What You Need to Know About Body Contouring After Massive Weight Loss

What You Need to Know About Body Contouring After Massive Weight Loss

September 20, 2017

Now that you have lost your excess weight, you are finally ready to get rid of all that hanging, excess skin and fat. Before you move forward, there are some important things that you need to know. From my experience as a plastic surgeon for patients that have body contouring after massive weight loss, these are the top 10 things for you to know.

10 Things For Body Contouring After Massive Weight Loss


Before any reconstructive plastic surgery can be performed, your weight must be stable. Typically, one year after weight loss surgery, most patients have lost their weight, and their weight is stable.  Before you consider reconstructive plastic surgery, your weight should be stable for three months. If your weight fluctuates 2 or 3 pounds, that is acceptable. However, anything more than a 2 or 3 pound fluctuation should be of concern and need for further investigation.


Because massive weight loss affects almost every part of your body, you will probably need reconstructive plastic surgery to many body parts. Decades of surgical experience and many plastic surgery articles have shown that all of your plastic surgeries should not be performed at the same time. Your plastic surgery procedures should be staged in several, well thought out steps.  Each surgical procedure should maximize results while minimizing blood loss and recovery time.


Many procedures like the Roux-en-Y gastric bypass alter your body’s ability to absorb iron. Iron is an essential element in red blood cells and helps hemoglobin carry oxygen to tissues. Without oxygen, tissues will not heal. Oxygen delivery is a critical component in healing from plastic surgery. Therefore, it is essential that you have your hemoglobin and iron levels checked before surgery.

To optimize your healing, if your iron and hemoglobin levels are low, you should have your levels corrected well before your surgery.  To correct low iron or low hemoglobin, you may need an iron transfusion or even, a blood transfusion.


Many medical insurance policies cover portions of reconstructive plastic surgery after massive weight loss. Medical insurance coverage entirely depends on your individual plan. Policies vary from state to state and from one individual to another. Some medical insurance plans cover many reconstructive plastic surgery procedures after massive weight loss. Other medical plans do not cover any procedures after massive weight loss.

Please check with your chosen plastic surgeon to determine if some of your desired procedures are covered by your medical insurance. In these changing times, it is difficult to say what is covered and what is not covered by your medical insurance.


After massive weight loss, your skin is placed under significant strain. The elastic fibers in your skin try to contract and cover the void left behind by disappearing fat. However, there are limitations to the amount that your skin can recoil. The result is that your skin tries to contract, but your skin cannot contract all the way.

You must realize that even though plastic surgery can achieve exceptional results, plastic surgery does have its limitations also. There may be underlying bone structure, poor tissue quality, weak fascia, and inaccessible pockets of fat around the intestines.


To optimize your plastic surgery results, you will need to maintain a healthy lifestyle before and after your reconstructive plastic surgery procedures. To maximize your results, you should continue to exercise for 30 to 60 minutes every day. You should eat a healthy diet high in protein and low in sugar.  You should take daily vitamins.

If you smoke, you must stop. If you vape or smoke cigarettes or hookah, your plastic surgery should not be performed.  Cigarettes, hookah or vaping all contain significant amounts of nicotine. Nicotine causes blood constriction, reduced circulation, and thus, diminished oxygen level to surrounding healing tissues. Therefore, nicotine negatively impacts your plastic surgery results.

After your plastic surgery and during your healing phase, it is essential that you eat at least 100 grams of protein a day. Also, it is imperative that you follow your plastic surgeon’s individualized postoperative instructions. Each plastic surgeon has their own individualized set of postoperative instructions. After the healing phase, it is vital that you continue to eat right, exercise, and take your vitamins. You do not want to revert to your old habits of eating poorly and not exercising, which could result in sub-optimal plastic surgery results.


Reconstructive plastic procedures after massive weight loss are relatively extensive operations. You will need help. These types of surgeries take a long time to perform, the incisions are long, and the amount of tissue removed is much more than an “average” plastic surgery procedure. Therefore, I highly advise that you have somebody assist you after surgery.

