Body Contouring Orange County Body Contouring
Twenty five years ago, it was rare to have a patient walk into a plastic surgeon’s office after substantial weight loss. But these days, we routinely see patients who have lost in excess of one hundred pounds. Eighty or ninety per cent of the massive weight loss patients we see did so with the assistance of bariatric surgery – such procedures have been designed to either decrease the size of the stomach pouch or some variety of “bypass” which shunts food down the intestines quicker without absorbing as many calories. We are in the midst of an obesity epidemic in America, but this problem is not one limited to the industrialized world.
The World Health Organization has stated that worldwide, currently, over a billion adults are overweight, and that at least 300 million are grossly obese (more than a hundred pounds overweight). The degree of obesity is commonly assessed by calculating the body mass index, or BMI. A BMI greater than 25 kg/m2 is defined as overweight and over 30 as obese.
The areas which we can address with plastic surgery in removing excess skin are the neck and face, breasts, inner arms, abdomen and back of trunk, hips, thighs and buttocks. Here, we will focus on procedures designed to improve the inner arms, abdomen, posterior trunk, hips, thighs and buttocks.
In all of these areas, the problem is an excessive amount of skin in all dimensions – most resections usually only remove skin in one dimension! For example, with a body lift, in which a transverse wedge of skin is removed from the abdominal wall and trunk, relatively vertical tightness will result, but some horizontal excess will remain, unless a vertical excision is also planned. It must be stressed that some long term skin laxity in these areas is absolutely normal. Every patient over the age of 20 will have some skin laxity in these areas, and the only time they should be addressed surgically is if the amount of skin laxity is much more than average, and if the degree of correction to be achieved can be justified by the resultant scarring.
You may visit your surgeon as many times as you wish, to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you understand the procedure to be performed, that this material has been explained to you, that you have read and understand these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for surgical soap that will be used before surgery, as well as for pain pills and antibiotics, along with instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 40, you will have to obtain a cardiogram. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or any state licensed laboratory (e.g. Kaiser Hospital, etc.). All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.
The operation will be performed in an outpatient facility under deep sedation or a light general anesthetic.
With a body lift, an incision is made clear around the lower body (thus the term “body lift” or “belt lipectomy”), beginning above the buttocks and extending, in a curved line over the hip areas and across the lower abdominal wall above the pubic area. The posterior skin is excised as a big wedge, with little undermining unless flaps are desired to enhance the buttocks area. The skin and fat of the abdominal wall are elevated to the rib margins. The navel remains attached to the abdominal wall, but is released from the surrounding skin and fat through a diamond shaped incision around the navel.
The abdominal muscles are tightened by suturing them together in the midline. These internal sutures are permanent but all of the remaining sutures used for the skin closure are absorbable. The excess skin and fat from the lower abdomen are trimmed.
Adequate pain medication will also be prescribed. All patients, who go home on the day of surgery or the next morning, will find that an assistant at home is a necessity for the first two or three days. High bulk foods are highly encouraged and laxatives may be necessary to prevent straining associated with constipation.
The patient will be encouraged to walk as much as possible at home after surgery as this will reduce the possibility of pneumonia or of clots forming in your calf veins. Patients are also encouraged to wear Tedd® compression stockings for the first few weeks thereafter. It will be necessary to avoid flexing the hips after thigh or buttocks procedures for the first few weeks to prevent excess tension on the suture lines.
The patient will usually be allowed to shower after the drains have been removed, but soaking in a bathtub is to be avoided for another two weeks. Wounds are generally closed with buried absorbable sutures. The incisions are covered with a surgical adhesive, which will peel off as you shower over the next few weeks. It is highly recommended that patients begin applying MD Performance® Ultimate Scar Formula once the glue peels off to the incisions to optimize healing.
Social activity should be limited while the patient is uncomfortable. Lifting anything that causes discomfort should be limited for approximately four to six weeks to allow the tissues to heal properly. Strenuous activity should be avoided during the initial six to eight weeks. Basically, most patients find that they can return to normal activity as the discomfort of the operation fades away.
Office work can usually be resumed within 1-2 weeks of surgery, but the patient should expect a six-week delay before returning to physical labor or strenuous exercise. It will take longer than a year for scars to fade and the scars to feel soft and relatively normal. The lower abdominal skin may feel numb forever and completely normal feeling is not to be expected.
Serious complications after a body contouring procedure are relatively uncommon. However, there will be a long scar that will always be visible without clothing. The scar may remain itchy, painful, thick, or otherwise unsightly. It is unusual, but possible, for some skin to die and areas of fat to liquefy and drain through the incision for many months. As with any body contouring procedure, it is also possible for a suture to become infected and to erode through the skin years later.
Fat is poorly vascularized, does not have much tensile strength and does not contribute significantly to holding the wound together. In this type of surgery in obese clients, particularly involving the trunk or lower extremities, there is a very high incidence (50%) of portions of the incisions pulling open. Occasionally the wound margins can be resutured, but most often the safest course of action is to leave the wound open and allow it to heal by contraction and secondary intention. This might take a few months to occur and may necessitate wound care at home from a visiting nurse.
Insurance companies do not pay for the skin tightening during body contouring or other purely cosmetic portions, irregardless of how much weight you have lost, how unsightly the remaining skin folds are, or even if the skin folds interfere with normal function. If there is reason to believe that your insurance company might help you pay for abdominal muscle tightening, the office staff will provide you with the necessary information to submit to your insurance carrier. Payment of all fees, however, is the patient's responsibility; all fees are due prior to surgery and the proceeds of the insurance check will go to you when the check arrives (minus a 6% billing fee if you chose to use our billing service). If requested, the office staff will assist you with forms, but recovery of any insurance benefits is between you and your insurance company.