Body shaping
Encyclopedia
Body contouring is a general term that refers to any surgical procedure that alters different areas of the body, whether it is in a massive weight loss patient or not. Body contouring after massive weight loss refers to a series of procedures that eliminate and/or reduce excess skin and fat that remains after obese individuals lose a significant amount of weight, in a variety of places including the torso, upper arms, chest, and thighs.
(BMI) is 30 or greater. BMI is calculated by dividing the patient's weight in kilograms by their height in meters, squared. Normal weight individuals have a BMI that ranges from 18 to 25. Overweight people have a BMI from 26 to 30, with 30 and above people considered obese. Once the BMI reaches 35 and above, patients are considered morbidly obese. From a BMI of 30 and above a person's life span is shortened. In addition, obesity negatively affects the economic health of a society as well as other aspects of adult and child health, often for life. Childhood obesity is on the rise in Europe as well.
. One such undesirable side effect that is very bothersome andvisible is the loose, hanging skin that covers much of a weight loss patient's body. Because hundreds of pounds have stretched the patient's skin to the maximum, it has lost its elasticity and the ability to spring back. Instead, the newly slimmed patient must deal with so much extra hanging skin, he or she can actually stumble on an overhanging panniculus
, the large apron of skin hanging from the stomach that can cover the pubis and groin
areas. Notably, many extra inches (and sometimes, feet) of floppy skin hang from the upper arms, the chest, the stomach, the upper thighs and buttocks.
Most people who have lost massive amounts of weight complain about the difficulty of getting their fleshy arms into sleeves and their excess stomach skin tucked into clothing. Many say that sitting on the loose skin is like sitting on Jell-O
. Most women in this state condition require a mastopexy, or breast lift, often in conjunction with breast implants. Men who have body shaping surgery usually undergo male breast reduction surgery to remove the pendulous skin hanging from their chests.
The extra rolls and sheets of skin rub against each other, creating many spots of irritation and leading to hygienic difficulties. The masses of excess skin also make any form of exercise difficult.
While the procedure is expensive, often running in the neighbourhood of US$20,000-50,000 for an entire body, it usually leaves long, visible scars on the arms, chest, stomach and legs. Most surgeons break the surgical task into an upper, and a lower, body lift. A lower body lift removes the sagging skin on the back, abdomen, buttocks and thighs while the upper body procedure removes loose skin from the arms, breasts and chest.
s and often, another surgeon to assist. Plastic surgeons advise patients that body shaping is not an obesity operation. A patient who is more than 50 percent over his or her ideal weight must first drop as many pounds as possible before proceeding. Other medical considerations the plastic surgeon must take into account include scars already present on the body, current medical conditions like heart disease
or bleeding disorders, and if the patient smokes. Other possible risks include infection
s and reactions and complications
due to being under anesthesia
for longer than six hours. The patient may also experience seroma
, a build up of fluid; dehiscence
(wound separation) and deep vein thrombosis
(blood clots forming in the legs.) Rare complications include lymphatic injury and major wound dehiscence. The hospital stay for the procedure can require from one to four days while recovery can require about a month for a total body lift. Essentially, the patient trades "skin for scars". But skin relaxation is always a risk and may not be stopped with a single procedure. Reputable plastic surgeons will explain all the risks and complications in full to their patients and even encourage a second or third consultation
visit with other plastic surgeons to get additional views on such a major undertaking.
The following are the individual components of body contouring:
Arm lift or brachioplasty. The extra flesh on the arms of bariatric patients virtually always appears on the underside of the upper arm and is sometimes referred to as "bat wings". Surgeons make incisions made from the armpit to the elbow to remove the skin and create a more pleasing contour. Consequently, surgeons open the arm on its underside so that the resulting scar is fairly well hidden. A brachioplasty procedure can employ some liposuction after the incision is made. With the arm opened, the surgeon pulls the skin tight and then trims away the excess skin which, depending on the patient, can be a pound of skin per arm or more.
Breast lift or mastopexy. By trimming excess tissue from the upper breast, the surgeon can move breasts which usually droop to the umbillicus to a more upright and full position. The procedure also often requires an implant to make up for lost fat and tissue
inside the breast. Scars on women are almost always hidden inside the area covered by the bra
.
