Post-Massive Weight Loss Surgery

Accomplished through a series of surgical procedures, body contouring aims to remove excess skin and fat and to tighten underlying muscles. The techniques employed are specific to each area of the body, ranging from the face and neck to breasts, abdomen, back, and buttocks. With proper experience and expertise, the surgeon you choose will help you decide which areas to target with surgery. The goal is to achieve smoother, firmer, shapelier contours for anyone experiencing the discomfort of excess skin. It can make a dramatic difference in your confidence, your day-to-day physical comfort and your overall health.

Interestingly, sometimes corrective measures may involve restoring volume in certain areas. This helps achieve a smoothly rounded, natural-looking shape, especially in the breasts, buttocks and face. Dr. Harris may recommend fat transfer for this, especially to lift the buttocks and to add volume under the eyes.

At Image Surgical Arts, we have found that many bariatric surgery patients did not clearly understand just how deflated they would appear, post-surgery. Many of our patients are also caught off guard by the sheer volume of excess skin. This creates multiple problems:

• Aesthetic – excessive skin is unsightly and makes it difficult to find clothes that fit well, despite your smaller size. You lost weight for your health, but you want to look your best, too. Many of our male patients confide that they want to look good at the beach.
• Functional – rolls and folds of pendulous skin are uncomfortable, often painful. They can make it difficult or even impossible to move around, and they interfere with personal hygiene, sexual activity and the ability to exercise.
• Physical Health – intertrigo (inflammation caused by skin rubbing on skin) can lead to rashes and secondary fungal or bacterial infections.
  Surgical body contouring, sometimes referred to as a body lift, can correct these problems, improving your appearance, physical function, quality of life and self-esteem. All of this can help to increase your motivation to maintain your new weight. Post-massive weight loss surgery can be totally life-changing, allowing you to be truly happy with your post weight loss self.

Because post-massive weight loss surgery involves multiple procedures, it is often safer to complete these surgeries in stages. This limits the length of time that you’re under anesthesia for each surgery. It also allows for faster, more comfortable recovery each time, which is crucial for good health and good results. The body automatically sends increased blood flow and growth factors to wounds to promote and support healing, so keeping the focus on a limited number of areas allows your body to do its best work without being over-taxed.

At Image Surgical Arts, the most common body contouring procedures that we perform are:

• Tummy tuck
• Breast augmentation or lift
• Face/neck lift (mid-face, jowls, neck)
• Male chest lift
• Arm lift (upper arms and axilla)
• Thigh lift (inner and outer thighs)

Depending on each patient’s specific physical condition and desires, we can also include:

• Breast reduction
• Body lift (tummy tuck with surgical buttock lift)
• Buttock lift

We perform these procedures to remove excess skin and tissue to eliminate sagging. Dr. Harris will also lift and reshape as necessary to restore normal projection and fullness, such as in the breasts and buttocks.

Areas to be addressed in each surgical stage will depend on your priorities and the safest path forward.

The Role of Liposuction

Despite having lost a tremendous amount of weight, you undoubtedly have remaining pockets of fat that exercise just cannot eliminate. Liposuction helps remove that lingering fat and re-contour the area. Most surgeons do that, but at Image Surgical Arts we take a more “whole-body” approach. We believe attention to detail is critical in order to give every patient the finest results possible.

So, to this end, Dr. Harris uses a 360^o liposuction technique whenever he performs abdominal surgeries such as tummy tuck (typically a central part of massive weight loss surgery), to produce smoother, leaner lines all around, not just in one area. To do this he treats the hips, mid- and lower back and flanks as well as the abdomen. He also uses VASER-assisted technology, which is much gentler and gives him more precise control than traditional liposuction.

Dr. Harris may also use liposuction to remove fat for better shaping even before he makes an incision. Essentially, this helps loosen the skin, freeing up even more excess that can then be removed. This is the attention to detail that makes a difference in producing tighter skin and better-defined contours.

