After Weight Loss Q & A

What happens to the body when people lose 100 to 200 pounds?

People are thrilled with their 100-200 pound weight loss, but now they are left with draping, hanging mounds of skin. With all this skin to carry, patients have difficulty moving around, are unable to exercise, and often have problems with skin irritation, rashes and excessive sweating. These folds of skin are constant reminders of the obesity that made them miserable.

With the advances in cosmetic surgery, the Body Lift and other skin lift procedures will remove the sagging, excess skin. Despite the scars, patients are pleased with their new-found freedom. They are able to move around with greater ease, exercise, and enjoy the kind of lifestyle they hoped for when they started to lose weight. The scars are strategically placed leaving only a small line. These surgical procedures typically require a 2 - 6 week recovery period.

Removing sagging excessive skin from a patient who has worked so hard to lose the weight, makes them feel like a new person. Since the excessive skin acts as a reminder of being overweight, the patient now feels her goals have been met.

Dr. Dean Kane, of Maryland is sensitive to patients with such excess weight loss and he has been performing these after-weight loss procedures for over 25 years.

What can be done about the excess skin from massive weight loss?

Simply put, the excess skin is artfully removed and reshaped. Incisions are created in designated areas of the body to tailor the excess skin; lifting and tightening the remaining tissues. There are many procedures and methods to remodel the skin redundancy: The Body Lift, Tummy Tuck, Breast Lift, Arm Lift and Thigh Lift.

Each of these lifts will work to remove the skin in your desired area of contouring. Our patients indicate that the scars resulting from the skin tailoring is of less personal concern than the new-found freedom and recovered personal shape following surgery. Patients are much happier. They are more mobile, feel better, are able to exercise and look great with or without clothes. Recovery time and treatments are determined based on the procedures performed.

The Body Lift, Tummy Tuck, Breast Lift, Arm Lift, Thigh Lift...
Let's begin with the Abdominoplasty or more commonly called a Tummy Tuck. Traditionally, the Tummy Tuck is performed when there is an apron of tummy skin and the internal muscles of the abdomen are stretched and distended (often as a result of multiple childbirths or excessive weight gain). The procedure pulls and sews the abdominal wall fascia or muscles together creating an internal corset. This results in a dramatic narrowing figure forming an "hour-glass" waistline. The excess apron of fat and skin is removed and the mons pubis or pubic mound is lifted in a pleasing rejuvenated position, while the abdomen is made tight and flat. The recovery from the traditional Tummy Tuck is generally 4 to 6 weeks. The traditional scar is placed on the lower abdomen and runs from hip bone to hop bone typically within the panty or underwear line. A person will recover at a 45% angle to avoid putting pressure on the abdominal scars. Patients are elated with the results of a flat, tight tummy. With a fully accredited operating room. Dr. Dean Kane performs the tummy tuck procedure at his facility, The Maryland Center for Cosmetic Surgery and Medi-Spa. Patients feel extremely comfortable and safe here with Dr. Kane, who is  very sensitive to those who have experienced massive weight loss.

When is a Tummy Tuck the right choice?

Tummy Tuck or Abdominoplasty is the appropriate approach for the following reasons:

1. When abdomen skin is loose and you can actually pinch or grab a roll of skin;
2. When there is a flap or pannus of skin that rolls over the panty line;
3. When the loose skin lacks elasticity, the only way to achieve a tight abdomen is to remove the excess skin;
4. When the internal tummy remains distended, appearing pregnant; and
5. When a person has multiple scars on their abdomen from prior surgeries ( c-section, gallbladder, ovarian surgery, etc.) A tummy tuck will remove these old scars and strategically place a horizontal scar hidden within the panty line.

How can you tell whether you need Liposuction of the Abdomen or a Tummy Tuck?

This is a very confusing area for many people. If someone just has a thickness and fullness of their abdomen, but mild skin laxity, then Liposuction would be the appropriate procedure. Liposuction can be performed in a circumferential approach, so that fat is removed from the front of the abdomen, sides and back, or the whole trunk. This circular approach reduces the entire trunk, contours the shape and allows a person to fit into small size clothes. Liposuction has the wonderful advantage of needing only 1 week recovery, allowing most people return to work in that time frame. A compression garment is required for a 6-8 week period to adhere the newly lipo-contoured skin to the body during the healing process.

At what point in my weight loss do I make the decision to have the Liposuction or Tummy Tuck procedures?

The answer depends on your motivation and ability to lose the weight. We always recommend that a person lose as much weight as is comfortable until a plateau is reached, or the weight is just not coming off any longer. We request that our patients be committed to a lifestyle modiciation in diet and exercise, before we perform the after-weight loss procedures, so that the fat does not come back in other areas. Liposuction should never be used as a weight loss technique because the fat WILL return in other places. If you continue to eat an improper diet retaining the same weight or even gaining more weight, the fat will redistribute. Once people have mentally committed to these lifestyle changes, Liposuction and/or a Tummy Tuck can be an incredible motivator to jump start an even stronger commitment to diet and exercise. These procedures give you fast results and a new body to maintain.

