We Offer Tummy Tucks, Body Contouring & More in Bellevue, WA
Many patients struggle to improve their body appearance, only to finally realize that problem areas can be resistant to attempts at contouring through diet and exercise. Surgical intervention can help restore a slimmer, more healthy and athletic body appearance. Cosmetic body surgery can restore a more positive body image following significant weight loss, or pregnancy related issues, and can correct gravitational or aging body changes. These procedures can address stubborn problem areas and help anyone achieve their desired improvements in their figures. Body contouring can be performed by eliminating loose, sagging or redundant skin, removing or contouring excess fat, and tightening abdominal wall muscles. While these options may not result in a substantial weight loss following surgery, body contouring can significantly alter and improve one’s appearance and enhance self-image and self-esteem. Let Dr. Nygaard help contour and reshape your figure flaws and create a more beautiful body silhouette, which may exceed your expectations.
Abdominoplasty (Tummy Tuck)
Dr. Nygaard specializes in tummy tucks and will carefully sculpt the abdominal region to correct your individualized abdominal problems. An abdominoplasty is designed to tighten, flatten, reshape, and rejuvenate the abdominal region following the stresses of pregnancy, significant weight loss, or the generalized flaccidity and droop of the abdominal wall tissue due to gravity, aging, or previous abdominal surgery. Patients with excessive intra-abdominal belly fat are not good candidates for this procedure.
An abdominoplasty typically entails removal of loose skin and fat in the lower abdomen (between the navel and the pubis), along with tightening of the loose or separated muscles of the abdominal wall, followed by re-draping of the remaining abdominal wall soft tissue to create a smoother, flatter, and sleeker abdominal appearance. When indicated, liposuction of the upper abdomen and the anterior flank region, or reduction in the bulk or sagging of the mons pubis region is also incorporated. Sculpting of even a very large overhanging fatty “apron” of skin and fat (called a “pannus”) can be accomplished. There are multiple types of tummy tuck procedures available, depending on each patient’s general body shape and personal objectives. These include a full tummy tuck, mini tummy tuck, extended tummy tuck, a full tummy tuck with vertical tissue excision, and “the belt lipectomy.”
Full Tummy Tuck
This is the most commonly performed abdominal procedure and is designed for patients who have abdominal wall laxity and excess abdominal wall tissue (skin and fat) above and below the umbilicus. Both the upper and lower abdominal regions are contoured with this procedure. Typically, all of the skin and fat between the navel and the pubic area (including all stretch marks in this region) is removed. The skin flap of the upper abdomen is elevated up to the level of the breast bone. The loose bulging abdominal wall muscles can be tightened with permanent sutures extending from the breast bone to the pubic region. Often, tightening of the lateral abdominal wall muscles can be performed as well, helping to further tighten the abdominal wall and shape the waistline. The upper abdominal skin and fat flap is then replaced back over the tightened muscle wall and the long hip to hip incision is closed with sutures. A new opening is created for the belly button, which can be made smaller if necessary, and the umbilicus (belly button) is sutured in place, creating a natural-looking “hood” at the top of the belly button. Liposuction of the upper abdomen and anterior waistline is also performed if necessary. The mons pubis can also be contoured or lifted to eliminate bulging in this area. Drainage tubes are used and are typically in place for 7–10 days. The incision typically extends past the hip bones on each side, but is still well hidden by underwear or bathing suits. Although raised and red at first, the scar fade significantly over time. Most people feel that the scars are a very acceptable trade-off to be rid of excess abdominal tissue and achieve a flatter, sleeker, and more attractive abdomen.
Only a few patients are actually good candidates for this procedure, which has the benefit of a significantly shorter scar, but only the lower abdominal region is addressed with this procedure. There is less skin and fat removal performed with a mini tummy tuck. This procedure is specifically designed for select patients with a very small amount of excess skin and fat in the lowermost portion of the abdomen only, and who have minimal bulging of the abdominal wall in the area beneath the belly button only. It does not address laxity of the tissue or excess fat in the upper abdomen.