Post-massive weight loss surgery is intended primarily to remove excess skin and tissue and re-contour remaining fat. But you want to look your absolute best, so Dr. Harris may recommend non-surgical follow-up procedures or treatments to put the finishing touches on your new body.

Laser Skin Resurfacing

At Image Surgical Arts we offer a range of skin rejuvenation treatments that are ideal for correcting imperfections and fine-tuning skin texture and tone. We can use these treatments to renew the skin (face or body), addressing everything from remaining skin laxity to fine lines and wrinkles, age spots and other hyperpigmentation issues and even acne scars.

And speaking of scars, Dr. Harris may recommend follow-up laser treatment to help minimize the appearance of scars you will have after your post-weight loss surgery.

Dermal Fillers

Because weight loss reduces fullness in the face as well as elsewhere, Dr. Harris may use dermal fillers to replace some of that lost volume – in the cheeks, for example – to restore more lifted, youthful looking contours.

If you’ve lost more than 100 pounds and are left with sagging skin, and you want to fine tune your appearance, you may be a good candidate for body contouring. However, if you are planning a future pregnancy, it is best to wait until afterwards so we can achieve the best results, especially for tummy tuck and breasts. The best candidates are:

• in good health overall
• have maintained a stable weight for at least six months -- weight changes up or down can negatively impact surgical results
• committed to maintaining a healthy weight and lifestyle
• non-smokers - smoking increases risk of complications, including delayed or poor healing, and it puts your overall health at continued risk. At Image Surgical Arts, when we say “no smoking,” we mean it. Your health is our #1 priority. Dr. Harris requires patients to be nicotine-free for at least six weeks before and six weeks after their post-massive weight loss surgery. Every surgery, if you have multiple procedures. We reserve the right to perform a nicotine test on any patient.

Risks associated with body contouring vary according to the amount of tissue removed as well as your age, lifestyle habits and overall health. Risk for complications is higher for those who have lost a massive amount of weight, especially via gastric bypass surgery as opposed to diet and exercise, and for those who have chronic health issues such as heart disease or diabetes.

For this reason, Dr. Harris may conduct a physical exam and/or lab tests to evaluate your overall health status prior to your surgery. Stable weight helps mitigate risk, which is one reason we require that patients maintain stable weight for at least six months before undergoing this surgery.

Any incision, no matter how big or small, creates a risk of bleeding, infection, and injury to surrounding structures. Potential complications vary according to the specific procedure(s) being performed, but in general they include:

• Blood clots (DVT or PE) – thrombosis risk is higher for post-massive weight loss surgery because the procedures are often longer than other types of surgery
• Heavy bleeding – blood vessels are bigger than usual after having supported a good deal more body tissue than you will have post-surgery. They do not contract when you lose weight, so you will need to be conscious of this.
• Dehiscence – Dr. Harris uses a special technique to ensure maximum skin tightening, and occasionally this can cause a slight pulling apart of the incision. This can be easily treated, but it is an inherent risk of the procedure.
• Skin necrosis (dying of a small area of skin) – this risk is significantly higher in smokers and diabetics. It can lead to a wider scar.
• Hematoma (collection of blood under the skin) – this is rare, and if it happens it will probably need to be drained surgically.
• Seroma (collection of fluid, not blood, under the skin) – this isn’t necessarily a dangerous complication, but it can be annoying and may require non-surgical drainage.
• Anesthesia – while minimal, there are also risks associated with anesthesia such as nausea, vomiting, allergic reactions, and others. Our anesthesia team will discuss all those risks prior to your procedure.
• Nerve damage
• Lingering pain
• Cardiac or respiratory complications
• Disappointing results – technically this isn’t a complication, but unhappiness could be a risk if you go into surgery with unrealistic expectations. This is why it is so important to have an open and honest discussion with Dr. Harris at your consultation. We want you to be truly pleased with your results.

This is not a complete list of risks and complications, just those that are most common. Even these are rare, overall. Nonetheless, body contouring is a major undertaking and it is especially important that you understand the possible risks or side effects. By working closely with Dr. Harris to discuss medical issues and prepare a detailed surgical plan, and by following post-surgical instructions carefully and completely, you can help reduce your own risk.

