abdominoplasty after weight loss

What You Need to Know About Having An Abdominoplasty After Weight Loss

February 26, 2018

After your journey of weight loss, whether through bariatric surgery, or diet and exercise, you might be considering having another surgery to address the excess skin that has been left after that much weight loss. One of those surgeries could be having an abdominoplasty after weight loss.

Following massive weight loss, abdominoplasty, or tummy tuck, is the most common plastic surgery procedure. Much has been written about how to ensure the best recovery following that procedure, but it is just as important to consider what will give you the best long-term results in addition to the smoothest recovery.

Having an Abdominoplasty After Weight Loss

1. Choosing An Experienced, Trustworthy, Qualified Plastic Surgeon

A good place to start is to simply make sure that the surgeon is a Plastic Surgeon certified American Board of Plastic Surgery, and is not a “cosmetic surgeon”. This certification will ensure his or her educational background.

Next, they should be particularly experienced in body contouring after massive weight loss. Many surgeons can and do perform tummy tucks, but there is a significant difference between a woman who has had two babies and lost 30 pounds and a person who has a large amount of loose skin from losing 100+ pounds or more.

Where to place the scar, how long to make the scar, how much will the skin stretch after surgery, what surgeries could be performed together and what order to perform the surgeries are just a few of the things that are important considerations that can make a difference between an average result and an excellent result.

Lastly, you should pick a surgeon you can trust, as this trust will help carry you through the recovery phase when you may have many questions about how things will turn out.

2. Scar Therapy

Scars are a normal trade-off for any surgery, and a tummy tuck or lower body lift does come with a long scar. The number one factor in scar outcome is a patient’s genetics, and this can’t be changed. How someone has scarred before is a good indicator of how they will scar with others surgeries.

The number 2 factor is the surgeon’s technique, and if you have heeded the first tip above, you should have this covered.

The third factor is how the scar is treated after surgery. I have found that almost all weight loss patients are readily willing to accept the scar in exchange for the removal of the extra skin but that doesn’t mean we can’t offer treatment to have the scar come out as good as possible.

There are many scar products on the market and most of them include some form of silicone, which has been proven to improve scars if used early after surgery. I most often prescribe Biocorneum®, a silicone gel, which also contains sunscreen, that dries into an invisible shield, treating the scar 24 hours a day. I also recommend silicone strips, and, for people who have a history of thicker scars, or want to do everything possible to prevent wide or thick scars, I recommend Embrace® a device designed to not only cover the scar with silicone but also take tension off of the scar which we know makes scars better.

3. Avoid Nicotine Products

Most people have heard this from every surgeon before having their tummy tuck surgery. Since the blood supply to the skin is altered during the surgery, every bit of blood supply is important for adequate healing.

Nicotine, in any form (including cigarettes, gum, patches or vaping), constricts the blood vessels, decreasing the blood supply to the skin. Most plastic surgeons will be comfortable with 4 – 6 weeks from the last nicotine use. However, I feel that three months is the minimum. It is on the conservative side, but I feel that with the time and expense invested in getting to the surgery, I would want to maximize the chances for a successful outcome and avoid complications that may detract from your final outcome.

4. Shaving Or Waxing

I usually see little discussed on this topic, but sometimes it is the little things that can make a difference. When someone shaves or waxes, this can be followed by small little red bumps for a day or two.

This represents inflammation or tiny little irritations in the skin. I prefer not to cut across these areas at the time of surgery as this may increase the chances of a wound infection. I ask my patients to avoid shaving or waxing for three days before surgery.

5. Nutrition

Following the RNY gastric bypass, as well as the gastric sleeve, most patients enter a period of starvation where their body not only loses fat but also muscle mass. The types and amounts of foods that maintain you normally, may be insufficient to help heal a surgical wound. That is why it is so important to focus on a healthy diet overall, with protein at every meal. I also recommend adding Vitamin C (either in the diet or supplements) in the weeks leading up to the surgery.

6. Start Or Continue An Exercise Program

We all know that the best candidates for abdominoplasty surgery are those at, or close to their goal weight, and at the very least at a stable weight. I have seen over the course of nearly two decades that those patients who exercise and are active do much better and return to normal activity much faster than the average person. In fact, much, much faster than the sedentary patient who has relied solely on their gastric sleeve or RNY to lose their weight.

One reason is psychologic and one is physiologic. Those who exercise are used to some pain and discomfort associated with intense workouts. After the surgery, they typically report much lower pain and discomfort associated with the surgery and are able to get up and moving much quicker.

Secondly, those who exercise typically have a higher amount of lean muscle which is a kind of protein storage area. Following surgery, those patients tend to heal their incisions quicker and are not as tired and fatigued, and can entertain the notion of another surgery on a different area quicker than those patients who are sedentary.

7. Have Realistic Expectations

Although having the appropriate expectations doesn’t really add to your results, it can certainly add or detract from how you ultimately view your results. It doesn’t happen very often, but when a patient has lost 100 pounds and brings me in a picture from a magazine that she, or he, wants to look like, I know we may not be a good match.

Techniques in plastic surgery after massive weight loss are always being refined and improved, but skin that has been stretched out for many years just does not act the same as that which has not. If you and your surgeon are on the same page when it comes to what the both of you can expect, the outcomes are almost always something to be proud of.


I hope these tips for achieving the best results with your abdominoplasty have been useful. These tips, along with common tips for recovery after a tummy tuck (such as setting yourself up for comfort and rest, arranging for help, taking the right amount of time off of work, avoiding constipation, early mobilization, and post-op garments) can help ensure your new tummy is just what you hoped it could look like.



Dr. Eric Mariotti, a board-certified plastic surgeon, is still just as excited about plastic surgery as he was when he entered the field decades ago. “I am blessed to have a job I love." At the Mariotti Plastic & Reconstructive Surgery in Concord, he performs most cosmetic procedures & breast reconstruction. He has developed his niche in plastic surgery after massive weight loss over the past 10 – 12 years. Dr. Mariotti is a regular speaker at weight loss support groups in and around the area.