The incision is shorter than that of the full tummy tuck and typically does not reach the hip bones. The abdominal skin and fat is elevated only to the level of the patient’s belly button. The lower abdominal muscles can be tightened, but the degree of abdominal flattening obtained is less than that of a full tummy tuck. A narrow strip of skin and fat is removed and the incisions are closed with sutures. One drain is typically used. The umbilicus (belly button) is not contoured or repositioned in this procedure, and the upper abdomen is not addressed. However, in the appropriate patient, this procedure is a very good solution to a lesser degrees of abdominal wall laxity. This more limited procedure can create a beautifully shaped, flat, lower abdomen with a shorter and less conspicuous scar. This is an ideal procedure if only slight contouring of the lower abdomen is needed.
This is a variant of the full tummy tuck, but is designed for patients with a more prominent or bulky pannus (apron of overhanging skin and fat). With this problem, the excess tissue of the lower abdomen often extends around towards the back of the hip region, and requires an extended scar that reaches around the patient’s back. The scar is usually well hidden by underwear or bathing suits and allows for removal of excess skin and fat from the posterior hip region as well as the abdomen. All of the other benefits of the full tummy tuck are also obtained with this procedure. This procedure is ideal for patients with a larger fold of excess skin and fat extending across the entire abdomen as well as to the back of the hip region, who feel that a longer scar is an acceptable trade-off to be rid of this excess bulk.
This is a continuation of the extended abdominoplasty, where the excess skin and folds of fat extend circumferentially around the entire lower abdomen and back. This is typically seen in massive weight loss patients. When there is redundant, loose, and sagging tissue along the posterior hips, liposuction alone is not a viable option for improvement. These patients require circumferential tissue excision all the way around the lower torso, much like a belt. This procedure allows for removal of a significant amount of excess skin and fat in a trade-off for a circumferential scar. The wraparound scar continues in the location of a standard full tummy tuck scar but wraps around the back, just above the buttocks.
Tummy Tuck with Vertical Tissue Resection
In this procedure, a vertical ellipse of tissue extending from the breast bone to the pubic region is also performed is to contour the upper abdomen. In addition, the lower abdominal region is contoured with a full or extended tummy tuck procedure. A tummy tuck with vertical tissue excision is typically reserved for massive weight loss patients. In these patients, there can be significant laxity of the residual skin and fat in both the vertical and horizontal abdominal planes. These patients achieve a nice degree of contouring and flattening of the lower abdomen with a standard tummy tuck, but are typically left with loose folds of skin in the upper abdomen, which is only minimally corrected with the standard tummy tuck. This often fairly extensive vertical ellipse can debulk and contour the upper abdomen to create better harmony with the flatter lower abdomen. In this procedure, the patient’s umbilicus (belly button) is typically reduced in size and appropriately repositioned.
Although the scars create a long inverted “T” type of scar on the abdomen, this procedure allows for removal of a significant amount of skin and fat in the vertical plane, as well as the standard horizontal plane.
Tummy Tuck with Hernia Repair
Patients with umbilical hernias or incisional hernias from previous abdominal procedures often request these hernias be repaired at the time of their abdominoplasty procedure. Typically, these types of hernias are easily repaired with excellent visualization, and often insurance companies pay for the hernia repair itself.
There is sometimes confusion regarding the term “rectus diastasis.” This is a term which describes separation of tissue between the rectus muscles that creates bulging of the abdominal wall. The diastasis is often caused by internal pressure from pregnancy. However, a rectus muscle diastasis is not an actual hernia and does not create functional problems in the abdominal wall. Rectus muscle diastasis is routinely repaired during abdominoplasty as part of the tightening of the abdominal muscle wall. Repair of standard rectus muscle diastasis by muscle plication is not a hernia repair covered by insurance.
Most insurance companies will cover the cost of umbilical hernia repair or incisional hernia repair. Often, pre-authorization for these procedures needs to be obtained from the insurance carrier prior to performing the hernia repair. A hernia repair is never “just a part of” a standard tummy tuck.
Abdominoplasty is frequently combined with other surgical procedures under the same anesthetic. Abdominoplasty is frequently paired up with:
- Breast augmentation
- Breast lift
- Breast reduction
- Liposuction of the flanks, hips, thighs, buttocks, arms, or knees
What to Expect
- This is an outpatient surgery and patients go home the same day as their surgery.
