Body contouring refers to a broad field of plastic surgery procedures that address areas of excess fat and/or skin. Body contouring procedures can be performed in overweighted patients, normal-weight patients, patients who have lost significant weight, usually 70lbs or more. The latter is more precisely referred to as post-bariatric body contouring or body contour restoration.

No matter how much you diet or exercise, the skin left behind after major weight loss doesn’t go away. Think of it this way: skin is known for being elastic. It has a good amount of stretch to it – a little give and take. If you gain or lose a little muscle or fat, your skin can easily stretch to fit. But, over time, your skin loses that elasticity. And, if it’s been stretched out for months or years when you suddenly lose all of that excess weight, then it’s impossible for the skin to “shrink” back up over the body. Elasticity is further decreased by:

• Age
• Certain genetic factors
• Sun exposure
• Smoking
• and, to a lesser degree, factors like diet, sleep, and stress

Between these factors and the notable loss of mass following bariatric surgery, many patients have reduced skin elasticity. As a result, patients turn to body contouring to finish the weight loss experience.

As a result of the severe weight loss through Bariatric operations, diet and/or exercise, there is a significant excess of inelastic skin, with typical formation of deep creases (with chronic skin inflammation) and sagging skin sacs.

The excess of inelastic skin leads to:

• Head and neck region: A drooping neck deformity “turkey neck deformity” 
• Upper Limb: there is a typical excess of skin in the sense of a “wing skin deformity”
• Upper and lower trunc: „sagging breasts“ and a typical ring formation (“Michelin man” deformity)
• Lower Limb: there is a typical excess of skin in the sense of an “empty pant deformity”

Body and Soul: Changes in body shape after massive weight loss lead to physical, aesthetic / psychological and / or functional impairments:

• Physical: Chronic inflammation in deep skin folds leads to an unpleasant odor, which often leads to a social isolation of the patient
• Aesthetic/Psychological: The unaesthetic body shape can be a great psychological burden for the patient.

Functional: Large skin fat pads can become mechanical obstacles to locomotion. B. in the area of ​​the inside of the thighs it comes to abrasion of the skin, with chronic wounds and scarring. A large hanging fat apron can severely impair normal locomotion or even make it impossible

A benefit of compression clothing is that it can help reduce irritation, pain, itching, and the risk of infection. Keep in mind that compression clothing doesn’t tighten skin, but it does help with the side effects of loose skin.

Massive weight loss patients often require multiple surgical procedures to address excess skin and fat throughout their entire body. From the healing and safety standpoint it is not feasible to perform all of these procedures in one operation. Typically, panniculectomy (removal of excess skin and fat from the abdomen) or lower body lift procedures are performed as the first stage. Breast reduction/lift procedures can be combined with either brachioplasty (arm) or medial thigh lift. The remaining procedure can be performed as a third stage. If there is significant facial laxity, a face lift can be performed, often, as the final stage. Typically, the time period between stages is 6 to 12 months to allow for recovery and healing.

Reaching your ideal body weight before body contouring is not required, but it is recommended. The lower your body fat percentage, the better your final outcome will be. You may combine liposuction with skin removal procedures to remove excess fat along with excess skin, but you must keep in mind that liposuction is intended to sculpt the body and will not result in significant weight loss. Ideally, patients should be weight stable for a minimum of 12 months. This is important because weight fluctuations, both gain or loss, can affect the aesthetics of body contouring procedures. This can lead to poorer outcomes, and increase the incidence of need for secondary procedures

The major factor that affects the longevity of results in post-bariatric body contouring is weight fluctuations. This is the main reason that these procedures are delayed until patients are weight stable for a minimum of 12 months. If patients are able to maintain their weight, long-lasting results can be achieved. The main issues in this patient population are related to scar migration and soft tissue laxity leading to contour deformities. These are the result of the altered skin/soft tissue characteristics related to the previous obesity.