Plastic surgery after massive weight loss

New weight loss drugs, semaglutides, with brand names such as Ozempic and Mounjaro have been a game changer for patients struggling with their weight. These drugs suppress the appetite in several ways by activating a certain hormone that affects the pancreas and other tissues. 

Working a few different ways inside the body, they stimulate insulin release to address increased blood sugar.. Additionally, they decrease gastric emptying, leading to a full feeling after eating very little. Finally, these drugs change the brain reward pathways so that eating is often less enjoyable.

The two generic versions of these semaglutides and tirzepatide drugs that are FDA approved for weight loss are Wegovy (semaglutide) And Zepbound (tirzepatide). Wegovy has been shown to cause a 15% weight loss in adults whereas Zepbound caused a 21% weight loss, with some patiently losing more and others less.

The Impact of Massive Weight Loss Drugs and the Psychological Challenges of Loose Skin

There are lots of instances where these drugs are causing truly massive weight loss; for example, a 200 pound patient could be easily expected to lose 30 to 40 pounds, it has become very common in our practice to see patients losing well over 100 pounds.

 Unfortunately, after massive weight loss there can be massive amount of loose skin. This is usually very difficult for patients who have accomplished so much weight loss and achieved their weight goal. Oftentimes, they even see the tremendous amount of loose skin as fat that they just can’t get rid of and continue wanting to lose more weight, even though they could already be extremely thin under all this loose skin.

This is where plastic surgery comes in. There are many different body contouring procedures that us plastic surgeons have been doing for decades to remove loose skin. Everyone is familiar with tummy tucks for loose abdominal skin, but there are also arm lifts, leg lifts, breast lifts and entire lower body lifts or upper body lifts.

Even Facelifts and neck lifts are common procedures to remove loose skin after massive weight loss. At one time, massive weight loss was usually seen after weight loss surgery such as gastric bypasses or gastric sleeves, these are now the minority of the weight loss patients we see. Instead, every week we are seeing patients who have tremendous amount of loose skin after medical weight loss using these new drugs.

Addressing the Complexities of Body Contouring in Massive Weight Loss Patients

Compared to normal cases who present themselves for these types of body contouring procedures, massive weight loss patients pose challenges such as skin quality being particularly poor after the massive weight loss.  Therefore, these patients see more stretching of the skin after surgery (rebound laxity) and even more wound healing problems than we would see in body contouring patients without massive weight loss, such as a tummy tuck patient after childbearing.

Another unique challenge in treating massive weight loss patients is that they have loose skin everywhere in their bodies- as opposed to common a mommy makeover-type patient who wants to focus mostly on their breasts and abdomen once they are done having children.

Because massive weight loss patients have so many areas to address, the surgeries need to be broken down into stages. For example, a patient will usually start with a tummy tuck or a lower body lift, possibly combined with a breast lift.  In Another surgery, the patient might have an arm lift and a thigh lift.

Pre-Surgery Considerations and the Importance of Stable Weight and Nutrition in Body Contouring for Massive Weight Loss Patients

Occasionally, patients include an upper body lift which involves a large skin resection to address all the loose skin in the upper back, resulting in scar that goes around the upper back and the bra line. Patients change this order based on their personal priorities.  Regardless of the patient’s priorities and the order or combinations of surgeries planned, the patient must have achieved a stable weight for at least a month and be well-nourished with a high protein diet at the time of the surgery.

Continued dieting around the time of the surgery will lead to wound breakdown due to lack of extra nutrition required to heal all the incisions. The patients need to be off their weight loss medicine for at least a week to make the surgery safer. 

Clearly, weight loss drugs such as semaglutide and tirzepadine have been a game-changer for weight loss medicine, almost representing the holy grail of weight loss.

The Growing Demand for Body Contouring Post-Massive Weight Loss and the Importance of Expert Care

As we have seen in plastic surgery, this advance has caused a huge increase in the need of body contouring after massive weight loss. These surgeries are very rewarding, but are also very serious, for this reason. patients must be sure to see an experienced Board Certified plastic surgeon to discuss their desires.