Massive Weight Loss Surgical Body Contouring

According to the American Society for Metabolic and Bariatric Surgery, “massive weight loss” is defined as the loss of at least 100 pounds or more than 40% of your excess weight, Over the last 50 years, worldwide obesity rates have tripled, creating a health care epidemic. Most healthcare professionals use a height and weight calculation called Body Mass Index or BMI to define obesity.  

• A BMI less than 18.5: underweight.
• A BMI is 18.5 to <25: healthy weight
• A BMI is 25.0 to <30: overweight.
• A BMI is 30.0 or higher: obese.

Obesity is subdivided into categories:

• Class 1: BMI of 30 to < 35
• Class 2: BMI of 35 to < 40
• Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “severe” obesity.

Massive weight loss is accomplished through diet and exercise but also through surgery or medications that provide needed assistance. The diet industry is massive, with the total United States weight loss market being $89.9 billion and 2023 and 93.8 billion in 2024. 

Modern Weight-Loss Solutions

Surgical options for weight loss include a lap band, gastric bypass, or gastric sleeve. Medications have been a focal point for weight loss and include hormones, appetite suppressants, psychiatric medications, and the now-popular semaglutide drug class.

Regardless of the method, weight loss is the goal. Achieving Massive Weight Loss has both functional and aesthetic repercussions due to excess and sagging skin many men and women experience as a byproduct. Weight loss surgery is a subspecialty of plastic surgery and is designed to address loose skin after massive weight loss.

These areas are most commonly addressed by patients following extreme weight loss:

• Face & Neck: Facelift or neck lift rejuvenation. Read about the Ozempic Facelift here.
• Arms: Arm liposuction and more commonly skin removal via an arm lift.
• Breasts: Breast lift with or without breast implants or via fat transfer breast augmentation.
• Abdomen & Love Handles: Tummy Tuck surgery: either extended (incision extending to back) or circumferential (around the body) with liposuction.
  
• Buttocks: Brazilian Butt Lift (BBL) using implants or via fat grafting.
• Thighs: Liposuction or thigh lift to remove excess skin at the thighs.
• Lower Body Lift: A combination of a circumferential tummy tuck and thigh lift with liposuction.

Patient Safety Should Always Come First

Weight loss rejuvenation procedures can be done simultaneously or staged out in multiple sessions for patient safety. Surgery should be done conservatively following these guidelines:

• No more than 6 hours of anesthesia.
• Careful management of blood loss and volume status. At most 5 liters of liposuction should be done at any time.
• Consideration of premorbid conditions such as age, high blood pressure, diabetes, and general health.
• Surgery should be done in a fully accredited surgery center or hospital by a board-certified plastic surgeon and board-certified anesthesiologist.

If done safely and with proper planning, weight loss surgery can be life-altering for these patients, restoring their body function and appearance.

What is Body Lift Surgery?

Body lift surgery is one of the mainstays of massive weight loss body contouring. It is designed to restore a patient's midsection, torso, and thighs. Most surgeons consider a body lift to include an extended or circumferential abdominoplasty or tummy tuck combined with liposuction and a thigh lift.

What Areas Of The Body Can Bet Treated?

Am I A Candidate For Body Lift Surgery?

BMI- Body Mass Index

Ideally, a patient’s BMI should be < 35 and preferably < 30. It is preferable to have a stable weight that can be maintained.  

Pre-op Clearance

Pre Op ClearancePreop clearance will vary based on the individual and should be reviewed with a board-certified plastic surgeon. At a minimum, blood work is needed to check blood levels and electrolytes. Many weight loss patients are anemic or have bloodwork levels that need to be addressed before surgery.

Patients who are older or have other health concerns such as hypertension, diabetes, cancer, or a heart condition will need approval from their primary physician to determine the risk for surgery. The primary care physician may order additional testing for pre-operative clearance.

Many doctors may recommend further testing such as a mammogram, ECG heart rhythm test, Echo heart function test, and chest x-ray, before surgery. These tests can help determine if the procedure will be safely tolerated, or if there are any pre-surgery interventions that should take place.

Preparing For Surgery

Weight loss surgery patients should good health at the time of surgery with no recent illness. Any medications that might interfere with anesthesia such as weight loss drugs like semaglutides, diet pills, blood thinners, etc, should be discontinued before surgery. The plastic surgeon performing the procedures should provide a list of drugs to avoid before surgery. Many patients have sleep apnea which can cause problems maintaining oxygen levels after surgery.