- Patients need to have commitment and cooperation with postoperative instructions and must be motivated to minimize the risk of DVTs (blood clots in the legs).
- A few days of fairly intense pain that is managed reasonably well with a combination of narcotic pain killers and muscle relaxants. The pain then becomes less, and most patients are comfortable by 10 to 14 days post-op, although occasionally a degree of pain lasts longer.
- Exercise restrictions for at least 6 weeks post-operatively. More strenuous activity is typically resumed 2 to 3 months post-op.
- Fatigue that can last for 4 to 6 weeks postoperatively.
- Typically patients take about 2 weeks off of work as this is a more painful and somewhat more tedious recovery than many other plastic surgery options.
- The abdominoplasty incisions themselves are closed with all dissolvable sutures. The rectus muscle plication is performed with permanent sutures.
- Transient pain, swelling, and bruising of the abdomen, as well as permanent numbness of a small area of the skin of the lower abdomen, directly above the incision.
- Initially, scars can be raised, red, and noticeable but typically fade away to a thin, flat white line in 1 to 1 1/2 years.
- Drainage tubes will be in place for 10 to 14 days postoperatively and will require frequent emptying.
- There are weight lifting restrictions of about 20 pounds, for 4 to 6 weeks. This translates to no carrying or lifting of heavy grocery bags, children, or suitcases.
- Typically, a permanently flat abdomen!
As a mother of 7 children herself, Dr. Nygaard is well aware of the significant changes that can occur in the female body, due to pregnancy and breast feeding. Although the joys of having children surpass the sometimes disheartening changes in the body, sagging breasts and protuberant abdomens often leave women wishing for their pre-baby body back. The so-called “Mommy Makeover” can help mothers of all ages reclaim their bodies, boost self-confidence, and reverse the physical effects of pregnancy and breast feeding.
Dr. Nygaard specializes in the spectrum of procedures that create a Mommy Makeover. This combination of breast and belly surgery is customized for each individual patient, depending on their body’s “starting point” and their specific concerns and goals. These procedures cannot re-create the exact shape of the body prior to pregnancy, but they can radically improve appearance and create a body that any mother could be proud of again. The Mommy Makeover can address tummy bulging or sagging, excessive abdominal fat, loose skin and stretch marks as well as “deflated” smaller breasts with overall volume loss, drooping or sagging breasts with large areola, and excess body fat that diet and exercise alone just cannot improve.
Typically the Mommy Makeover procedure entails a combination of abdominoplasty, breast augmentation, breast lift, and/or liposuction. For breasts that became larger with breast-feeding, a breast reduction procedure can re-create smaller, perkier breasts to compliment a flatter, contoured abdomen. Pateints often prefer to have both their breast and abdomen issues corrected under one anesthetic, with one recovery period, rather than with two or more separate procedures.
An abdominoplasty creates a flatter, sleeker, abdomen and usually involves tightening of the abdominal wall muscle, and removing all of the excess fatty tissue, loose skin and stretch marks between the navel and the pubic area.
Breast augmentation enhances the breast volume a little, or a lot, depending on patient preference. Silicone gel or saline implants can be used for this procedure, and Dr. Nygaard will help you to select the size and style of breast implants best suited to meet your goals for fuller breasts.
A breast lift can reshape sagging or drooping breasts and reposition the breast mound higher on the chest wall. Enlarged areolae (the darker skin around the nipple) or enlarged nipples themselves can be reduced to create a more youthful breast appearance. Breast size is not significantly altered if a mastopexy (breast lift) is performed alone.
Mastopexy/augmentation is a combination of procedures that creates fuller, perkier, more rounded and youthful appearing breasts, by combining breast augmentation with a breast lift. The implants also help to create lasting upper pole breast fullness. A variety of mastopexy techniques are available, based on the preoperative appearance of the breasts and the patient’s desires. Often, both mastopexy and breast augmentation are reqiored to achieve optimal restoration of pre-pregnancy breast appearance.
