Massive weight loss is defined as a weight reduction, achieved through diet/exercise or bariatric surgery, that is substantial and maintained over time, and which leads to an improvement in quality of life and associated comorbidities.
The success of bariatric surgery and massive weight loss presupposes:
Skin laxity
Excess skin, especially on the arms, breasts, abdomen, and thighs.
This can negatively affect one’s self-perception.
At Clínica Planas, we propose performing post-bariatric reconstructive surgeries, a set of surgical procedures designed to treat excess skin and changes in body contour that occur following significant weight loss.
Post-Obesity reconstructive surgeries
After undergoing bariatric surgical treatment or experiencing massive weight loss, several months may pass before the aesthetic alterations resulting from weight loss become evident.
These sequelae do not follow a defined pattern. They consist of skin laxity and localized lipodystrophies in different body regions, depending on the degree of prior obesity and the constitution of each individual.
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We are backed by 50 years of experience as a clinic specialising in plastic surgery and aesthetic medicine.
After massive weight loss, when is reconstructive surgery indicated?
The optimal timing for performing these treatments should not be based on the patient’s perception alone, but on an evaluation by an interdisciplinary team:
Bariatric surgeon
Nutritionist
Psychologist
Plastic surgeon
Internist
Anaesthetist
Personal trainer
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The procedures are classified into three main groups:
Upper body contouring surgery
Brachioplasty
Torsoplasty
Breast surgery
Male chest contouring
Lower body contouring surgery
Abdominoplasty
Gluteal region contouring
Thigh lift (Cruroplasty)
Cervicofacial region surgery
Additionally, a final stage of liposuction can be considered for localized lipodystrophy not associated with another procedure, to achieve greater definition of the body contour.
The choice of the anatomical region for the first surgical stage is made by consensus between the plastic surgeon’s judgement and the patient’s individual aesthetic and functional needs.
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Lipoabdominoplasty treats the torso of our patient at 360º, shaping the abdomen, flanks, and back. It allows us to:
Remove excess skin following massive weight loss
Reconstruct the abdominal wall through rectus abdominis plasties
Remove localized fat deposits
Depending on the amount of excess skin present, the surgeon will decide which surgical technique to apply in each case. We can distinguish:
Abdominal dermolipectomy
The horizontal scar is positioned at the level of a caesarean section and extends laterally to the iliac crests. Through this procedure, we repair diastasis or separation of the rectus abdominis muscles, remove excess skin, and tighten the abdominal skin. Additionally, Vaser liposuction is performed to shape the silhouette.
Extended dermolipectomy
Similar to an abdominal dermolipectomy, but in this case the scar needs to be longer to remove excess skin from the flanks. Likewise, this procedure repairs diastasis of the rectus abdominis muscles, removes excess skin, and tightens the abdominal skin. Vaser liposuction is also performed to sculpt the silhouette.
Flor de Lis dermolipectomy
Offered to patients with an extraordinary and marked excess of anterior abdominal skin, where a good cutaneous remodelling cannot be achieved with a horizontal scar alone. It consists of a dermolipectomy with a horizontal scar and an additional vertical scar extending from the sternum to the pubis, intended to remove central excess abdominal skin. It may also be referred to as an inverted T.
Circumferential dermolipectomy
Also known as a Body Lift, it is offered to patients with excess skin not only on the abdomen but also on the flanks and with sagging buttocks. It is defined as circumferential because the scar will extend 360º, allowing us to remove skin from both anterior and posterior areas, producing a gluteal lifting effect. It can be combined with gluteal fat transfer.
Breast surgeries
Reduction Mammoplasty:
Removes excess skin, fat, and glandular tissue in cases of large, sagging breasts following massive weight loss. The scar is usually an inverted T or vertical.
Mastopexy without Implants:
A procedure that allows the breasts to be lifted by removing excess skin and repositioning the tissue without reducing breast volume. The scar is usually an inverted T or vertical.
Mastopexy with Implants:
Indicated for deflated and sagging breasts after massive weight loss. The breast is elevated using an implant to restore lost volume. The scar is usually an inverted T or vertical.
Torsoplasty:
A procedure that corrects lateral and posterior deformities of the trunk. It can be lower, at waist level, or upper, at the level of the bra clasp.
A surgical technique that removes excess skin from the inner and upper areas of the arms. It restores firmness by tightening the skin and reducing arm volume.
Part of this procedure involves Microaire Liposuction, which allows the arms to be sculpted and volume reduced.
Thighs
Thigh Lift (Cruroplasty):
A procedure to improve the appearance of the lower limbs by removing excess skin and adipose tissue, enhancing the firmness and shape of the thighs. Microaire liposuction is performed, and the skin excision involves an incision in the groin area that extends posteriorly and vertically along the inner thigh.
Benefits of Lipoabdominoplasty
Improves confidence and self-esteem by reconstructing your body silhouette.
Enhances abdominal wall tone by tightening musculature, correcting diastasis and abdominal hernias, thereby improving posture and reducing back pain.
Improves hygiene by removing the abdominal fold that can occur after massive weight loss.
Rejuvenates the pubic region through a lift of the external genitalia.
Scars are always placed in inconspicuous areas that can be easily covered with underwear or a bikini. During the first 18–24 months, scars may appear redder and more prominent, as the tissue is still healing and maturing. After 18 months, scars gradually lighten and become less noticeable. For pathological scarring (hypertrophic scars or keloids), Clínica Planas offers a Laser Unit to evaluate treatment options.
Is the surgery very painful?
After post-bariatric body contouring surgery, 1–2 nights of hospitalisation are recommended. During this time, intravenous analgesics help control discomfort. Manual lymphatic drainage is also initiated in the hospital to minimise swelling in the early hours. Upon discharge, a one-week pain and anti-inflammatory regimen is prescribed.
Who can undergo a lipoabdominoplasty?
Patients with abdominal laxity, excess abdominal skin, and diastasis who have maintained a stable weight after weight loss. This requires at least 3–6 months after diet-induced weight loss, or 18 months following bariatric surgery.
How can loose skin be removed?
For mild laxity, there are non-surgical technologies that can improve skin appearance, such as Carboxytherapy or Morpheus 8, or surgical techniques like BodyTite or Renuvion.
For more severe laxity, excess skin must be removed and the figure reshaped with liposuction, as in the case of lipoabdominoplasty.
Which surgeries can be combined after massive weight loss?
Surgeries can be combined depending on patient needs, provided safety is maintained. It is not recommended to exceed 6–7 hours of surgery, nor to remove more than 10% of body weight via liposuction/surgery. The procedure will be decided jointly with the patient, considering overall health and prioritising safety.
How long will I need to wear the compression garment?
The compression garment is fitted in the operating theatre at the end of surgery. It acts as a compressive dressing, helping reduce swelling and oedema postoperatively. It should be worn 24 hours a day (removed only for showering) for the first 45 days, then gradually reduced to 12 hours daily, usually removed at night, for an additional 15 days.
Will I need massages?
Yes, a specific type of massage called manual lymphatic drainage will be recommended. This should be performed frequently during the first 10 postoperative days (almost daily), then reduced depending on local inflammation, and combined with other physiotherapy techniques or technology if necessary. Massages help reduce local inflammation, mobilise liposuction-treated tissue, and prevent fibrosis and adhesions.
When will results be visible?
Partial results are visible immediately after the procedure, but final and stable results are achieved after 6–12 months, once postoperative inflammation has completely subsided.
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