All weight loss patients should have a good plan after surgery to help with care. Most patients will assign helpers to assist with childcare and other responsibilities. Patients should have a place to sleep in an appropriate position and a plan for meals, showering, and a close bathroom. Many patients have stairs which might not be best attempted in the early phases of recovery. At the minimum, weight loss surgery patients should have at-home assistance for the first day after surgery.

How is Body Lift Surgery Done?

Upper Body Lift

The upper body typically focuses on the arms, axilla (armpit), breasts, and back. The breast will typically require a breast lift and possibly a breast implant or fat transfer if additional volume is needed. The breast lift requires an anchor incision technique to remove excess skin. An implant can also be placed under the chest muscle to add necessary volume, upper pole fullness, roundness, and cleavage.  

The arms are usually treated with a combination of liposuction and skin removal. The skin removal is done by removing an ellipse of skin from the elbow up to the underarm, leaving a linear scar concealed in most cases, at the inner arm. This is called a brachioplasty. Often this can be extended into the armpit to remove excess armpit or axillary tissue. Finally, the back can be liposuction to shape the back and remove “bra fat” which can be problematic with clothing.

Lower Body Lift

A lower body lift is designed to address excess skin and fat on the torso, butt, and thighs. The procedure generally involves an extended or circumferential tummy tuck.

An extended tummy tuck involves placing a low, bikini incision to remove skin and fat from the belly button to the pubic area. Liposuction removes fat from the upper abdomen, flanks, and back to shape the body. The abdominal muscles are tightened to flatten the abdomen and cinch in the waist giving an hourglass shape while the belly button is resectioned to an appropriate place on the abdomen.

A circumferential tummy tuck may be necessary to remove excess skin on the lower back and lift the buttocks. If excess skin can be pinched at the lower back or if the buttock's appearance is flat and saggy, then a circumferential tummy tuck may be necessary.


Read Dr. Burns' Blogs:
What To Do About Ozempic Butt
How To Tell If You Need Tummy Tuck or Liposuction

Panniculectomy

A panniculectomy refers to a procedure similar to an extended tummy tuck involving the removal of excess abdominal skin and fat. Neither muscle re-tightening nor liposuction is performed with a panniculectomy. This procedure is typically only requested in cases where there is redundant skin that is causing functional problems such as limitations in movement or skin rashes.

Read More: Avoiding Trendy Lipo: Why Elegant Lipo is Better

How Long Is The Surgery?

Many factors determine the length of weight loss surgery such as the surgeon’s experience, the size of the patient, and the number and type of procedures being done. Surgery time should be less than 6 hours for patient safety.

General Anesthesia

Weight loss surgery should be done by a board-certified anesthesiologist under general anesthesia.  

Time In Recovery

For longer, more extensive cases, patients should consider overnight stay in a hospital or overnight care facility.

An overnight facility allows your surgeon and team to monitor you after surgery, assist you in getting out of bed, walking, using sequential compression devices (SCDs) to keep your blood circulating in bed to prevent blood clots, and controlling your pain. Some patients may require IV fluid to reestablish their blood volume after their procedure.

If you plan to go home after surgery you’ll likely spend 1 to 2 hours in recovery. Recovery nurses have a checklist of things to monitor before discharging patients. Patients are strongly advised to have a friend or family member look after them following surgery for a minimum of one-day post-op.

What To Expect After Body Lift Surgery

Recovery

Depending on the procedure(s) performed, patients will require 1 to 2 weeks for initial recovery In most cases the tummy tuck and thigh lift procedures require the most downtime. Dr. Burns uses a medication called Exparel to lessen post-surgery pain. Breasts and arm procedures usually require less recovery time.

Graduated Clearance

Graduated clearance is granted throughout various healing stages of recovery. In most cases, light physical activity may be resumed within 1 month. Light activity generally refers to activities that limit bouncing or lifting. These might include light walking, stationary bikes, elliptical trainers, or stairmasters. As recovery progresses, patients can add light weights to a workout routine as tolerated and return to full exercise approximately 3 months following surgery. Understand that every patient is unique and some may ease back into working out while others may require more time.

Scars & Scar Therapy

 Weight loss surgery requires extensive scars with the removal of excess skin. Plastic surgeons are trained to close skin meticulously, but all patients heal differently. Caring for the incisions is paramount to an optimal result, simply because incisions will eventually become surgical scars. We recommend scar creams such as Skin Medica Scar Recovery Gel or Biocorneum. We recommend silicone sheeting placed over the scars to further optimize scar quality. Finally, we recommend post-surgery laser therapy which we provide at EpiCentre which is our skin care and laser center.  

