Post Bariatric Plastic Surgery with Dr. Agha
July 16, 2014Siamak Agha-Mohammadi, MD PhD, is a Board-Certified Plastic Surgeon who completed his medical education at the prestigious University of Cambridge, England, and his residency in Plastic and Reconstructive Surgery at the University of Pittsburgh Medical Center; one of the most respected and comprehensive plastic surgery training programs in the United States. He is a member of the American Society of Plastic Surgeons.
Dr. Agha’s expertise in body contouring and post-bariatric plastic surgery has earned him well-deserved prominence in not just Southern California, but nationally. His cutting-edge innovations in plastic surgery have been remarkable, with his development of the revolutionary High Definition Body Lift™, Abdominoplasty™, Spiral Thigh Lift™, and Buttock Reshaping procedures. Dr. Agha has appeared as a Faculty Member of Body Contouring Live Surgery Courses and has published numerous peer-reviewed articles. He has published multiple textbook chapters in basic science, stem cells, aesthetic plastic surgery and post-bariatric body contouring techniques.
Dr. Agha has extensive experience in breast and body contouring surgery, as well as post-bariatric plastic surgery. Prior to relocating to Orange County, California, Dr. Agha worked closely with Dr. Peter Rubin, Director of the Life After Weight Loss Program at The University of Pittsburgh Medical Center and the co-author of Aesthetic Surgery after Massive Weight Loss, Plastic Surgery book (2007). He subsequently worked with Dr. Dennis Hurwitz, pioneer of the Total Body Lift procedure, at Hurwitz Center for Plastic Surgery in Pittsburgh for several years. Dr. Agha now dedicates approximately three-quarters of his practice to post-bariatric procedures. He is considered an expert in Body Contouring and Post-Bariatric Plastic Surgery and has developed cutting-edge techniques such as High-Definition Abdominoplasty ™, Spiral Thighplasty™, and Buttock Reshaping.
Dr. Agha is considered by many of his peers to be a pioneer in the field of body contouring procedures. His observations over the last decade in regards to post-bariatric plastic surgery are a shift from functional and reconstructive to cosmetic. He believes these procedures have to be looked at through the lens of cosmetic surgery. This rings true with his experience as a surgeon since no two patients are alike. From their face, eyes, nose, breasts, abdomen and legs, each patient is unique with their own set of concerns and desired results.
High Definition Body Lift™
Dr. Agha’s most distinguished contribution to the post-bariatric plastic surgery field is a procedure he developed known as the High Definition Body Lift™. Since 2005, Dr. Agha, has pioneered and performed his signature body contouring procedure that aims to return a three-dimensional correction. This involves correction of both vertical and circumferential laxity, as well as the third dimension of projection and contour. The latter is most applicable to the breasts, the lower back, the buttocks and the abdomen. He typically performs a Total High Definition Body Lift in two stages. This involves about 16 hours of surgery in stages. Dr. Agha is able to complete each stage of the surgery in about six to seven hours. Depending on the patient’s desire or what produces the best outcome, one stage will address the lower body and another stage the upper half.
He performs his lower body lift with a three-dimensional depiction of the female body in mind. Dr. Agha’s guiding philosophy regarding the female shape is its embodiment of the true sense of a three dimensional form in space. It not only represents curves in a two-dimensional hour-glass form, but also curves that are appreciated as the bust in the front and the buttock in the back. Unfortunately, the body lift procedure is a purely one-dimensional correction of the issue of vertical tissue laxity. The standard body lift procedure thus results in loss of definitions and creation of a masculine, boxy contour. It does not correct the horizontal laxity nor the lack of contours, curves and projections.
Dr. Agha starts the procedure on the patient’s back. First the upper back rolls are liposuctioned. The upper and lower incisions of the circumferential abdominoplasty are then made on the lower back and the upper buttock, respectively. The lower back tissue, in between the two incisions, is then mobilized as flaps for augmentation of the buttock region. Appropriately sized pockets are then created under the buttock regions for flap accommodation. This procedure is known as Autologous Buttock Augmentation. The buttock is then lifted and the incisions are brought together by internally placed absorbable sutures. In this way, the buttock sag and laxity are corrected with a buttock lift, and the volume lost is replaced through the patient's own lower back excess tissues. Thus buttock projection that defines feminine beauty and sensuality is returned and enhanced. Many patients discover a curvier and fuller buttock than ever before.
