Saggy Skin & Realistic Expectations After Weight Loss

August 25, 2016

First of all, I would like to share my own personal experience with plastic surgery after weight loss because I believe I can better explain based on my own experiences as well as that of my patients. It is important to me that plastic surgery patients are knowledgeable about saggy skin and have realistic expectations from their success at losing weight and having plastic surgery.

I grew up overweight, disliking my body, dieting, doing strenuous exercise, however, ALWAYS up and down, bouncing back to the weight I hated. I never had the curves or the attractive body that I desired. I ruined the tissues of my skin at a very early age. There is only a certain degree of gaining and losing weight that our tissues can tolerate before they begin sagging.

Causes of Saggy Skin

The worst areas which will not forgive major variations in weight fluctuation will be the breasts, then thighs, arms, abdomen, buttocks, face and last, but not least, the back area. Genetics also play an important role in the way we all develop saggy skin. There are tiny ligaments which attach the skin to the deep tissues: muscles, fascia, and bones. These ligaments overstretch as we put on weight and then shrink when we lose it. However, as with everything in life, there is a limit. I have observed in patients who have had one baby, or gained and lost weight even once, or built huge muscles then lost them, they will develop a more significant degree of sagging skin on different areas of their body.

I have observed in patients who have had one baby, or gained and lost weight even once, or built huge muscles then lost them, they will develop a more significant degree of sagging skin on different areas of their body.

For whatever the reason, the severity or amount of times after weight fluctuation, the probability that skin will tighten again through exercise, massages, garments, mesotherapy, any type of device or equipment, liposuction, laser, cool sculpting, etc. is practically absent for the vast majority of us.

We must acknowledge that skin after extreme weight loss that has been under different forces during overstretching. After losing volume and weight, the skin will acquire a significant degree of flaccid excess sagging skin. Exercise certainly helps, however, the only way to actually tighten this excess stretched-out sagging skin is by surgically doing Skin Resection and or a Lift. Fortunately, there are many surgical options for anyone that has lost a significant amount of weight.

I want to stress that the aftercare throughout the healing process is critical to our surgical outcome. I highly recommend to all of my patients that they have 24-hour professional nursing care for the first five to seven days, to learn and prepare for their home care and the lifestyle changes that we will live by.

I am proud to be able to say that my weight loss journey has changed my life in a multitude of ways. Most importantly, I am truly blessed to have found that my specialty lies in helping others through this same journey.

Plastic Surgery Procedures, Expectations, and Potential Results

Facial Procedures

The first signs of aging are reflected in the face and neck. With significant weight loss, aging, losing a volume of fat, loss of bone and muscle mass, the appearance of deeper marionette/smile lines, flattening of the cheeks, sunken eyes, sagging jowls, double chin, and flabby neck begin.

Non-surgical fillers can help as a temporary solution. However, the only real way to a lasting and natural solution is a surgical Face and Neck Lift. By lifting sagging tissue, removing excess skin, tightening underlying muscles and repositioning the skin on the lower face and neck will turn back the clock. A realistic expectation is that you will erase years of facial aging. Restoring a smooth, natural more youthful beauty.

Limbs Procedures

Limbs suffer a very interesting process after gaining and losing weight. The extra volume will affect the width of the skin after weight loss. The majority of patients will develop a significant degree of saggy skin and will need an Arm or Thigh Lift, removing excess skin, lifting and reshaping the contour of the area. You can realistically expect to have slimmer, tighter and more attractive arms or thighs allowing you to wear the clothing of choice with confidence.

Breast Procedures

Firm breasts have intact the Cooper ligaments which attach the skin/breast tissue to the fascia muscle, keeping position and shape intact. After massive weight loss, the overstretched ligaments will never retighten on their own. Breasts lose their youthful shape, firmness, volume, position and begin to sag and droop. The only way to resolve this is to reposition skin and sagging breast tissue to a more attractive natural position on the chest wall through a Breast Lift. In some cases, adding volume by using implants will help to improve volume and fullness of the cleavage.

As plastic surgeons, we will determine if a Benelli (periareolar) incision, Lollipop (areolar and vertical incision), “J” incision or Anchor breast lift will be needed. You can realistically expect the breasts will be lifted to a more youthful and attractive profile, restoring firmness, shape, creating a balance with the rest of the body, clothes will fit better all resulting in patient self-confidence and self-esteem, enhancing beauty and sexuality.

With all breast procedures, please remember there will always be differences in between one and the other, on their shape and volume, because they are “sisters” not “identical twins”.

Body Procedures

The abdomen, torso and back areas sag differently, they overstretch in both the width and length. In many cases, just a Tummy Tuck or Body or Back Lift is enough, however, sometimes it is absolutely necessary to address both vectors: width and length. In these cases, a Fleur de Lis Tummy Tuck or Lateral Vertical Torsoplasty would be needed in combination with a full Body Lift. A Lower Body Lift (without overstretched width) in my surgical hands will include a Circumferential Tummy Tuck, Abdominal Muscle repair, Lateral Thigh Lift, Buttocks Lift, minor Liposuction to Lower Back and often Fat Transfer to Buttocks and Hips.

For surgeons with many years of experience specializing in "After Weight Loss" patients will do a complete evaluation, and then discuss with you the best surgical plan for your individual needs.

Complete healing with these procedures can take from six months to one year. However, in some cases depending on a patient’s age, health and procedures performed, final results can be seen in just three months. To maximize the results of your plastic surgery procedures, make sure to take care of your scars. Realistic expectations are very dramatic and exciting, eliminating many negative health issues, achieving a more youthful and beautifully contoured body with curves for women, and for men a more masculine physically fit look, that both have only dreamt about. A feeling of self-confidence in the clothes you wear, creating a greater self-confidence in the new you.

For Your Safety as a Plastic Surgery Patient

• Your realistic expectations must be clear before any surgical procedure to avoid the insecure feelings of being deceived or mislead.
• Selecting a Board Certified Aesthetic, Plastic and Reconstructive Surgeon with training and experience in After Weight Loss surgery is critical and first on the list.
• An evaluation and surgical plan must be made by your surgeon, based on your individualized needs and desires with safety being the first priority.
• An open line of constant communication with your surgeon is of the utmost importance throughout your journey, and will reward you with secure positive feelings.
• All the required laboratory testing must be completed three to four weeks prior to surgery.
• Understanding that more co-existing medical conditions in addition to massive weight loss, the more difficult the plastic surgery will be to achieve great results.
• The ideal BMI to have safe plastic surgery after extreme weight loss is 30. A higher BMI has a higher risk of complications. With Hemoglobin level above 11.5 or Albumin above 3.5.
• A professional recovery care program with 24-hour nursing care is critical for a safe and speedy healing process to attain your goals.

After explaining all of the above, I hope you are better able to understand the skin, tissue and muscle issues involved in suffering significant overstretching and deflation after massive weight loss to your face and/or your entire body.

Realistically understanding that plastic surgery through skin resection, tissue re-positioning, and re-shaping with a highly skilled and experienced surgeon will enable you to achieve your realistic goals, creating a healthier and more youthful you with a renewed self-confidence and self-esteem.

ABOUT THE AUTHOR Dr. Carmina Cardenas is a Board Certified Aesthetic, Plastic and Reconstructive Surgeon. She completed her residency and graduated with honors from the Mexican Institute of Social Security, at the Hospital of Specialties in Plastic and Reconstructive Surgery. She is owner of Beauty Enhance Plastic Surgery. Read more articles from Dr. Cardenas!

Photo credit:  wikimedia.org cc

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