Once you’ve lost all that weight, it’s normal to be anxious about putting the finishing touches on your new body. We would love to have you in for a consultation to discuss your goals and all of the possibilities. However, in order to set you up for success after any surgery, we need to be sure that your weight has stabilized. This means that you’ll need to wait for about six months before moving ahead with any procedures. This can certainly be frustrating, but fluctuations in weight post-surgery will negatively affect your results, which would be a shame!

Let’s review some other important considerations to make.

Time Commitment

Just like the decision to undergo weight loss surgery, there is a lot to think about when considering restorative follow-up procedures. It can be a lengthy process, involving multiple surgeries that affect many areas of the body. That means a renewed commitment to the time and effort required for recovery, which may impact not only you, but your friends and family as well. It probably took you a year or two to lose weight. It may take just as long for your body contouring results to be fully revealed.

There are several things to think about when arranging all of the moving parts for your procedure and recovery.

Length of Recovery Time

You will need to set aside enough time away from your work and home responsibilities so that you can recover with few distractions. Dr. Harris will explain the limitations that are recommended for each of the procedures in your surgical plan. If your job or other responsibilities involve strenuous activity, you may need extra time to recover, to prevent any undue discomfort or delay.

Vacations or Special Events

You should be fully healed before venturing out, for safety as well as appearance reasons. Keep in mind you will be undergoing multiple surgeries, each with a unique recovery period. Procedures of or near the face can leave bruising, swelling, and redness - you’ll want to leave time for these to fade before stepping in front of any shutterbugs!

Your Caregiver’s Schedule

We recommend that someone stay with you at all times for at least 48 hours after your procedure. This time is crucial for optimal recovery, and getting help will relieve stress so you can focus on healing. The longer you have some assistance around, the easier recovery will be.

Time in Compression Garments

Recovery for many of your procedures will require that you wear a compression garment. These are used to support the skin and underlying tissue as it heals and to help reduce swelling, both of which help speed and improve the recovery process. How long you will have to wear a compression garment varies according to the type of surgery, but it could be anywhere from a short period to 3-4 months.

Expectations

It is vital that you understand what is involved, the risks as well as potential benefits and, above all, the kind of results that surgery can realistically produce. Surgery can transform your body, but there is no such thing as perfection. Each person has specific reasons for considering post-massive weight loss surgery. You will discuss your concerns, desires, expectations, and priorities with Dr. Harris at your private consultation. He will explain the risks involved with this process as well as the benefits you can achieve and the recovery process for each procedure. Then he will recommend a surgical plan tailored just for you. He will combine the procedures you choose when possible – for example face/neck lift along with arm lift – but he will start with those procedures that you have deemed a priority.

By now, you have studied before and after photos of similar patients, so you have a realistic idea of the improvements you might expect to see. Perfection is unrealistic, but you will look and feel so much better.

Going into Surgery

Convenience and comfort matter. They can go a long way toward making your surgical experience a positive one. At Image Surgical Arts, our patients appreciate the fact that we do everything in-house. Our clinic and state-of-the-art surgical center are located together, so there is no need to go to a hospital.

To prepare for your surgery, we may give you antibiotics to take ahead of time or ask you to avoid aspirin, anti-inflammatory drugs, herbals or other products that could increase risk of bleeding. And if you smoke, you will need to quit at least 6 weeks ahead of time.

We perform all surgeries under general anesthesia in our own accredited, state-of-the-art surgical center, so it is familiar and convenient for patients. You will arrive and go home the same day, so you’ll need someone to drive you.

The surgical steps are essentially the same, regardless of which parts of the body are being addressed, though there will be some variations. In some cases, Dr. Harris may augment his surgical techniques to further enhance recovery and results. For example:

• For breast procedures, he injects platelet-rich plasma to help reduce the appearance of scars. This is entirely safe since PRP is made from a small sample of your own blood.
• For a face and/or neck lift, he may recommend fat transfer to restore volume under the eyes. Rounder features make you look younger and refreshed instead of hollows that can give you a gaunt appearance.

