High-Definition Body Contouring after Weight Loss
By: Siamak Agha-Mohammadi, MD PhD
Learn more about Dr. Agha-Mohammadi, click here to read his bio.
Plastic Surgery Body Contouring Center
400 Newport Center Drive, Ste. 500, Newport Beach, CA 92660.
Phone #949.644.2442.
Today, one of the most popular treatment strategies to obesity is bariatric surgery. More people are opting out for the surgical alternative, with its consistent track record of success. Of all the available methods for weight loss, bariatric surgery is currently the most effective method for sustainable weight loss and the improvement of obesity-related complications.
The current mainstay of bariatric surgery procedures is drastic reduction of food consumption by means of restricted food intake, malabsorption of the food, or a combination of both interventions. The two most common bariatric surgeries are the laparoscopic adjustable banding (LAGB) and the roux-en-Y gastric bypass (RYGBP). LAGB is a restrictive procedure, in which a small stomach pouch is created, resulting in early and prolonged satiety. The RYGBP procedure involves both restrictive and malabsorptive components. Typically, gastric bypass surgeries produce weight loss within a year after surgery, which is 3 to 4 times superior to what can be achieved with non-surgical weight management programs. More importantly, most of the lost weight is maintained for many years.
Hence, the number of bariatric operations has risen each year with an estimate of 205,000 procedures performed in 2007, according to American Society for Metabolic and Bariatric Surgery. The popularity of bariatric surgery has led to an increasing population of post-bariatric patients who require body contouring surgery. According to statistics released by the American Society of Plastic Surgeons, about 66,000 body contouring procedures were performed in 2006.
Gastric bypass surgery (bariatric surgery) or massive weight loss (MWL) leaves a spectrum of changes that most patients find upsetting. For some, a near normal appearance may be the result; but more often, excess skin and soft tissue persists throughout the body. One of the most important considerations for a plastic surgeon is to realize that a bariatric patient must be treated differently from non-bariatric body contouring patients. What has worked well for many years on other patients simply does not provide adequate shaping and contouring for the bariatric patient.
The female physique embodies the true sense of a three dimensional shape in space. It not only represents curves in a 2 dimensional hour-glass form, but also curves that are appreciated as the bust in the front and the buttock in the back. Unfortunately, the body lift procedure is a purely one-dimensional correction of the vertical tissue laxity. It does not correct the circumferential laxity nor for the lack of contours and projections. Dr. Agha performs his signature Body Contouring Procedure that aims to return a three-dimensional correction to the tissue laxity. This involves correction of both vertical and circumferential laxity, as well as the third dimension of projection and contour. The latter is most applicable to the breasts, the lower back, the buttocks and the abdomen.
Typically, Dr. Agha performs his signature âHigh-definition Body Contouringâ in 2 to 3 stages. This involves about 16 to 20 hours of team surgery in total. By using trained physician assistants, Dr. Agha is able to complete each stage of the surgery in about 7-8 hours. Depending on the patientâs desire and what produces the best outcome, one stage will address the lower body and another stage the upper body. He performs his lower body lift with a three-dimensional depiction of the female body in mind. He starts the procedure on the patientâs back. First the upper back rolls are liposuctioned. This liposuctioned fat is then collected in a sterile container, washed with antibiotics and processed for injection into the buttock regions as small droplets (see buttock lipoaugmentation section). In this manner, the contour and projection of the lower buttock regions are restored. The upper and lower incisions of the circumferential abdominoplasty are then made on the lower back and the upper buttock, respectively. The lower back tissue, in between the two incisions, is then mobilized as flaps for augmentation of the upper buttock region. Appropriately sized pockets are then created under the upper buttock regions for flap accommodation. The buttock is then lifted and the incisions are brought together by internally placed absorbable sutures. In this way, the buttock sag and laxity are corrected with a buttock lift, and the volume lost is replaced through your own lower back excess tissues. Thus buttock projection that defines feminine beauty and sensuality is returned and at times even enhanced.
Many patients discover a curvier and fuller buttock than ever before. Dr. Agha then continues the lower body lift procedure by completing the outer thigh lift. The outer tight tissue is selectively undermined using a special instrument as far as the knee region. It is then elevated and secured at a higher position with deep stitches.
Dr. Agha next completes the circumferential abdominoplasty in the front, followed by completion of his signature reduction thighplasty. The reduction thighplasty, unlike other thigh lift procedures, reduces both the thigh excess in a vertical as well as circumferential dimension. Most of Dr. Aghaâs patients notice a marked reduction in their thigh measurements as well as their overall size. The whole mark of Dr. Aghaâs approach is return of a three-dimensional contour to the body, as well as placement of symmetrical incisions that are placed low on the abdomen and well-hidden in a bikini. This combination of procedures can take anywhere from 7 to 8 hours of surgery.
During the subsequent stage, the remaining body contouring procedures, including an extended brachioplasty (arm lift), an upper body lift, and breast reshaping, is completed. This combination of procedures can take anywhere from 7 to 8 hours of surgery. The second stage is best undertaken once all the incisions of the first stage are fully healed and the nutritional reserves of the patient replaced. In Dr. Aghaâs practice, most patients typically wait between 3 to 6 months for the second stage. The brachioplasty corrects for the significant arm skin and tissue laxity. The upper body lift can be performed as a vertical incision on the outer chest under the arm pit, or a horizontal incision on the back. The choice depends on the degree of back tissue laxity, the orientation of the laxity and the patientâs desires and aversions of scars. Finally, he finishes the breast reshaping.
For those with existing large breasts and sagging, Dr. Agha commonly perform a Wise-pattern breast reduction with internal breast lift by employing the dermal bra suspension technique. This procedure has been developed and described by Dr.s Rubin and Agha in Plastic Surgery Book: Aesthetic Surgery after Massive Weight Loss; Published in 2007.
For others who require breast volume, Dr. Agha offers either the use of breast implants or your own excess upper body tissue as flaps for breast augmentation. This latter technique has been pioneered and developed by Drs. Hurwitz and Agha and have been published in Annals of Plastic Surgery in 2006. For certain patients, Dr. Agha has found this approach an effective and safe strategy to aesthetically contour the breast and upper chest and back. It treats the breasts and the upper body laxity in unison and uses the excess upper abdominal tissue, as well chest tissue or upper back tissue to supplement the lost breast volume. Both breast reshaping and upper body lift are thus performed simultaneously.
In summary, body contouring surgery after weight loss is a complex tandem of surgeries that is best performed by a Board Certified Plastic Surgeon who specializes in this field.
For more information on Dr. Aghaâs practice, post-bariatric procedures, and gallery of pre and post-operative pictures, please visit our website at www.plasticsurgerybodycontouring.com or call us for a complimentary patient guide.