Dr. Agha continues the lower body lift procedure by completing the outer thigh lift. The outer thigh tissue is selectively undermined as far as the knee region. It is then elevated and secured at a higher position with deep stitches. Next, he turns his attention to the thigh region below the buttocks. To correct laxity of the thigh back, Dr. Agha has instituted a custom procedure which he has termed “Spiral Thighplasty”. This procedure corrects for the thigh laxity starting below the buttock region. The excess upper thigh tissue is excised at the buttock fold, and the thigh is elevated to a higher position. The thigh is then secured to the underlying tissues and the buttock fold is carefully reconstructed. After closure of all the skin incisions, the patient is rotated on the bed and placed on her/his back. Dr. Agha next completes the circumferential abdominoplasty in the front, followed by completion of the Spiral Thighplasty. The Spiral Thighplasty, unlike other thigh lift procedures, reduces both the thigh excess in a vertical as well as circumferential dimension. Most of Dr. Agha’s patients notice a marked reduction in their thigh measurements as well as their overall size. The whole mark of Dr. Agha’s approach is the return of a three-dimensional contour to the body, as well as placement of symmetrical incisions that are placed low on the abdomen and well-hidden in a bikini. This combination of procedures can take anywhere from seven to eight hours of surgery.
The second stage is best undertaken once all the incisions of the first stage are fully healed and the nutritional reserves of the patient replaced. In Dr. Agha’s practice, most patients typically wait between three to six months for the second stage. During the subsequent stage, the remaining body contouring procedures, including an extended arm lift, an upper body lift, and breast reshaping, are completed. This combination of procedures can take anywhere from six to seven hours of surgery. The extended arm lift corrects for the significant arm tissue laxity. The upper body lift can be performed as a vertical incision on the outer chest, or a horizontal incision on the back. The choice depends on the degree of back tissue laxity, the orientation of the laxity and the patient’s desires and aversions of scars. Finally, he finishes the breast reshaping by performing a breast lift together with either a breast reduction or augmentation, as necessary. Dr. Agha uses the patient's own excess chest and back tissue for breast augmentation or a breast implant. The former procedure is known as the Spiral Flap and was pioneered by Drs. Hurwitz and Agha. The procedure has been described in the May 2005 issue of Annals of Plastic Surgery.
Spiral Thigh Lift™
There are several different types of thigh lifts performed by Dr. Agha. Each procedure targets a certain area for a specific result. A medial (inner) thigh lift reduces excess skin and fat on the upper portion of the inner thigh. This type of thigh lift helps people who have trouble eliminating excess fat from this area of the body through diet and exercise. An inner thigh lift may also be used to treat reduced skin elasticity caused by the aging process or extreme weight loss. During an inner thigh lift, an incision is made at the junction of the thigh and pubic area that goes to the back of the crease of the buttock. A wedge of skin with fat is then removed and the inner thigh is lifted and secured at a higher position. The groin crease is then reconstructed. The scars are undetectable under clothing. This provides a tighter and smoother inner thigh contour and enhanced skin flow.
In a lateral (outer) thigh lift that includes a buttock lift, the incision generally overlaps with that of a circumferential abdominoplasty or a lower body lift. Through these incisions, the excess waist and upper outer thigh tissues are excised, and the thigh is elevated and secured at a higher position. This results in a smoother contour of the outer thigh skin. Also, the waist concavity is recreated. The disadvantage of this procedure is the length of the incision. However, most patients find that the scar is a reasonable trade-off for the results.
A spiral thigh lift is the premier thigh lift procedure Dr. Agha developed for those who require lower body lift surgery. As the name implies, the spiral thigh lift improves the thigh laxity of the front, back, inner and outer thigh. This procedure combines the incisions of an inner thigh lift with that of a lower body lift to improve the thigh contour circumferentially, to lift the buttocks, to restore an hour-glass waist, and to tighten the lower back and abdomen.
A vertical thighplasty is recommended for the treatment of loose skin of the thigh in a transverse or circumferential dimension, especially in the mid and lower thighs. The procedure involves removal of a large ellipse of skin and inner thigh tissue through a vertical incision that starts at the groin crease and extends to the inner knee. The procedure is recommended for a select number of patients who have lost significant weight. For these patients, Dr. Agha combines the vertical thighplasty and the upper-inner thigh lift in a procedure known as the “T-Thighplasty.” Whereas the scars after the medial thighplasty are covered by most underpants, the vertical medial thighplasty scar will be seen when the inner thighs are exposed.
Breast Reshaping
Typically with significant weight loss, the breasts undergo mild, moderate, or severe loss of fatty tissue and deflation. The dermal stretch gives a damaged quality to the breast skin. The nipple areola complex (pink part of breast) often becomes distorted and sags. The inframammary fold under the breast loses its semi-circular form and becomes semi-linear over the outer aspect of the chest due to the weight of the excess abdominal tissue and back rolls. The breasts are displaced downward and outward on the chest. They also appear broadened by the loss of outer breast tail/chest demarcation. This results in flattening and loss of breast projection with mild, moderate, or severe degrees of sagging.