Stomach lift or abdominoplasty. Excess skin hanging down over the pubic region is often the distorting feature that most concerns and bothers patients. The stomach pannus
retains moisture, and causes rashes due to skin rubbing against itself which usually leads to poor hygiene. While the surgical procedure to remove it is known as a panniculectomy, there is often more work to be done for patients who suffer from large amounts of hanging skin. To provide improved contours on the waist, back and flanks, surgeons sometimes perform a belt lipectomy, (also known as a torsoplasty or a circumferential lipectomy). The incision goes all the way around the patient's midsection at the level of the lower waist. The surgeon uses more liposuction on the stomach and flanks while trimming excess skin from the patient's back and sides as well. The abdominoplasty and belt lipectomy incisions are placed so that the resulting scar is hidden within most underwear and swimsuits.
Lower body lift trims excess skin on the buttocks and thighs. For an inner thigh lift, the surgeon makes an incision high on the inner leg, starting near the groin and continuing down to the knee. Some fat may be removed with liposuction. The surgeon then removes excess skin and redrapes the remaining skin before closing the long incision, leaving the patient with tighter and more attractive thighs.
The outer thigh and buttock can be lifted through a hip-to-hip incision across the back, above the buttocks.
When researchers at the University of Pittsburgh
enrolled 18 bariatric patients just before the subjects decided to undergo body contouring, their average age was 46, plus or minus ten years. The researchers studied the patients’ body perception, quality of life and mood
at three and six months after the body contouring procedures. They found the subjects’ quality of life improved and significantly enhanced their moods which had remained stable at the six-month point.
Most body lifting patients return to non-strenuous work in about two to three weeks.
Except for brachioplasty, virtually all body shaping procedures require the patient to wear a support or compression garment for two to six weeks. The garment speeds and aids in healing.
Patients can usually drive again within one to three weeks, depending on the extent of the surgery, their health and general robustness.
History
Obesity is in epidemic proportions in the US and many parts of the world. It is defined as a condition where a person's body mass indexBody mass index
The body mass index , or Quetelet index, is a heuristic proxy for human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat. It was invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing...
(BMI) is 30 or greater. BMI is calculated by dividing the patient's weight in kilograms by their height in meters, squared. Normal weight individuals have a BMI that ranges from 18 to 25. Overweight people have a BMI from 26 to 30, with 30 and above people considered obese. Once the BMI reaches 35 and above, patients are considered morbidly obese. From a BMI of 30 and above a person's life span is shortened. In addition, obesity negatively affects the economic health of a society as well as other aspects of adult and child health, often for life. Childhood obesity is on the rise in Europe as well.
Laser Assisted Lipolysis and Radiofrequency
Body contouring and shaping includes different techniques to help reshape and rejuvenate almost any area of the body. In the past, plastic surgery has been the only answer to these issues. Now, we are able to use non-invasive technology to achieve a reduction in size of certain body areas, increased tone in lax or redundant skin and a diminished appearance of cellulite.Bariatric surgery
In response to a serious obesity crisis, medical science has devised a handful of bariatric (obesity treatment) surgeries, including gastric bypass, stomach stapling, lap banding, stomach reduction and other techniques that reduce the amount of food the stomach can hold. For instance, in the United States, the American Society of Bariatric Surgery (ASBS) reports that the year 2000 saw an estimated 37,700 surgeries to restrict the size of a patient's stomach. But in 2006, the most recent year for which statistics are available, there were 177,600 such operations. Usually, by 18 months after the surgery, patients report having lost anywhere from 45 to 136 kg (100 to 300 pounds).Body lifting
Food-restriction operations to the stomach have several side effectsAdverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
. One such undesirable side effect that is very bothersome andvisible is the loose, hanging skin that covers much of a weight loss patient's body. Because hundreds of pounds have stretched the patient's skin to the maximum, it has lost its elasticity and the ability to spring back. Instead, the newly slimmed patient must deal with so much extra hanging skin, he or she can actually stumble on an overhanging panniculus
Panniculus
Panniculus is a medical term describing a dense layer of fatty tissue growth, consisting of subcutaneous fat in the lower abdominal area. It can be a result of obesity and can be mistaken for a tumor or hernia. Abdominal panniculus can be removed during abdominal panniculectomy, a type of...
