Coming Back from Obesity: Weight Loss and Body Surgery

CYNTHIA GREGG, MD
FACE & BODY SPECIALISTS

Dr. Wu

“Let’s be clear,” says Dr. Cindy Wu, “plastic surgery is not a one-step solution to obesity. While body contouring procedures can provide transformative results, they have major limitations on how much fat they can safely remove. Further, not only does excess weight have serious health consequences, but obese patients are at greater risk of complications during and after surgery.

“So, for any surgery I do, it’s important that patients are not seriously overweight,” she explains. “As a general rule, I want patients to have a BMI (Body Mass Index) of no more than 30 in order for surgery to be safe and successful. That’s not a strict cutoff; we look at all aspects of the patient’s health status to determine if they’re a candidate for surgery. And, for patients who have lost considerable weight, they need to be at their stable weight for three months before we ideally want to have surgery.

“However,” says Dr. Wu, “although plastic surgery is not the way to remove fat, it can be a valuable part of an overall weight loss program. And one of the most rewarding parts of my practice is working with patients like “Suzy” who have made the effort to lose weight and keep it off, and who need help in dealing with the consequences of major weight loss.”

Health&Healing: Where does body surgery fit into a weight loss program?

DR. WU: I see it as the second phase—especially when someone loses large amounts of weight. Liposuction, for example, is helpful in removing stubborn pockets of fat that resist weight-loss efforts. But surgery is most valuable in addressing the problems that result from major weight loss. And, in fact, I will often work with prospective patients to develop a plan that leads up to surgery. The first step are the lifestyle modifications—including diet and exercise—that result in weight loss. But surgery is not a kickstart to a healthier lifestyle; it’s the other way around. You have to alter your lifestyle first and then stablize your weight before you can benefit from surgery.

H&H: What are the problems that result from major weight loss?

DR. WU: You’ll see many changes when you lose fat—especially with weight loss of 50 pounds or more. The main changes are sagging breasts and excess, loose skin. When you lose weight, breasts sag and the upper part of the breast gets flatter. So surgery—either a lift alone or a lift with implants—is needed to restore volume.

Loose, excess skin is the other major problem after major weight loss. And the solution is to remove it altogether and tighten up the skin edges. So that’s just one part of a tummy tuck. The other part of the tummy tuck is putting the muscles back together that may have separated. This frequently occurs in pregnancy.

H&H: What kinds of procedures are typically used for those who have lost large amounts of weight—50 pounds or more?

DR. WU: Because of the popularity of new weight loss drugs, such as Wegovy and Ozempic, we’re seeing patients who are losing a lot of weight more quickly. And, as a result, patients are having more skin laxity on their abdomen and flank areas as well as their breasts. So these patients typically require a combination of breast and abdominal surgery, commonly referred to as a “mommy makeover.” With rapid weight loss, breast tissue gets a lot smaller. So patients often need to lift breast skin and an implant to restore volume. They also typically require a full tummy tuck, which might also be combined with liposuction.

Sometimes these surgeries can be accomplished in a single procedure. But in more complex cases when there are multiple surgical sites, I will often stage the surgeries. It really is based on the amount of time under anesthesia required.

H&H: When is obesity a contraindication for surgery?

DR. WU: When there are serious underlying diseases—such as diabetes that is not controlled, or if they have a really high blood pressure that puts them at a higher stroke risk. Obesity puts patients at a higher risk for a blood clot. And that’s the thing that I am concerned about the most. We know that the higher your weight is, the higher your risk for a blood clot under anesthesia.

The second thing we look at is the duration of surgery under anesthesia. Surgery on a heavier, overweight patient requires more time, because I have more work to do on that patient.

In addition to concerns about clotting and too much time under anesthesia, sometimes obesity means that the aesthetic result is not the best, because the patient has a lot of visceral fat. This is especially important for tummy tuck patients, because I’m only able to remove the fat in the skin above your muscle and the visceral fat is in your abdomen. So I can only get you as flat as your visceral fat will allow.

Shedding Pounds and Regaining Her Body

“A patient I’ll call Suzy is a wonderful example of a transformational weight loss experience,” says Dr. Wu. “Suzy is a 47-year-old who had done the hard work of losing 90 pounds the healthy way—with diet, exercise, and lifestyle changes. It was an impressive accomplishment, and the results were gratifying in many ways. Habits of healthy eating and exercise contribute to health way beyond the loss of pounds. But one of the inevitable results of such extreme weight loss is excess skin—stretched by excess weight. Her breasts sagged and the excess skin was a burden.

“Suzy wanted her sagging breasts lifted and her abdominal skin removed. So we worked together to design a surgical procedure that would address these issues. Her surgery included a breast lift and fleur-de-lis abdominoplasty, during which 5.25 pounds of skin were removed.

“The fleur-de-lis tummy tuck,” explains Dr. Wu, “is designed for those who have undergone massive weight loss leaving a lot of loose skin. It involves vertical and horizontal incisions to remove skin and fatty tissue from the upper and lower abdomen, and tighten the skin both horizontally and vertically.

“The tummy tuck and breast lift procedures were done at the same time, and Suzy had a smooth recovery. She is pictured here six months after her surgery; she is 5’2”, and now weighs 138 pounds. She says she is thrilled with her results; she feels lighter, her clothes fit her better; and—most importantly—she has regained her confidence!”

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