The type of surgery you undergo will dictate how long your friend needs to help you. If you have a 360 circumferential lower body lift, you will need your friend to assist you for at least 7 to 10 days. If you have a thigh lift, you will need your friend to help you for 7 to 10 days also. If you have an arm lift, you will need your friend to assist you for 5 to 7 days. During your recovery time, your friend will help you to move from the bed, redress your bandages, change your position in bed, and assist you in the bathroom. I would not suggest undergoing these reconstructive procedures without having someone to help you in your recovery.


With massive weight loss, there is a loss of fat. Typically, the result is excess skin and some residual, excess fat. Excess fat can be removed with liposuction. However, the only way to remove excess skin is with surgical excision. Fortunately, given the correct treatment, most surgical scars heal exceptionally well with time.

Approximately one month after surgery, I would suggest application of silicone cream and silicone strips. I also advocate compression garments. Compression garments should be worn for 6 to 8 weeks to help minimize swelling and contribute in the flattening of scars. If your scars are still unacceptable after six months, I would suggest laser scar revision. If your scars are still unacceptable after twelve months, I would recommend surgical scar revision. Most surgical scars heal very well with time.  Laser scar and surgical scar revision rarely need to be performed.

Fortunately, almost all patients are willing to have a surgical scar than deal with all that excess skin and fat after massive weight loss.


During gastric bypass surgery, several small incisions are placed on the abdomen. In total, the incisions measure approximately 4 inches at the most. During your gastric bypass surgery, your abdomen or peritoneal cavity is inflated. Depending on the type of gastric bypass, your stomach is then cut. The air in your abdomen is removed, and your incisions are closed with one or two sutures. Since there are no sensory pain nerves in the stomach, there is minimal pain.

After your gastric surgery and with subsequent weight loss, your skin is going from a tense, distended state to a soft, relaxed state. Also, before your gastric bypass, even though you are malnourished, you are eating a sufficient quantity and quality of food to maintain proper wound healing functions.  Typically, apart from diabetes, most morbidly obese patients have adequate healing properties.

In comparison to gastric bypass surgery, plastic surgery is completely different. During plastic surgery, the skin is undermined, resected, and pulled tightly. Unlike gastric bypass surgery, the skin is going from a relaxed state to a state of maximum tension.  The skin has thousands of nerve and pain receptors. During plastic surgery, these sensory nerves are stimulated.  For these reasons and others, plastic surgery is more painful than gastric bypass surgery.

Some types of gastric bypass procedures can cause low iron levels. Low iron levels can cause iron deficiency anemia and sometimes, low hemoglobin levels. Anemia issues can cause profound healing problems during plastic surgery. Gastric bypass surgery usually causes a decrease or loss of appetite. Loss of appetite can negatively impact the healing capacity after plastic surgery. Please do not compare your gastric bypass surgery with your upcoming plastic surgery. These surgeries are very different types of surgery indeed.


You should be undergoing reconstructive plastic surgery for yourself, no one else. You should consider plastic surgery to complete your weight loss journey and achieve the body of your dreams. Please remember your priorities before undergoing extensive plastic surgery reconstruction.

You should not have plastic surgery just to please others. Also, others should not restrict you from having plastic surgery. Undergoing plastic surgery is a curious event. You may gain many new friends; however, you may lose some friends along the way. However, overall, staged reconstructive plastic surgery after massive weight loss is a safe procedure. Most of these types of procedures are performed on an outpatient basis without the need for hospital admission or blood transfusions.


I hope this list helps if you’re considering plastic surgery after massive weight loss. So, if you are thinking about plastic surgery, go ahead and complete your weight loss journey.

timothy katzen


Dr. J. Timothy Katzen is certified by the American Board of Plastic Surgery, and is the President of the American Society of Bariatric Plastic Surgeons. Dr. Katzen specializes in reconstructive plastic surgery after massive weight loss. He has written many articles and given lectures around the world about how to perform plastic surgery on patients who have undergone massive weight loss. Dr. Katzen has plastic surgery offices in two different states and two different countries. Specifically, he has offices in Beverly Hills (California), Las Vegas (Nevada), and Dubai (United Arab Emirates). Read more articles from Dr. Katzen!