, the large apron of skin hanging from the stomach that can cover the pubis and groin
Groin
In human anatomy, the groin areas are the two creases at the junction of the torso with the legs, on either side of the pubic area. This is also known as the medial compartment of the thigh. A pulled groin muscle usually refers to a painful injury sustained by straining the hip adductor muscles...
areas. Notably, many extra inches (and sometimes, feet) of floppy skin hang from the upper arms, the chest, the stomach, the upper thighs and buttocks.
Most people who have lost massive amounts of weight complain about the difficulty of getting their fleshy arms into sleeves and their excess stomach skin tucked into clothing. Many say that sitting on the loose skin is like sitting on Jell-O
Jell-O
Jell-O is a brand name belonging to U.S.-based Kraft Foods for a number of gelatin desserts, including fruit gels, puddings and no-bake cream pies. The brand's popularity has led to it being used as a generic term for gelatin dessert across the U.S. and Canada....
. Most women in this state condition require a mastopexy, or breast lift, often in conjunction with breast implants. Men who have body shaping surgery usually undergo male breast reduction surgery to remove the pendulous skin hanging from their chests.
The extra rolls and sheets of skin rub against each other, creating many spots of irritation and leading to hygienic difficulties. The masses of excess skin also make any form of exercise difficult.
While the procedure is expensive, often running in the neighbourhood of US$20,000-50,000 for an entire body, it usually leaves long, visible scars on the arms, chest, stomach and legs. Most surgeons break the surgical task into an upper, and a lower, body lift. A lower body lift removes the sagging skin on the back, abdomen, buttocks and thighs while the upper body procedure removes loose skin from the arms, breasts and chest.
Potential risks and side-effects
Body lifting is not lightly undertaken. The process requires a commitment on the part of the patient who must stay with the program through bariatric surgery, during the 18 months required for weight loss, then the body contouring procedures and recovery. Often, beginning to end takes three years. A single body lifting operation can require seven to 10 hours under general anesthesia, blood transfusionBlood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
s and often, another surgeon to assist. Plastic surgeons advise patients that body shaping is not an obesity operation. A patient who is more than 50 percent over his or her ideal weight must first drop as many pounds as possible before proceeding. Other medical considerations the plastic surgeon must take into account include scars already present on the body, current medical conditions like heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
or bleeding disorders, and if the patient smokes. Other possible risks include infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
s and reactions and complications
Complication (medicine)
Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathological changes, become widespread throughout the body or affect other organ systems. A...
due to being under anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
for longer than six hours. The patient may also experience seroma
Seroma
A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are ruptured, blood plasma can seep out; inflammation caused by dying injured cells also contributes to the fluid....
, a build up of fluid; dehiscence
Dehiscence
Dehiscence can refer to:*Dehiscence is the spontaneous opening at maturity of a plant structure, such as a fruit, anther, or sporangium, to release its contents.*Wound dehiscence is a previously closed wound reopening....
(wound separation) and deep vein thrombosis
Deep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
(blood clots forming in the legs.) Rare complications include lymphatic injury and major wound dehiscence. The hospital stay for the procedure can require from one to four days while recovery can require about a month for a total body lift. Essentially, the patient trades "skin for scars". But skin relaxation is always a risk and may not be stopped with a single procedure. Reputable plastic surgeons will explain all the risks and complications in full to their patients and even encourage a second or third consultation
Consultation
The Consultation served as the provisional government of Mexican Texas from November 1835 through March 1836 during the Texas Revolution. Tensions rose in Texas during early 1835 as throughout Mexico federalists began to oppose the increasingly centralist policies of the government. In the...
visit with other plastic surgeons to get additional views on such a major undertaking.
