I lost 100 lbs., but nobody told me about all this loose skin! What can I do?

So, you have lost all the weight and don’t know where to start? Congratulations on losing weight. You have now increased your life span and, ideally, your quality of life. Your heart, liver, kidney, and all your joints will thank you. However, with significant weight loss comes excess skin that does not bounce back. For some patients, even though they lose hundreds of pounds, their skin bounces back quite successfully. Unfortunately, this is quite rare. What often happens is that patients are left with excess, sagging skin after significant weight loss. Now comes the effort of getting rid of that excess skin but, where to start. After specializing in this field for the past 20 + years, Dr. Katzen has devised an orderly approach to total body reconstruction after weight loss. Of course, every patient is different, expectations vary, and results differ from one patient to another. The following is a general guideline to address most but not all patients. 

“I lost all this weight, and now what to do?”

A thorough, personal, confidential physical examination and history will be essential to determine your exact needs. Often, Dr. Katzen gets asked, “I lost all this weight, and now what do I do?” To address all body parts, Dr. Katzen uses the following systematic analysis to accurately determine what surgical procedures you need after weight loss.  

First Surgery: Phase One

Assignment: The Lower Body 

#1) TUMMY, HIPS, AND BUTTOCKS: If your abdomen bothers you, you will probably need a tummy tuck or, the medical term, an abdominoplasty.  This will include mons reduction, mons lift, rectus abdominis muscle plication, belly button reconstruction, and removal of the excess skin and fat from the upper pubic region to at least above the belly button. If you have excess skin and fat around the hips, the tummy tuck incision may need to be lengthened into an extended tummy tuck. Suppose your buttocks sag, or you have excess skin and dimpling of the buttocks or excess buttock fat. In that case, you may need to convert the extended tummy tuck into a 360 circumferential lower body lift. Usually, the tummy tuck, extended tummy tuck, or 360 circumferential lower body lift is the first surgery that Dr. Katzen recommends to set the foundation of your new, post-weight loss body. 

#2) THIGHS: The second area of concern is the thighs. If your thighs bother you, Dr. Katzen will suggest one of 5 different types of thigh lifts or, really, thigh reductions. If the excess thigh skin and fat only bothers you in the upper ? of the thigh, Dr. Katzen may make an incision in the groin or from the groin partially down the inner thigh. Suppose the excess skin and fat extends to the inner knee. In that case, Dr. Katzen may suggest a vertical longitudinal medial thigh reduction which would include thigh liposuction.  This would involve an incision from the groin to the knee and the removal of a large ellipse of inner thigh skin and fat.  Calf liposuction or excision can also be combined with a thigh reduction.  

Before any surgery, multiple blood labs, urinalysis, EKG, and chest X-rays are reviewed.  Depending on your health, you may be able to combine the 360 circumferential lower body lift or tummy tuck(abdominoplasty) with the thigh reduction. Of course, suppose you would instead prefer to stage your procedures. In that case, you could have your tummy tuck, posterior body lift, and a vertical longitudinal medial thigh reduction separately.  However, most patients want as much done safely at one time as possible.  The length of the procedure and recovery time varies.  These procedures are performed under general anesthesia with the guidance of a anesthesiologist. You should plan to at least one month between each surgery. After each surgery, labs will need to be repeated.    

Second Surgery: Phase Two

 Assignment: The Upper Body 

#1) BREASTS: Female or male, Dr. Katzen will analyze your breasts.  If you are a female patient, you will need to ask yourself, “What are my goals for breast surgery?”

Dr. Katzen will ask you two particular questions: 1) do you want your breast lifted? And 2) do you want your breasts fuller?  If you want your breast lifted, you will need a form of breast lift or the medical term, mastopexy.  Usually, female weight loss patients require an anchor lift. If you desire more breast fullness, you will probably need breast augmentation with FDA-approved breast implants. Usually, breast augmentation and an anchor breast lift or mastopexy are performed together. 

Typical male weight loss patients want their chests reduced. If the chest skin excess is mild, you may only need chest liposuction. However, if you have significant excess chest skin, you may need a formal chest reduction with skin excision. The male chest reduction can be performed through a vertical or horizontal incision.  The vertical torsoplasty or stealth incision extends from the armpit down the side of the chest.  The horizontal male chest reduction is completed by making an incision under the male breast and relocating the nipple.  

#2) BACK: Dr. Katzen will ask you about your back. If your back bothers you, you may require liposuction or a horizontal or vertical torsoplasty. During a vertical torsoplasty, an incision is made from the armpit down the side of the chest or torso.  A large ellipse of lateral torso skin is removed.  The beauty of the vertical torsoplasty is that the vertical torsoplasty scar is hidden when your arms are by your sides.  In contrast, during a horizontal torsoplasty, an incision is made across the back, and a large ellipse of skin is removed from the back.  The horizontal torsoplasty is also called a bra-strap plasty or braplasty because the scar follows the bra-strap line.  Usually, the horizontal torsoplasty removes more skin and fat than the vertical torsoplasty.  However, the horizontal torsoplasty scar is more visible than the vertical torsoplasty scar since the horizontal torsoplasty scar extends across the back.  Often, the torsoplasty can be performed with the breast surgery in men and women. If an anchor breast lift and a horizontal torsoplasty are combined, this results in a 360-circumferential upper body lift. 

#3) ARMS: Dr. Katzen will ask you about your arms.  If there is mild arm skin excess, you may be a candidate for VASER arm liposuction. If you have excess skin and fat in the upper inner ? of the arm, you may be a candidate for a crescent arm lift. If you have excess arm skin and fat to the elbows, you will need arm liposuction and an incision from the armpit to the elbow. Often, the arm lift can be combined with the breast surgery and back or torsoplasty surgery. 

Again, these surgeries are performed under general anesthesia. Surgical and recovery times will vary. 

Third Surgery: Phase Three

Assignment: The Face and Neck 

#1) FACE AND NECK: The third area of concentration is the face. Typically, most weight loss patients are dissatisfied with their neck. Most of the time, most patients have excess residual fat in their necks. Usually, this can be treated with new state-of-the-art liposuction.  If you only need neck liposuction, this procedure can be performed during your lower or upper body procedure. If the excess skin and fat are more significant in the face and neck, you may need a formal neck lift or facelift. You may also consider having your upper and lower eyelids corrected.  Usually, if you need a facelift, neck lift, and eyelid surgery, these are performed during the third stage of surgery. 

So, there it is!  A simple approach to even the most complicated weight loss patient.  

So, whatever bothers you, please call Dr. Katzen for a confidential consultation. You and he will come up with a personalized surgical plan.  Dr. Katzen is an internationally recognized plastic surgeon and body contouring expert.  Dr. J. Timothy Katzen has offices in Beverly Hills, CA, and Dubai. Physical or virtual consultations can be arranged. Virtual consultation options include FaceTime, Zoom, Skype, and WhatsApp. Call (310) 859 - 7770 TODAY to schedule your FREE private in-office or virtual consultation to achieve the body of your dreams.