Many of the aforementioned changes occur independently on each side of the body, and the degree of change is often asymmetrical. It is not surprising to find that the breasts are also asymmetrical in many aspects, most noticeably shape and size. For some, the breasts will be completely deflated and empty, whereas others will still have very large breasts (macromastia). In between these extremes, there are variable breast shapes and sizes. However, virtually all weight loss patients will require some form of a breast lift procedure. This is often combined with either a breast reduction or a breast augmentation.
For those with existing macromastia and sagging, Dr. Agha commonly performs a Wise-pattern breast reduction with internal breast lift by employing the dermal bra suspension technique. This procedure was developed, described, and published by Drs. Rubin and Agha in Plastic Surgery Book: Aesthetic Surgery after Massive Weight Loss in 2007.
For others who require breast volume, Dr. Agha offers either the use of breast implants or the patient's own excess upper body tissue for breast augmentation. This latter technique has been pioneered and developed by Drs. Agha and Hurwitz and was published in Annals of Plastic Surgery in 2006. For certain patients, Dr. Agha has found this approach to be an effective and safe strategy to aesthetically contour the breast, upper chest, and back. It treats the breasts and the upper body laxity in unison, using the excess upper abdominal, chest, or upper back tissue to supplement the lost breast volume. Both the upper body lift and breast reshaping are performed simultaneously.
Obesity Statistics
In the United States, more than two-thirds of adults are overweight or obese. Obesity is defined as a medical condition where excess body fat has expanded to the point that it adversely affects an individual’s health. Since the 1970’s, obesity rates have more than doubled in adults and children. Dr. Agha believes obesity is one of the leading health problems in our country. Sadly, this health crisis has shown to be trans-generational. Some patients may have been predisposed to particular weight and health issues and, as Dr. Agha has consulted with younger generations, he has discovered that many of their health and diet practices are a direct correlation of the way in which they were raised.
As a society, people who suffer from obesity are paying a high cost for the excess weight they carry. Many would be surprised to know that in the United States, deaths for adults under the age of 70 related to obesity rank 2nd to deaths related to tobacco. With the declining use of tobacco and the rising rate of obesity, there is some speculation that these two great harms to health in our society may at some point cross with obesity being the number one cause of death. Many people suffering from obesity have been shown to suffer from depression, anxiety, low quality of life, low self-esteem, body dissatisfaction. Startling is the fact that studies have indicated obese children rate their quality of life lower than children diagnosed with cancer. Inadequate concentration
levels, sub-par academic success and social isolation are also direct correlations
to weight gain.
Over the last decade, Dr. Agha has developed a strong interest, as a surgeon, to find a way to treat not only the initial process of losing the weight but what to do after the weight is lost. A patient may not feel whole again or motivated to stay on the path of health and a new way of living if the body they see in the mirror does not reflect the image they desire.
Dr. Agha’s advice to a patient considering weight loss surgery is not only to choose a procedure, rather select a new program for your life. Counseling in the form of emotional and nutritional aspects is an imperative part of the weight loss process. For example, perhaps stress was a trigger for your emotional eating. You will still experience days where you feel overwhelmed and anxious. While you have lost the weight it is to your benefit to understand and find a healthy way to cope with these triggers so as not to fall back into bad habits.
Additionally, Dr. Agha believes that an understanding of the human anatomy and the changes that occur through aging, pregnancy, weight loss, and life style are fundamental for achieving optimal surgical results. In addition, appreciation of aesthetics, beauty, and human physique forms the basis of optimal artistic results. His approach is to minimize the size of any given incision and to complete surgical procedures through well-hidden incisions.
For patients that are considering post-bariatric plastic surgery, Dr. Agha stresses that choosing your surgeon is one of the most important decisions a patient will make. Apart from training in the discipline of plastic and reconstructive surgery, it is also important to understand the artistic and aesthetic philosophy of your chosen plastic surgeon. He advises this is best appreciated by reviewing a surgeon's gallery of pre and post-operative photos. His personal philosophy is to choose your plastic surgeon as if your results depended on it. Dr. Agha’s philosophy is commitment to excellence in patient care and superior surgical results.
 | ABOUT THE AUTHOR Siamak Agha-Mohammadi, MD PhD of Plastic Surgery Body Contouring, is a Board-Certified Plastic Surgeon who completed his medical education at the prestigious University of Cambridge, England, and his residency in Plastic and Reconstructive Surgery at the University of Pittsburgh Medical Center; one of the most respected and comprehensive Plastic Surgery training programs in the United States. Dr. Agha has extensive experience in breast and body contouring surgery. |