Body lifting surgical procedures
While body shaping can be done in one marathon session, it is usually broken into one to three surgical stages, with the patient under general anesthesia. But if the patient is a smoker, has a history of deep venous thrombosis or clotting disorders along with a high BMI and other medical risk factors, the surgeon will probably insist on doing several short procedures in a hospital setting to insure maximum safety for the patient.The following are the individual components of body contouring:
Arm lift or brachioplasty. The extra flesh on the arms of bariatric patients virtually always appears on the underside of the upper arm and is sometimes referred to as "bat wings". Surgeons make incisions made from the armpit to the elbow to remove the skin and create a more pleasing contour. Consequently, surgeons open the arm on its underside so that the resulting scar is fairly well hidden. A brachioplasty procedure can employ some liposuction after the incision is made. With the arm opened, the surgeon pulls the skin tight and then trims away the excess skin which, depending on the patient, can be a pound of skin per arm or more.
Breast lift or mastopexy. By trimming excess tissue from the upper breast, the surgeon can move breasts which usually droop to the umbillicus to a more upright and full position. The procedure also often requires an implant to make up for lost fat and tissue
Tissue (biology)
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...
inside the breast. Scars on women are almost always hidden inside the area covered by the bra
Brassiere
A brassiere is an undergarment that covers, supports, and elevates the breasts. Since the late 19th century, it has replaced the corset as the most widely accepted method for supporting breasts....
.
Stomach lift or abdominoplasty. Excess skin hanging down over the pubic region is often the distorting feature that most concerns and bothers patients. The stomach pannus
Pannus
Pannus is a medical term for an abnormal layer of fibrovascular tissue or granulation tissue. Common sites for pannus formation include over the cornea, over a joint surface , or on a prosthetic heart valve...
retains moisture, and causes rashes due to skin rubbing against itself which usually leads to poor hygiene. While the surgical procedure to remove it is known as a panniculectomy, there is often more work to be done for patients who suffer from large amounts of hanging skin. To provide improved contours on the waist, back and flanks, surgeons sometimes perform a belt lipectomy, (also known as a torsoplasty or a circumferential lipectomy). The incision goes all the way around the patient's midsection at the level of the lower waist. The surgeon uses more liposuction on the stomach and flanks while trimming excess skin from the patient's back and sides as well. The abdominoplasty and belt lipectomy incisions are placed so that the resulting scar is hidden within most underwear and swimsuits.
Lower body lift trims excess skin on the buttocks and thighs. For an inner thigh lift, the surgeon makes an incision high on the inner leg, starting near the groin and continuing down to the knee. Some fat may be removed with liposuction. The surgeon then removes excess skin and redrapes the remaining skin before closing the long incision, leaving the patient with tighter and more attractive thighs.
The outer thigh and buttock can be lifted through a hip-to-hip incision across the back, above the buttocks.
Usual results
While considered major surgery, the outcome of body shaping can require several months to see the full effects of the procedure.When researchers at the University of Pittsburgh
University of Pittsburgh
The University of Pittsburgh, commonly referred to as Pitt, is a state-related research university located in Pittsburgh, Pennsylvania, United States. Founded as Pittsburgh Academy in 1787 on what was then the American frontier, Pitt is one of the oldest continuously chartered institutions of...
enrolled 18 bariatric patients just before the subjects decided to undergo body contouring, their average age was 46, plus or minus ten years. The researchers studied the patients’ body perception, quality of life and mood
Mood (psychology)
A mood is a relatively long lasting emotional state. Moods differ from emotions in that they are less specific, less intense, and less likely to be triggered by a particular stimulus or event....
at three and six months after the body contouring procedures. They found the subjects’ quality of life improved and significantly enhanced their moods which had remained stable at the six-month point.
Most body lifting patients return to non-strenuous work in about two to three weeks.
Except for brachioplasty, virtually all body shaping procedures require the patient to wear a support or compression garment for two to six weeks. The garment speeds and aids in healing.
Patients can usually drive again within one to three weeks, depending on the extent of the surgery, their health and general robustness.
Further reading
- Total Body Lift: Reshaping the Breasts, Chest, Arms, Thighs, Hips. Waist, Abdomen & Knees after Weight Loss, Aging & Pregnancies, Dennis J. Hurwitz, M.D. F.A.C.S., M.D. Publish, NYC
- Body Contouring Surgery After Weight Loss, Joseph Capella, M.D., Peter Rubin, M.D., and Jeffrey Sebastian, M.D., Addicus Books, Omaha, Nebraska