Read More: 5 Secrets For Nearly Invisible Tummy Tuck Scars

Risks Associated with Body Lift Surgery

While body lift surgery produces significant improvements in body contour and overall appearance, like any surgical procedure, it carries certain risks and potential complications. Some of these risks include:

• Bleeding: Bleeding during or after surgery is a risk with any surgical procedure. While surgeons take steps to minimize bleeding, excessive bleeding can sometimes occur, requiring medical attention.
• Infection: Infections can occur at the surgical site or within the body following surgery. Patients are typically prescribed antibiotics to reduce the risk of infection, but it remains a potential complication.
• Poor Wound Healing: In some cases, wounds may heal poorly or may not heal properly, leading to delayed healing, wound dehiscence (wound opening), or the formation of hypertrophic scars or keloids.
• Seroma or Hematoma: Fluid accumulation (seroma) or blood collection (hematoma) under the skin at the surgical site can occur after surgery. These may need to be drained to prevent complications.
• Numbness or Altered Sensation: Some degree of numbness or altered sensation in the treated areas is common after body lift surgery. This may improve over time but can be permanent in some cases.
• Skin Discoloration or Irregularities: Changes in skin pigmentation, unevenness, or contour irregularities may occur following surgery.
• Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): Like with any major surgery, there is a risk of blood clots forming in the legs (DVT) that can potentially travel to the lungs (PE), causing serious complications. We have protocols in place to minimize this risk.
• Anesthesia Risks: Risks associated with anesthesia include allergic reactions, respiratory problems, and medication reactions.
• Unsatisfactory Results: Despite the plastic surgeon's best efforts, some patients may be dissatisfied with the aesthetic outcome of the surgery.

Body Contouring Surgery Benefits

A body lift removes excess skin and restores both form and function. By removing excess skin patients will feel comfortable wearing a variety of clothing that they otherwise might not. Some patients with excess skin experience skin rashes, sweating, and odor that is resolved after surgery. Most importantly, patients are happy with their new bodies and can return to a full and normal life.

Frequently Asked Questions

Does insurance cover weight loss surgery?

Our office does not take insurance but in some select cases, insurance might cover a part of the procedure. However, in the vast majority of cases, this is considered cosmetic surgery and not covered by insurance.

What is the cost of a body lift in Dallas, Texas?

The cost will depend on many factors such as the experience of the surgeon, number and complexity of procedures, time in the operating room, facility and anesthesia fees, and fees for miscellaneous items such as breast implants, recovery garments, specialty medications and equipment, and overnight facility costs. The best way to determine is to consult with a board-certified plastic surgeon who will provide you with an accurate estimate. It is always recommended to get several different opinions but not always choose the cheapest option.  

Make sure you understand the policy surrounding refunds and touch-up procedures which are very common in weight loss surgery. Most surgeons will have these policies outlined in their paperwork.

Can I finance plastic surgery after massive weight loss?

Yes, most patients will utilize some sort of financing. We offer third-party financing from CareCredit, Alphaeon, and PatientFi. You can apply online here.

Are the results of body lift surgery permanent?

Yes, your body will still age and respond to gravity but the skin removal is permanent. Maintaining a consistent weight is paramount in maintaining your results. After weight loss surgery you can expect your results to last as you age gracefully.

Book Your Complimentary Consult Today

Dr. John L. Burns Jr. MD is board-certified by the American Board of Plastic Surgery and President of the Dallas Plastic Surgery Institute, one of the largest plastic surgery group practices in the United States. Dr. Burns is also the Medical Director for the EpiCentre Skin Care and Laser Center, a world renowned medical spa. Dr. Burns dedicates his practice to aesthetic or cosmetic plastic surgery.

Dr. Burns widely known for his expertise in cosmetic breast surgery, facelift, and fat transfer to the face, breast, and body. Dr. John. L Burns, Jr., MD has been named among America’s Best Plastic Surgeons 2023 for Facelift, Rhinoplasty, and Breast Augmentation by Newsweek Magazine and Statista. He also named among D Magazine's Best Doctors  Realself Top Doctors.


D Magazine's Face of Breast Augmentation
D Magazine's Mommy Makeover Expert


Dr. Burns offers complimentary consultations for those seeking weight loss surgery and body contouring Dallas. We invite you to meet our team and experience our difference. Get started here.

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