The Long Road to Cosmetic Rehabilitation After Massive Weight Loss (MWL): The First Steps

The most important reason to undergo MWL (defined for this article as greater than 50 lbs.) is the preservation of health, longevity, and improvement of quality of life. Despite achieving this Herculean goal, many patients find this a hollow victory.

The most common presenting complaint I hear from MWL is "I lost all this weight and I still feel fat". Part of this is due to a distorted mind-body perception, which may persist, even after successful cosmetic procedures. Part of this perception is based on physical reality.

Although age, degree of obesity (BMI), length of time being obese, medical conditions, and factors such as history of smoking, excessive sun exposure, intemperate use of alcohol, and poor nutrition, can give clues as to how a well tissues will shrink after MWL, nobody can really predict who will need surgical correction, or which procedures will be needed. Additionally, people have different values: What bothers one person doesn't concern another.

It is crucial to understand that cosmetic rehabilitation is more of a marathon than a sprint, and therefore it must be addressed as a process that demands a logical, orderly, and, unemotional approach. At all times, the guiding principle is safety first!

In many regards, recovery from the plastic surgery procedures required to achieve the cosmetic result are more rigorous to recover from. Frequently the recovery time is much longer, as they cannot be done with a scope. They tend to leave long scars, many are more painful than the bariatric procedure, and post-operative restrictions may be more restrictive.

Recovery from surgery after bariatric surgery (especially R-N-Y gastric bypass) is more difficult. This is not usually intuitive as patients are otherwise healthier than they have been in years. The reason is that the digestive physiology has been altered, and this affects all processes. During the immediate postoperative period, patients are frequently very dehydrated, and malnourished. With decreased capacity to take substances by mouth, intravenous support is essential. Later on, healing may be very tricky due to inability to consume adequate calories and proteins.

Before considering any cosmetic procedures, the patient must give adequate time for the bariatric surgery to work its magic- usually around 18 months. Additionally, the weight should be stable and within about 10 to 15 pounds of the realistic target weight. Blood work, EKG, chest X-rays, and general medical health must be excellent. It is not unusual for the patient to require medical clearance prior to surgery.

The most commonly requested procedures that I see in my practice are: 1) abdominoplasty (tummy tuck), 2) breast rejuvenation mastopexy or breast lift, with or without implants), 3) brachioplasty (upper arm lift), 4) back lift alone or combined with abdominoplasty (i.e., body lift or 360 lift), 5) inner thigh lift, 6) other procedures, including facial rejuvenation.

In the coming months, I will discuss the plastic surgery principles for the most common procedures, and what you should consider for each step. Of course, space is limited so every aspect cannot be considered. Therefore, it must be stressed, that you must do your homework, and seek out a highly experienced plastic surgeon that specializes in these procedures, who has a passion for the MWL patient, and with whom you feel comfortable.

The journey is long and rigorous, but you are worth it!