After Weight Loss Surgery
Patients who experience major weight loss are usually ecstatic, having moved past a big hurdle in life. The downside: while their new shape represents a proud accomplishment, sometimes they will face additional frustrations. This is due to the loose, excess skin that remains on the body. Massive weight loss often leaves men and women with skin that cannot shrink to the new, smaller size. No matter where the sagging skin resides after weight loss/skin removal surgery is necessary to eliminate the issue. Board-certified Beverly Hills plastic surgeon Dr. Jaime S. Schwartz works with many amazing clients who want to complete the weight loss journey and restore their bodies. This life-changing procedure, many times, serves as one of the final steps in a weight loss patient's personal transformation.
An Expert approach
After weight loss plastic surgery involves a comprehensive surgical approach, and patients considering this procedure should turn to a skilled and experienced board-certified plastic surgeon. Dr. Jaime Schwartz dedicates himself to creating policies aimed at enhancing and developing safer and innovative techniques for his patients. Having performed countless body contouring surgeries for massive weight loss patients, Dr. Schwartz has the compassion to understand their personal journey and works with each individual to meet their cosmetic surgery goals. He has received national recognition and awards for his patient care and techniques. He has published numerous peer-review journal articles, been the principal investigator for FDA clinical trials, and has developed national guidelines for plastic surgical procedures to educate and assist other surgeons. Dr. Schwartz has also been asked to appear on TV shows such as "The Doctors" and "Botched!" so he can share his knowledge.
Skin Removal Candidates
The best individuals for skin removal and tightening surgery are those who are dealing with the problems or even the cosmetic concerns from the excessive loose skin after massive weight loss. Excess loose skin can become a problem with hygiene as the areas underneath are more susceptible to odors, rashes, and infections. It is often difficult to find properly fitting clothing and in some cases, extra clothing that is tight is worn to hold the excess in. This can also lead to pain, chaffing, and skin breakdown. In most cases, this challenge is seen early on as the weight is lost. Stretched skin in the abdomen, breasts, arms, thighs, buttocks, or lower back each has its own individual challenges, concerns, and cosmetic principles. Dr. Schwartz can reduce the excess for a tighter, more contoured appearance. It's recommended that patients be at their stable weight for 6 months before having this procedure. Patients who are under the care of a bariatric surgeon should discuss their medical history and weight loss progress with Dr. Schwartz so he can measure their readiness for surgery. Dr Schwartz will also contact your other physicians so that they can all work together as a team to make your weight loss and body contouring journey as safe and easy as possible.
"A Pain-Free, Easy Decision leaving me Confident and Happy! - As a busy working wife and mom of 2 toddlers I was extremely nervous about taking the time to do what I had carefully considered for years....getting a mommy makeover! So, I opted for one piece of that makeover, a breast augmentation. Working in the healthcare industry and meeting many surgeons along the way challenged me to be quite selective. Meeting Dr. Schwartz and his staff made my..."- S. / RealSelf / Apr 29, 2018
"botox for vaginismus - I've been dealing with vaginismus since 2012, and I quite honestly didn't even know it was called that until this procedure with Dr. Schwartz was featured on Buzzfeed. My previous gynecologist had merely told me it was a muscle spasm and that I needed physical therapy (which helped but did not work). My good friend had known I was dealing with it and sent me the video as soon as she saw it. I..."- C. / RealSelf / Apr 17, 2018
"It's hard to balance science with sexy, Dr. Schwartz and his team are the experts at both. He's incredibly knowledgeable and skilled in his craft and it shows in his results. My entire experience, from pre-op planning, to the surgery, to the aftercare went as smoothly as I could have ever hoped. He and the whole team at The Roxbury Institute will ensure that you're healthy and happy throughout the entire process. I'm finally starting to like the skin I'm in and that's only due to Dr. Schwartz!"- A. / Healthgrades / Dec 03, 2017
"Incredible work - I had a labiaplasty done with Dr. Schwartz and it's been day and night for me. Ive had insecurities about my vagina since I can even remember; always kind of nervous to have new partners, not really wanting a lot of light in the bedroom. This has been so liberating and the results are amazing. I had very thick tissue which did cause my recovery to be really extended and quite painful, but that..."- K. / RealSelf / Apr 02, 2018
"I came to Dr. Schwartz for botox to treat vaginismus, and my experience was phenomenal. Vaginismus is pain during any kind of vaginal penetration. After 6 years of pain and frustration, there was finally a solution that could help me. A year after the procedure, I am now able to have painless sex, painless pap smears, and I can use tampons. Not to mention all of the staff was incredibly nice and helped calm my nerves during the experience. This procedure changed my life. Thank you, Dr. Schwartz!"- M. / Healthgrades / Mar 04, 2018
Patient Safety First
After weight loss surgery is typically aimed at cosmetically reducing the excessive areas and creating a more natural and rejuvenated area. Many people who lose massive amounts of weight can be nutritionally depleted and also have poor, stretched out skin quality. This lends itself to a higher complication rate than when surgeries are performed on people who have not undergone massive weight loss. The literature states that even up to 70% of these patients can have complications such as incision breakdown (dehiscence), fluid build-up (seroma), fat necrosis, and infection to name a few of the more common. Even after the factors such as nutrition have been corrected and skin is closed perfectly, there still is a large discrepancy in outcomes.
