Following your consultation, you should understand and have answers to the following questions:

  • Are you a good candidate for surgery after weight loss?
  • What procedure types are you going to need to achieve your goals?
  • What treatment options are there and how will the results differ?
  • Are your goals realistic and achievable?
  • The length, quality, duration and location of scarring.
  • The important aspects of your recovery.
  • The timing of your return to work and other activities.
  • The risks of surgery and the likelihood of complications and what is required to manage them.
  • What is required of you to achieve the best outcome from surgery both in preparation for the procedure and the recovery from surgery.

A/Prof Magnusson can assist patients across Brisbane with surgery after weight loss. You can arrange a consultation him at either his Gold Coast or Toowoomba clinics.

Dr Magnusson

Dr Mark Magnusson

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