What can be done about the excess skin along the back as well as the front of the body?

The Body Lift is a remarkable surgical procedure that tailors an overall tightening and skin reduction of the body. It achieves the lifting of the leg, buttocks, lower and upper back, and abdominal skin. The back rolls are smoothed and love handles and "muffin tops" are contoured. Everything about and below the circular scar is tightened and firmed. The recovery period is 4-6 weeks. During this time a firm garment is worn to hold and support the body that has undergone surgery.
The Body Lift scar is an extension of the Tummy Tuck scar. Like the Tummy Tuck
 the Body Lift removed the skin from the front of the abdomen, and continues around the entire back, removing and tightening the back and lifting the buttock mound and skin. Consequently there is a circular scar with a heart-shaped appearance over the buttocks, around the entire tummy and within the panty or underwear line.
The Full "Booty" is in Style! When a person loses all that weight, they lose it everywhere including the "booty" or buttock. The excess skin from the back can be fashioned and tucked into the buttock to enhance the "booty" during the Body lift procedure.
Dr, Dean Kane, of Maryland performs the Body Lift with or without the booty enhancement in his Maryland Center for Cosmetic Surgery and Medi-Spa. Since the Body Lift can be difficult to heal from in one procedure, Dr. Kane may recommend that patients separate the body lift into two parts. The tummy tuck would be performed first, and several months to a year later the back lift can be performed. The decision to do the entire body lift in one procedure will depend on the nutritional status of the patient and will be discussed in consultation.

Can the Body Lift work to tighten the excess skin of my inner thighs?

The Body Lift is excellent at pulling the skin on the buttocks, outer thighs and front thighs. However, it has a minimal effect on the inner thighs. For the inner thigh area, a Thigh Tuck or Thigh Lift can be offered. Incisions are made depending on where and how much skin needs to be removed. For lose skin just in the upper inner thigh, a Thigh Tuck incision is done along the panty line in the groin area only.
The Thigh Lift is needed for individuals with excessive skin that extends down to the knees. The procedure will often require an incision that begins along the inner groin and travels downward along the inside seam of the leg to the knee. Again, every effort is made to conceal the scar along the inside of the leg.
In general, this surgery requires the longest recovery time because walking places a lot of pressure on the incision sites. The recovery period is approximately 6 weeks during which time, we ask that you minimize your activities. This reduces the tension on the incision and thereby diminishes the risk of opening the surgical area.

What about excess skin along my arms, breasts and upper back?
Arm Lift - To Remove the excess skin from the arms, skin tailoring is also used. An incision is made along the underarm so that the scar will be concealed. We have also found that liposuction in conjunction with an arm tuck or arm lift creates an even tighter, smaller contoured upper arm. A support garment will be used during the healing process for 6 weeks.
The Breast Lift can be performed to return the breasts back to their more firm, youtful look. For small breasted women, silicone or saline implants can be used to add extra fullness to the upper portions of the breasts giving a nice breast contour. For larger breasted women, the excess tissue can be removed along with the extra skin to give a reduced but fuller, upright, perky breast shape called the Breast Reduction. Both procedures will elevate the nipple and areola to a higher position on the chest wall and remove the excess skin. A fuller, perky well shaped breast is created by the scars being placed around the areola with a lone down from the areola to the base of the breast and along the crease of the breasts. The recovery period is approximately 3 weeks.

Is there a Breast Lift procedure that minimizes the scars on the breast?

Yes! Donut Breast Lift or Donut Mastopexy or Circumareolar Breast Lift. The only visible scar is around the outer pink-brown edge of the areola. The excess skin of the breast is removed in a circular donut approach in which the scar becomes the new edge to the areola. The breast tissue is tightly packaged and lifted inside the newly formed breast envelope. There are no other scars on the breast skin such as the "T" or the anchor typical of a traditional breast lift. this procedure is ideal for the smaller breasted woman who has breast ptosis or skin laxity but doesn't need the full lift. A breast implant can be placed inside the breast at the same time if a woman wants a fuller, larger yet perkier and lifted breast.

What can be done about the upper back roll near the bra area?

Because of the 25 year experience of performing after weight loss procedures, Dr. Kane has evolved a new technique that removed the excess back skin and rolls at the same time as an arm lift or breast lift procedure. The traditional procedure would remove this excess skin with an incision that goes across the back and hidden under the bra strap. However, Dr. Kane has developed his technique by using an incision alongside the outer side of the breasts up to the armpit. The scars are well hidden and the back is free from showing any widening, thickening or unsightly scars. Strapless dresses are a true possibility without the added bulges and scars.