News & Features

Body Contouring

Achieving a Shapely Body After Massive Weight Loss

by Richard A. D'Amico, MD
President, American Society of Plastic Surgeons

With cases of morbid obesity at epidemic rates, the goal to lose weight has become a priority for a growing number of Americans.

But shedding the pounds doesn't necessarily promise a flattering figure. For the majority of massive weight loss patients, losing the weight is just the beginning of a new journey toward looking and feeling healthy.

Loose, Hanging Skin

When a person is morbidly obese, significant weight loss of 100, 150, or even 200 pounds can create large amounts of sagging skin that is difficult to camouflage. This drooping skin commonly includes loose, hanging skin on the abdomen, breasts, arms, and thighs.

"..shedding the pounds doesn't necessarily promise a flattering figure."

Hygiene problems can persist due to infections and skin-to-skin friction. Many patients find that they are still physically restricted from the hanging skin, making exercise difficult. But exercise is a necessary aspect of post-bariatric surgery to maintain the weight loss and to improve the patient's general health. To overcome these hurdles, many patients develop a long-term relationship with a board certified plastic surgeon and develop a staged surgical re-contouring program to remove the loose, hanging skin.

Tummy Tuck and Liposuction

One of my experiences was with C.M., a 28-year-old single female who lost 130 pounds after a gastric bypass in 1996. C.M. came to my office in 1998 with a stable weight and a goal of improving the contour of her torso and lower extremities, which were left with too much skin, a more-or-less typical result of her rapid weight loss. Following her consultations, a surgical plan was developed. Our patient began her body re-contouring with an extended abdominoplasty/body lift, performed in September of the same year. Liposuction of the torso and lower extremities was also carried out later that year in December with fantastic results.

Unlike C.M., however, many bariatric patients never truly complete their weight loss journeys.

Breast Lift

Imagine shedding excessive pounds with nothing to show for it but large amounts of loose, sagging skin. Plastic surgeons take care of these problems with many different potential options, including abdominoplasty (tummy tuck), breast lift or reduction (or in the case of males, gynecomastia excision), upper arm lift, medial thigh lift ("saddlebags"), and lower body lift.

These patients may also be candidates for other procedures including additional liposuction and facelift surgery. The American Society of Plastic Surgeons (ASPS) statistics show that while most bariatric patients consider plastic surgery to re-contour their bodies after losing excessive amounts of weight, less than 15 percent of patients actually go through with it.

Costs of Plastic Surgery

Finances are a major part of the low percentage. In C.M.'s case, the total cost of her surgery was about equal to what a family of four would spend on a vacation. (Read more about costs of plastic surgery.)

At 28, C.M. was left with loose, hanging skin
after losing 130 pounds.

Ten months later, C.M. shows the results
of body shaping surgery.

Recontouring procedures are very difficult to obtain insurance reimbursement for, making the majority of the procedure self pay. Staged surgeries require multiple recoveries and for most patients that means one to two weeks away from work, depending on the number and severity of the procedures, which also has financial implications. For some patients, it is simply a reluctance to have additional surgeries.

For those who do opt for plastic surgery to complete their weight loss journey, the following is suggested for best results:

Be as close to your ideal weight as possible
Typically, patients lose the majority of their excess body weight two years after weight loss surgery. When your body is at your desired weight, you will have more surgical options, surgery will be safer, and you will experience better results.

Maintain a stable weight for at least three consecutive months
If you are still losing weight right before or during the time of surgery, it can negatively impact your healing and recovery.

Devise a surgery plan with your plastic surgeon
You may need multiple surgeries to achieve your desired results. You should work with your plastic surgeon to decide what order to have your body contouring procedures, which procedures you should have, and when you will have them.

Eat healthy
Many patients are unable to digest well or do not enjoy eating protein after bariatric surgery. However, protein is essential to reduce blood clots and promote healing. Weight loss surgery may also alter the body's absorption of certain fat-soluble vitamins such as Vitamin K. Therefore, it may also be necessary to take certain dietary supplements to maintain proper nutrition.

Have a diet and exercise routine in place
There is no substitute for the healthy lifestyle you need to adopt to maintain your outcome after plastic surgery.

Have realistic expectations
It is difficult to achieve perfect symmetry during body contouring in complex cases. Your age, the extent of loss of skin elasticity, and areas of the body affected are all factors that have an impact on the outcome. Be sure to get a clear explanation of what your procedure(s) will entail, and be prepared for the possibility of necessary revision surgeries.

General Anesthesia

For healthy patients, staged outpatient procedures under general anesthesia in a hospital outpatient center or an accredited office-based surgical facility are an appropriate and efficient way for massive weight loss patients to reach their goal. Whether recontouring the arms, breasts, body or legs, patients can expect a recovery within one to two weeks, depending on the exact procedure.

By 2007, our patient C.M. has become a fit, happy, healthy 37-year-old with a fantastic husband and two children. She works full time and maintains a stable body weight.

"…drooping skin commonly includes loose, hanging skin on the abdomen, breast, arms and thighs."

But she still had some extra fat under her chin. So in December of 2007, it was corrected with sub-mental liposuction, or liposuction of the neck and jowls - a short, low-risk, relatively inexpensive procedure, with results similar to that of a facelift.

C.M. couldn't be more pleased, "I have a neck now - I never had one before!"

About the doctor: Richard A. D'Amico, MD, is a board certified plastic and reconstructive surgeon, and the medical director of the Englewood Hospital and Medical Center in Englewood, New Jersey. To learn more, please visit

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