For Weight Loss Patients

Many patients also feel that the excess skin is an unpleasant reminder of their former selves, and find that it interferes with the positive psychological progress they could make after their weight loss. In the past, skin excess of the abdomen, hips, thighs, and buttocks were corrected by separate operations without consideration that all areas of excess skin are in fact related to one another. To give a more comprehensive and patient-friendly alternative, Dr. LoMonaco developed a lower body lift procedure that corrects many areas of skin excess through a single incision at one surgery.

This allows the patient to experience only one downtime, time off work, and one exposure to anesthesia. A Lower Body Lift is an advanced operation that can treat laxity of the abdomen, waist, hips, and buttocks. If needed, a pubic lift and buttock augmentation can easily be integrated, again using no separate incision.

A lower body lift is always custom tailored to meet the needs of the individual patient, but usually includes:

• Tummy tuck
• Buttock Lift
• Front thigh lift
• Outer thigh lift
• Pubic reduction
• Liposuction of all areas
• New belly button

Other procedures, such as breast lift, inner thigh lift, and arm lift can also be combined with a lower body lift, depending on the patients anatomy and their desires.

Individuals who have lost a large amount of weight pose special concerns for the plastic surgeon. There is usually a marked excess of skin, and that skin has often been damaged by extreme fluctuations in weight. The longer a person has been overweight, the more pronounced the skin laxity will be. Age and nutritional status also play important roles in how the skin responds to weight loss and the lifting and tightening procedures of plastic surgery.

In most cases, patients who have lost over 60 pounds will need plastic surgery techniques that surpass what is needed by the general population.

Patients who have had bariatric surgery have even more specialized needs that must be met by the plastic surgeon. In general, the nutritional alteration brought about by the weight loss surgery will negatively affect healing. Dr. LoMonaco is familiar with the specific nutritional defects that the various forms of weight loss surgery produce, and is knowledgeable in treating them.

Lap band: the lap band port is usually repositioned to a less noticeable location at the time of tummy tuck or body lift. Dr. LoMonaco is familiar with these techniques, and can also switch patients to a lower profile port if they want.

The small gastric pouch will not stretch much, so a form of liquid protein tolerable to the patient must be selected prior to surgery so the patient can meet their goals for optimal healing.  Malabsorption of iron may produce anemia, which also must be addressed before surgery.

Finally, the band should be unfilled for surgery to allow adequate nutrition and also to prevent stomach swelling, nausea, and vomiting after surgery.

Roux-En-Y bypass: RNY patients often have anemia and have an increased need for water-soluble vitamins, as these are poorly absorbed and may be deficient.  Special consideration for proper protein supplements must be made and an evaluation for incisional hernia and Peterson hernia must also be considered.

Duodenal Switch: In additional to requiring increased protein intake after surgery, DS patients may be deficient in calcium and Vitamin D. Because appetite may be suppressed after surgery, an appropriate regimen to ensure proper nutrient intake must be developed.

Dr. LoMonaco will discuss with you the proper timing of surgery. Rather than fixate on a certain goal weight, he may decide to wait until you reach a stable weight over several months. Consultation with your bariatric surgeon may be needed, but most patients can consider plastic surgery about 1 year after their bariatric surgery The timing of surgery also depends on your original weight, your current BMI and body fat percentage, and the type of weight loss surgery you have had.

Plastic surgery after weight loss poses increased risks of bleeding, infection, delayed wound healing, and need for revision surgery compared to standard cosmetic surgery. As such, it is critical to have systems and personnel in place to address all possible complications or problems.

Dr LoMonaco operates only at accredited facilities with a 24 hour doctor in house, a fully staffed hospital ICU, blood bank, laboratory, and radiology services. In addition, the protocols for aftercare of all patients while in the hospital is standardized, so that care after complex cases becomes more predictable and routine for hospital staff.

Because a large amount of skin is often removed, space is left beneath the skin. Drains are placed to remove this fluid until your body is healed. This process can take many weeks. Drain care is simple and can be done at home, but your doctor will tell you about your chances of developing a fluid collection. The retained fluid can become infected and require aspiration or re-insertion of drains to treat. Hospitalization is rarely needed but is a possibility. Wearing your compression garment and following your doctor’s directions after surgery can help minimize the chances of a fluid collection after surgery.

Surgery to remove excess skin may be covered by insurance but only if you have significant medical problems from the excess skin. This means multiple visits to the doctor for skin rashes or infections with prescription medication. Patients who have an abdominal hernia may also receive help from insurance at the time of excess skin removal. Check the section PATIENT RESOURCES to learn more about insurance coverage. Dr LoMonaco’s office has various financing plans to help you meet the out of pocket costs associated with many procedures. Approval for financing can often be accomplished in one day.

As part of your surgical fee for a Lower Body Lift, Dr. LoMonaco’s office includes at no additional cost some important items and services for your comfort, safety, and convenience. We include a pain pump and medication for the first 2-3 days after surgery at no additional cost. The pain pump system often allows patients to lessen their dose of narcotics and pills after surgery, and can greatly aid in recovery. We also include the VitaMedica line of vitamins and nutritional supplements to speed your healing and recovery.

All weight loss patients have special nutritional needs. Before surgery, it is very important to be sure you are getting enough protein intake. This is essential for normal healing. Your vitamin absorption may also be limited, and proper intake of vitamins is also needed to ensure the best nutritional status before surgery. Your doctor will perform blood tests before surgery to determine any deficiency you may have. Excessive dieting before surgery should be avoided, as it can lead to poor nutrition and cause healing problems.

Some patients may develop a mild anemia after weight loss surgery, and this should also be corrected as much as possible before surgery. The anemia may make a blood transfusion more likely, and your doctor will discuss this issue carefully with you. Several options are available in case a blood transfusion is needed after surgery.

Weight loss surgery represents a major change in a person’s life. Often, there is a period of time needed to adapt to these new changes. Friends and family may have mixed feelings about the weight loss surgery, plastic surgery, or both. Take time to work through these issues before surgery so that you and those around you are comfortable with your decision.

Many patients may experience depression or anxiety in the months following surgery. Dr. Lomonaco and his staff are familiar with this phenomena and are available to help you gain acceptance of your new body image. This is a process that may take several months to resolve.

Enlist your doctor’s help to explain the procedures and the recovery process to those close to you. Many times, they are more concerned about your comfort and safety than you are!

Plastic surgery after weight loss is a big decision, but can go a long way to give you a feeling of normalcy, control, and help restore your self-confidence.