Before beginning any surgery, Dr. Harris will draw marks on your body that will serve as a template for his work. Surgeons almost always do this, but Dr. Harris takes it a step further. He often uses liposuction to remove some fat first, so he can refine his incision plan and remove the maximum amount of excess skin and fat. Then, before he finalizes this work, he uses staples to temporarily close incisions, to see how you will look. This enables him to make adjustments to produce even better contouring results before he permanently closes.

The duration of your surgery will vary according to the number and type of procedures in each stage of your surgical plan. A tummy tuck is the most extensive procedure, and it can take 3 to 4 hours. We noted earlier that Dr. Harris incorporates 360° liposuction with tummy tucks for all-around contouring that smooths the lower and mid-back, back bra roll, waist, hips, mons and upper and lower abdomen. He almost always uses liposuction during other post-weight loss procedures as well, to create the most pleasing, natural looking contours.

When the surgical steps are complete, Dr. Harris will place one or two drains as he closes the incisions, to release any build up of fluid. You may be placed in a compression garment, then we will move you to the recovery room where one of our nurses will monitor you until it is safe for you to go home. Dr. Harris will see you back in the office the following morning to check on your surgical sites, show you how to do your first dressing change, make sure all is well, and answer any questions you may have.

Availability of Aftercare

You will need help from a friend or family member, especially at first. That includes physical and emotional support, both of which are important for healing.You will need to have a responsible adult with you at all times for the first 48 hours at least. You will need assistance with daily basics at first, and you will want (and deserve) some extra pampering.

We will give you detailed written instructions for self-care after you return home. We will go over everything with you before you leave, to be sure you understand – that said, you should feel free to call any time you have questions or concerns. You can read more about the recovery process below.

It is crucial that you follow all of your at-home instructions because there is an important reason behind every detail. You can also take other steps to ensure your recovery goes as quickly and successfully as possible:

Get Comfortable

Before your surgery, designate a spot as your recovery headquarters – a place where you can relax comfortably (a recliner is a good choice, but a chair and ottoman or cushy sofa are also good options), with water, medications, TV or movies or a good book within easy reach.

Get Moving

At first, movement will be restricted by your own body and by our home care instructions, but short walks and deep breathing exercises are vital. This promotes circulation of blood and oxygen that support healing, keeps your lungs clear and reduces risk of blood clots. Follow your instructions, but don’t overdo it.

Be sure to budget plenty of time for recovery. Short-changing yourself at this point can actually delay healing, cause complications, or reduce the quality of your results. We will give you detailed, written instructions for at-home care, and we’ll go over everything with you before you leave.

Your instructions will cover:

• Incision care – dressings or bandages will be placed over your incisions, and they will have drains that must stay in place for a week or so (except for the face and neck). Dr. Harris will remove them at the appropriate time.
• Medications – broad-spectrum antibiotics and/or anti-inflammatory analgesics that we prescribe
• When and how to wear your compression garment(s)
• Allowable movements and exercise, based on your specific procedures – for example, a certain amount of walking is necessary to promote healing and minimize blood clots in the legs, but we may ask that you not bend over, lift anything or stand up straight for the first few days to avoid putting strain on your incisions and muscles.
• The schedule for your follow-up visits.

You will have some bruising and swelling at first, which will gradually subside. You will feel stiff and sore, and you won’t be able to stand fully upright or fully extend your limbs, depending on your procedure. After a week or two, though, you can start easing your way back to normal.

Recovery time will depend on which procedure(s) were included in your surgery. Tummy tuck requires the most time because it is so extensive, typically including repair of underlying abdominal muscles as well as fat removal, skin excision and tightening.

Every surgical procedure we perform at Image Surgical Arts is personalized for each patient. That is especially the case for post-massive weight loss surgery, since it is a complex process that involves multiple individualized procedures. Because there are so many variables, there is no set fee and patient costs can vary widely.