One of the main reasons Dr. Schwartz believes after weight loss patients have a higher complication rate, is that traditional ways of skin removal usually involve “cutting and sewing”. While this intuitively makes sense, to remove excess skin and close together, the issue lies with what is being removed. When the excess is skin is cut straight down the deeper facial layers and removed, it also removes blood supply, lymphatic vessels, and nerves. Whereas if there was a way to leave a lot of the more vital structures behind (blood and lymphatic vessels) while removing the excess and unwanted fat and poor quality skin, there should be a better chance of healing with fewer complications. Dr. Schwartz has incorporated this into his Body LipoLift® procedures for after weight loss surgery and body contouring techniques.
More recent literature has confirmed that performing liposuction first to remove the subcutaneous tissues (fat) and then removing only the skin (either just the top layer or both layers) decreases overall complication rates. This is due to the fact that utilizing this technique spares many lymphatics and blood vessels. Lymphatic vessels follow lines of deep, superficial and subdermal. The more of these we can spare, the less likely for fluid buildup (seroma). The more blood vessels we can leave behind, the better blood and oxygenation to the tissues which is essential for wound healing.
Most Common Approaches
According to U.S. data, the average person that undergoes massive weight loss needs approximately five reconstructive procedures. Most commonly:
- Circumferential Torso (Lower Body Lift)
This address the abdomen and buttocks. If there is a lot of excess tissue above the umbilicus (bellybutton), Dr. Schwartz may recommend a Fleur-de-lis abdominoplasty that is very powerful at removing skin vertically and horizontally which can also shape the hips, waist, and even some of the lower back. Patients that have skin laxity and excess that goes completely around the torso (360°) and also has sagging buttocks, a circumferential abdominoplasty (a lower body lift) may be a better option. This surgery is meant to address the entire midsection. Dr. Schwartz pays special attention to the pubic area known as the mons pubis and includes a monsplasty. The gluteal lift can also sometimes include auto-augmentation utilizing the excess skin and fat to give a better shape and contour.
- Circumferential Upper Body
The upper body from the chest through the armpit to the upper back is usually the most individualized for men and women that have lost a lot of weight. For men, there are varying degrees of chest contouring which may also include gynecomastia correction. Depending upon the amount of excess skin there are many techniques to remove, shape, and contour to create a more masculine chest. Most women will need some type of breast lift and many will also need volume either with an implant or a fat transfer, which can be used with the excess fat taken during the liposuction stage. If there is extensive upper back laxity creating back rolls which can also extend into the axilla (under the armpit) a bra-line back lift also known as an upper body lift may be indicated. This procedure is powerful in that you can reshape the back as well as the waist with an incision that can be hidden underneath the bra or bikini area.
- Arm Lift
An arm lift, also known as a Brachioplasty is a procedure designed to remove the excess skin and fat that hangs below the arm sometimes known as a bat-wing deformity. This excess skin makes finding properly fitting, clothing difficult. Most will also tell you the excess weight is difficult to hold up and can also lead to some shoulder and neck discomfort. Depending upon the other planned procedures, as well as the amount and area of excess, the arm lift can be extended into the armpit and down the side to treat skin redundancy in this area.
- Thigh Lift
A thigh lift is meant to tighten the upper leg by pulling and removing the excess skin toward the medial or inside portion of the thigh. Massive weight loss patients commonly battle hanging, loose skin in the thighs. This treatment helps create a tone and smooth upper leg appearance
- Facial Cosmetic Procedures
With weight loss patients, the face is also affected. Lost volume in the cheeks, lower face, and under the eyelids is common and can be corrected with cosmetic treatment. Depending upon how much skin laxity and areas of sagging, Dr. Schwartz may recommend any combination of procedures designed to restore facial volume and rejuvenate the face, neck, brow, and eyes. Fillers can also be used to increase volume where necessary.
Schwartz Rapid Recuperation®
Board-certified plastic surgeon Dr. Jaime Schwartz has developed protocols and techniques designed to allow clients that undergo skin removal and body contouring surgery the opportunity to get back to their normal daily lives as quickly as possible. This begins with a more gentle form of anesthesia that is designed to keep you comfortable during the procedure but will be out of your body within hours after its completion. Side effects that can sometimes accompany general anesthesia, such as nausea and vomiting have been eliminated in over 98% of patients utilizing this technique. Dr. Schwartz also uses special oral medications as well as longer acting numbing injectable medications so that most clients will just use plain Tylenol and Advil after all surgeries. Decreasing the use of narcotic medications allows for faster healing since these medications are sedating, constipating, and also increase the risk for nausea and vomiting.
Dr. Schwartz will go over in great detail how the Schwartz Rapid Recuperation® technique can help you achieve your goals faster and safer.
Plan Your Procedure
Reach Your Goals
Losing weight is such an amazing accomplishment when you finally meet your weight loss goals. If excess skin is a new frustration, Dr. Schwartz invites you to learn more about your alternatives for skin removal after weight loss surgery. Body contouring utilizing Body LipoLift® surgery could further sculpt your physique and help you meet and surpass each of the amazing goals you made for yourself.
As a very active member of the American Society of Plastic Surgeons (ASPS) and a diplomate of the American Board of Plastic Surgery, Dr. Schwartz has special interest in helping clients achieve their goals safely after weight surgery. He serves on many national committees for the American Society of Plastic Surgeons, which include Health Policy, Patient Safety, Emerging Trends, Quality and Performance Measurement, and the Clinical Trials Network. Dr. Schwartz uses the most advanced techniques and literature to care for his patients.