Setting Expectations for Weight Loss Body Contouring

April 30, 2018

Most plastic surgeons have experienced this. They see a patient for a procedure on one day and see a very similar looking patient the next. The recommendation for surgical treatment is the same.  The procedures are performed the same week, and both patients progress well without complications. During follow up, the first patient is ecstatic with her result and wants to talk about her next procedure. But the second patient, whose results are equivalent, greets you with a tear in the eye and words of frustration.

Why is one patient celebrating the achievements of the procedure, and the other feeling only disappointment?  The difference is - expectations!

And it is not a problem isolated to the weight loss population, but bariatric patients are in many ways, vulnerable. Their weight loss journey often has lasted years, if not a lifetime, and despite successfully shedding pounds, their body goals are often unfulfilled.

They may present with frustration and maybe looking for body contouring to solve all their problems. Sometimes, patients have been unable to quite make it to their ideal weight or to achieve their weight loss goals, and they may look to body contouring for additional weight loss. Finally, the Internet and social media do not necessarily distinguish bariatric body contouring from traditional body contouring surgery, and they may be expecting changes that simply cannot be achieved. Patients benefit from preparing ahead for body contouring surgery after massive weight loss.

Advances in Weight Loss Body Contouring

At the time of consultation, I emphasize to my patients the great advances that have been in weight loss body contouring over the last decade. I genuinely want patients to be excited about all that can be achieved! I show them before and after photos, and share notes and texts from patients, attesting to the significant improvement in the quality of life that can be anticipated.

But I also temper the discussion by educating my patients with the goal of setting realistic expectations, and I emphasize the following points:

Body contouring surgery, while certainly removing tissue, is about shapes and silhouettes, and not about additional weight loss. Goals are measured not on the scale but in terms of improved self-esteem and by evaluating changed shape and form on before and after images.
The magnitude of these procedures should not be underestimated. Surgery should not be viewed as an event but a process. There is the operation itself, but then comes a prolonged period of healing with incision care, discomfort, activity restrictions, and social downtime.  This reality needs to be acknowledged and planned for to facilitate comfortable healing and recovery.
All surgery assumes risks of complications, and this is especially true for weight loss body contouring. Note that some body contouring procedures are prolonged operations of significant magnitude, and they often require more operative time than bariatric procedures. Furthermore, some patients present with nutritional deficiencies related to bariatric procedures that may make them more susceptible to these problems. Other patients may have medical conditions related to the prior weight gain such as diabetes that may increase their risk. Know that dedicated surgeons are there for their patients not just for the operative procedures, but for the entire recovery process and all that may come with it.
Most patients who have achieved massive weight loss have a list of concerns. While it is not uncommon to combine body contouring procedures, it should be emphasized that most patients require surgery to be performed in a few stages to achieve their desired results.
Body contouring procedures usually represent a trade-off. While improved shapes and contours can be realized with surgery, the procedure is performed in exchange for surgical incisions which produce surgical scars.  Every effort is made to execute the best scar as possible, both in terms of surgical technique and incision care postoperatively, but scarring is not as predictable as we would like.
There are consequences to weight gain and loss, and a patient’s skin and lymphatics may be compromised. These procedures can remove excess skin, but they don’t change the quality of the skin that remains.  It is common to excise the maximal amount of skin, but the remaining skin, once the prolonged swelling resolves, may appear loose.  The period of swelling may also be quite prolonged.

None of these things are emphasized to discourage a patient from undergoing surgery, as it is inarguable that massive weight loss body contouring can produce dramatic changes.

The changes can have a significant impact on an individual’s self-esteem and quality of life, and many patients note that the changes are as dramatic and significant as weight loss. But nothing ensures the success of a procedure more than being prepared and having realistic expectations of outcomes!



Harvard-Trained Board Certified Plastic Surgeon, Dr. Larry Lickstein is in private practice at the Bitar Cosmetic Surgery Institute, a full service cosmetic center in the Washington DC area. A former attending physician at the prestigious Cleveland Clinic, Dr. Lickstein was named a top doctor by Baltimore Magazine and the Castle Connoly Listing for 10 consecutive years.

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