That said, cost generally ranges from $10,000 to $50,000 or so, depending on the procedures you choose. One patient may want only a tummy tuck, whereas you may want a tummy tuck plus thigh lift, breast lift and/or something else.

We will discuss costs with you before you make a final decision to move forward with surgery, and we will give you a detailed written estimate. If you are comparing prices with another surgical practice, be sure to do that item by item, because cost estimates can differ. One that is incomplete will be lower and look more attractive, but it could cost you more in the end once you discover the hidden costs.

At Image Surgical Arts, we value transparency. We want you to know exactly what you’re getting, so we always quote an all-inclusive price that covers:

• Surgeon’s fees
• Anesthesia fees
• Operating room fees
• Surgical supplies
• Follow-up visits

If there will be extra charges for items such as prescription medications or compression garments specific to your surgery, we’ll explain that up front. We do not want to surprise you!

Post-massive weight loss surgery is considered cosmetic, so it is usually not covered by insurance and we do not accept insurance at Image Surgical Arts. 

Financing Options

We understand this surgery can be quite expensive, given the fact it is actually a combination of several procedures. If you will have two or more separate surgeries, you can pay for each one separately. However, we encourage our patients to consider the possible financial benefits of treating their body contouring surgeries as a single package. Why? We offer a 5% cash discount. That’s $2,000 if your total bill is $40,000 – money you could save if you have cash on hand, or an immediate reduction in the amount you would need to finance.

Image Surgical Arts patients can use any of these financing options:

• We accept CareCredit and Alphaeon credit cards, with no-interest financing for 12 months. You may also be able to use these cards for extended payments up to 60 months, but because the financing is unsecured the interest rate will be higher. Depending on the amount financed, monthly payments could be uncomfortably high.
• United Medical Credit works with patients to secure third-party financing.
• Your own bank or credit union. Bank loans and home equity lines of credit are secured with collateral, so interest rates tend to be lower.

One final thing to keep in mind regarding cost: post-weight loss surgery is about results, and your health and safety are paramount. Choosing a surgeon and practice you trust will boost your confidence and peace of mind, and that’s priceless.

When you decide to have any type of surgery, you are putting your body into someone else’s hands. In the case of cosmetic surgery, the results of their work will be very visible – that’s the point. So everything about your surgery, your health and safety and satisfaction, all depend on the person you choose to perform your procedure. Successful cosmetic surgery requires extensive training, skill that can only come from experience, and an exceptionally artistic eye.

You want to be supremely confident in your surgeon’s abilities in all three of these areas. And did you know that almost any licensed physician may perform these procedures, even if they do not have any specialized training? Furthermore, even many otherwise-experienced cosmetic surgeons do not have much experience in post-major weight loss surgery. Frankly, they don’t want to do these procedures because they are especially complex and time-consuming.

You want the best. Not just anyone – especially since you will be undergoing multiple different procedures. The fact that Dr. Harris is board certified in general surgery as well as cosmetic surgery and facial cosmetic surgery underscores his skill and experience in performing surgery on all parts of the body. Successful results require detailed anatomical knowledge that guides skin excision and contouring. Dr. Harris’ specialized expertise enables him to meticulously tailor his work to match each patient’s desired goals, always with utmost safety.

Beyond the best in talent and competence, you want a surgeon who makes you feel comfortable. If you don’t feel at ease, you won’t be able to have the kind of honest personal discussion required to learn about and plan post-massive weight loss surgery. Do you trust that everyone associated with this practice has your best interests in mind at all times? Do you like the surgeon and the other team members? Friendly people and a welcoming environment can do wonders to soothe your anxiety and boost your ultimate satisfaction.

Board Certification

Surgeons are not required to be board certified, but they can earn this designation that confirms their competence through rigorous written and oral examinations – but only after having performed a certain amount of procedures. Board certification tells you this surgeon is not only highly trained but committed to using the most advanced medical knowledge and techniques to help patients achieve their goals. Some surgeons pursue board certification in two specialties. At Image Surgical Arts, we are especially proud to say that our Dr. Brady Harris is triple board-certified.

