350 lbs Weight Loss Skin Removal

According to the CDC, about 42% of Americans are obese. Obesity can lead to heart disease, stroke, diabetes, certain types of cancer, and premature death.

This case study examines one of Dr. Katzen's patients' weight loss journey. This patient is a 44-year-old female from Nevada who decided to turn her life around when she reached 556 lbs. She dieted, exercised, and underwent gastric bypass surgery; she lost 350 lbs.! After her weight loss plateaued, she presented to Dr. Katzen for evaluation and consultation. Losing large amounts of weight was highly beneficial to her health and well-being. However, the side effects of massive weight loss include loose, excess skin that can only be corrected with surgery. Diet and exercise alone will not correct skin issues like these.

On physical examination, this patient's abdomen hung halfway down her thighs and completely covered her pubic region. She had a large buttock and disproportionate hips. Her thighs were very big, from her groin to her ankles. Her breasts were utterly deflated and hung below her belly button. Also, she had very large upper arms. Heavy, excess skin and fat cause extreme discomfort and pain while performing daily tasks. Also, this excess skin and fat made exercising extremely difficult.

This patient desired a full-body transformation. Dr. Katzen advised her to stage her surgeries into three parts. Stage 1: 360 circumferential lower body lift, which included abdominoplasty (tummy tuck), hip lift and reduction, and buttock lift and reduction. Stage 2: brachioplasty with arm liposuction (arm lift and reduction), anchor mastopexy (breast lift and reduction), and vertical torsoplasty. Stage 3: longitudinal medial thigh lift and reduction (with thigh liposuction) and calf reduction.

Stage 1: 360 circumferential lower body lift: abdominoplasty (tummy tuck), hip lift and reduction, and buttock lift and reduction

Dr. Katzen began on the posterior (back) side and made an incision from one hip to the other. Next, he dissected towards the buttock and released adhesions along the way. This dissection released bands that cause cellulite in the buttocks and hips. Once these adhesions were freed, Dr. Katzen lifted the buttock to create a more slender figure. Then, Dr. Katzen checked his anticipated resection three times before resecting the excess skin and fat. Finally, Dr. Katzen meticulously closed the many anatomic layers using a combination of permanent and dissolving sutures with a six-layer closure. Once Dr. Katzen finished suturing, the patient was flipped, and the anterior (front) side surgery was begun.

An incision was made above the pubic region and extended over the hips. This incision is connected to the posterior incision. Next, Dr. Katzen dissected to the sternum. This dissection exposed the rectus abdominis muscles. Next, to flatten the anterior abdominal wall, Dr. Katzen plicated the six-pack muscle. Next, Dr. Katzen pulled down the excess skin and approximated the abdominal skin and fat resection.

The 360 circumferential lower body lift was performed under general anesthesia with a anesthesiologist and medical doctor. This patient's procedure took six hours. During this procedure, 21 lbs. of skin and fat was removed from the patient's abdomen, hips, and buttocks. This patient recovered over four weeks and returned three months later for stage two -- the upper body.

Stage 2: Brachioplasty (arm lift and reduction), anchor mastopexy (breast lift and reduction), and vertical torsoplasty. The upper body procedure included a long brachioplasty with arm liposuction (arm lift and reduction), vertical torsoplasty, and an anchor breast reduction with a breast lift (mastopexy) with the relocation of the nipple.

For the upper body lift, Dr. Katzen began with the arm lift and reduction, also known as a brachioplasty. First, Dr. Katzen began with arm liposuction to give the patient the best results. Next, an incision was made from the armpit to the elbow and placed where a shirt's inseam would be. Next, Dr. Katzen dissected down the arm to free as much skin as possible. Then, Dr. Katzen pulled that skin forward to meet the incision.

After approximating how much skin could be removed, Dr. Katzen resected the extra arm skin. The arm was closed in three layers. Next, Dr. Katzen worked his way down the side of the body. This part of the procedure is called a vertical torsoplasty. In this patient's vertical torsoplasty, her incision extended from the armpit and past the breast or infra-mammary fold. Next, excess skin and fat of the torso, also known as the "side boob," was dissected and resected. The final step of Stage 2 surgery was the breast lift with an anchor incision and mastopexy. The areolas were reduced, and the breasts were lifted. Next, the breast tissue was skinned to preserve the blood supply of the remaining breast tissue. The breasts were then lifted and reshaped into the patient's desired size. Next, the nipples were relocated, and the breasts were closed in a three-layer closure.

The upper body lift, or Stage 2 procedure, took seven hours to complete. Two lbs. of skin and fat were removed from the arms, 1 pound of skin and fat was removed from the breast, and 2 lbs. of skin were removed from the torso. The total amount of skin and fat removed for stage 2 was 5 lbs. This patient's arm circumference at the beginning of surgery was 16 inches. At the end of the surgery, her arm circumference was 10 inches.

Before and after arm lift & reduction + breast lift and reduction by Dr. Katzen. To see more before and after photos, go to https://beverlyhills.timothykatzenmd.com/before-after-photos/body/after-weight-loss-surgery

Before and after arm lift & reduction + breast lift and reduction by Dr. Katzen. To see more before and after photos, go to https://beverlyhills.timothykatzenmd.com/before-after-photos/body/after-weight-loss-surgery

Stage 3: longitudinal medial thigh lift and reduction (with thigh liposuction) and calf reduction.

The third and final procedure was a longitudinal medial thigh lift and reduction along with the calf reduction. The procedure started with liposuction of the thighs and calves. After thigh and calf liposuction, Dr. Katzen made an incision from the groin to the knee and the inner ankle. The incision was placed where the inseam of the jeans would be. Dr. Katzen dissected towards the back of the thigh, measured his resection, then excised the excess skin of the upper thigh. After closing the thigh with a six-layer closure, Dr. Katzen moved to the calves. The dissection and resection were repeated on the calves. A total of 6 lbs. of skin and fat was removed. The longitudinal medial thigh and calf lift reduction surgery took six hours and was performed under general anesthesia with an anesthesiologist.