Professional Focus

Dr. Harris has always concentrated on performing cosmetic surgery. He not only reaches out to learn new techniques from other leading surgeons, he also teaches other surgeons to expand and refine their own skills. He is an internationally recognized expert in advanced liposuction, a distinct advantage for patients who benefit from his 360° liposuction technique as part of their post-weight loss body contouring.

Meticulous Attention to Detail

When you’re entrusting the appearance of nearly your entire body to someone, you want that person to be concerned with the overall result, as well as the smaller details that contribute to that picture. Dr. Harris takes tremendous pride in performing the very best surgery for every patient, in every detail. He knows that massive weight loss patients need and want to look as trim as possible from every angle.

Open Communication

Deciding to have body contouring surgery is a complicated and deeply personal matter. You can achieve dramatic change, but will it be worth it? The only way to make a decision that’s right for you is to explore every detail, pro and con. During a personal consultation you will have all the time you need to discuss your situation with Dr. Harris and determine the best course of action. He will never rush you to make a decision because he is well aware of the gravity of the situation.

Dr. Harris will evaluate your situation from a medical and surgical standpoint. How can he tailor a surgical plan that will most closely deliver the results you want to achieve? Your job is to be completely open and honest about your medical history, your lifestyle, and above all about the changes you want to see and your priorities. This conversation will help you decide if surgery is right for you and if Dr. Harris is the right surgeon to perform your surgery.

You want to lose all the excess skin you now have, but what will you look like afterward? It’s the fundamental question every patient asks. There is no simple answer, because every patient is a unique combination of age, gender, skin and body type. Plus, post-weight loss surgery affects many different parts of the body.

The most important thing to remember is that you will not be happy with your results unless your expectations are realistic. Surgery can produce dramatic improvement – a slimmer profile and smoother contours from every angle – but no surgeon can create perfection because that doesn’t exist. So, what is possible?

The best way to imagine your own results is to study how surgery has changed other patients. Before and after photos allow you to compare side-by-side how a patient looked prior to and after their surgery. The more photos you study, the easier it is to picture how you might look. That said, the best photos are those of patients who are most like you in age, gender, body type and “before” condition.

Most important, you’ll want to review before and after photos of your own surgeon’s patients. Are you comfortable with this person’s work?

Immediate Results

After waiting so long to create the “new you,” we know you will be excited to see how you look. Despite initial post-surgical swelling and bruising, you will immediately be able to see a big difference. And in the days and weeks as you recover, you’ll see increasing improvement. However, depending on the procedure(s) you elect, it might take six months or even longer before you see full, final results.

As long as you continue to maintain a healthy lifestyle and weight, you will continue to enjoy your results. You will also continue to age, so you may develop new skin laxity, in which case we can help reverse or minimize that with non-surgical skin treatments.

Body Contouring Scars

Scars are inevitable with any type of surgery. A well-skilled and experienced cosmetic surgeon uses the smallest possible incisions and places them where they will be least detectable under clothing or even swimwear. However, due to the amount of excess skin left behind after significant weight loss and the need to remove excess fat as well, longer incisions are usually required.

Also, to produce the most appealing contouring and tightening results, the incisions may have to be located where they will be visible. For example, Dr. Harris prefers the fleur-de-lis style tummy tuck for massive weight loss patients, but this does leave a visible scar on the abdomen. And in locations such as the upper arm, there isn’t anywhere to hide them.

Still, Dr. Harris takes exceptional care with every patient to ensure there will be the least possible scarring as he plans and performs each procedure. And as much as you’d rather not have scars, in this case they may even serve as a source of pride -- emblems of your weight loss success. Remember, too, that although scars never disappear, they do fade over time.

As you review before and after photos to see what surgery can achieve, you can also make note of the types of scarring produced by different procedures.