Sometimes breast volume is increased noticeably with pregnancy and breast feeding, and may not decrease following delivery or the cessation of breast feeding. Breast reduction can restore a smaller, perkier, or shapely breast size to better match a slimmed-down tummy. Excess breast tissue and fat are removed, and the areolar complexes are reduced to create a more harmonious balance in breast appearance, and the “skin brassiere” is tightened.
Liposuction can remove diet and exercise resistant areas of “baby fat” from the abdomen, the waist area, the hips, flanks, buttocks or thighs, helping to create a more slender silhouette. Liposuction cannot re-create smooth tight skin or correct cellulitic dimpling.
The recovery time from a Mommy Makeover depends which combination of procedures is performed, as well as individual patient factors. Ideal options for each individual patient will be explored at the consultation and the most appropriate combination of procedures will be recommended, depending on the mom’s presenting body shape and her individual goals. Often, the recovery from a combination of procedures is about the same as for an abdominoplasty alone. Postoperative medications make the recovery period manageable and you will be supported through your journey in the realm of your Mommy Makeover.
Additional details about each of these procedures can be found in the breast and body sections of Dr. Nygaard’s website.
Suction Assisted Lipectomy
Liposuction is a surgical technique that permanently removes excess fat cells in areas that are resistant to diet and exercise. The procedure is designed to improve body contours and proportions, and can create a more flattering figure, both in and out of clothing. It is important to balance the removal of enough excess fat to change body contour, but leave enough fat behind to create a smooth and natural body appearance. Liposuction should be thought of as a contouring modality, and not as an actual weight loss procedure. Liposuction can help create the figure that you never had, or restore a body’s silhouette that has been altered by weight gain, pregnancy, or aging. Ongoing attention to diet and exercise will always be necessary in achieving one’s desired appearance, but excess fat can be very difficult to eliminate. Let Dr. Nygaard help you realize your vision by removing excess fat, and sculpt the excess adipose tissue away to reveal the beautiful body contour beneath.
Liposuction is typically performed as an outpatient under a general anesthetic. Most liposuction techniques utilize the “tumescent” method, where a special solution is used to saturate the targeted areas of excess fat. The solution helps shrink the local blood vessels to minimize postoperative bleeding and bruising, and also helps with postoperative discomfort. The solution also temporarily makes the fat deposits more firm, which in turn allows for more precise “lipo-sculpture” of the excess fat, minimizing contour irregularities. A small hollow liposuction cannula, or metal tube, is then inserted through tiny incisions in the skin and excess fat is removed, typically utilizing both a power-assisted gentle vacuum-like device, and final sculpting with a hand-held syringe. Liposuction takes advantage of the skin’s natural elasticity, which allows normal skin to re-drape and contract across the treated areas. If the skin has multiple stretch marks, cellulite, or superficial irregularities, or if there are loose folds of skin, this is not conducive to obtaining optimal results in that particular body area.
New gadgets and gimmicks are common in liposuction and so-called “smart” options are available, involving freezing of fat, or lasers, or water assisted fat extraction. These various adjunct techniques may have some usefulness, but to date there is no documentation that any of these “higher tech” methods offer improved results over the more traditional, conventional and proven techniques. The use of increased technology does not guarantee more satisfying results. Dr. Nygaard brings over 20 years of experience and expertise to her liposuction patients, with high rates of patient satisfaction and noticeable, lasting contour changes.
For optimum outcomes, the patient needs to understand the limitations of liposuction. The procedure cannot correct cellulitic rippling or dimpling that is commonly seen in the buttocks or the thighs. It cannot re-create smooth tight skin where laxity or stretch marks are already present. Liposuction is not a treatment for generalized obesity or a substitute for proper diet and exercise. If substantial weight is gained following the procedure, the results of the procedure will be less apparent and excess fat can re-accumulate.
Typical areas treated:
- Hips and flanks
- Male chest
- Submentum-(area beneath the chin)
Liposuction is frequently combined with other surgical procedures such as abdominoplasty, breast reduction, breast lift, or “Mommy Makeovers”. Use of a compression garment for about four to six weeks postoperatively can help to reduce swelling and help to achieve final contour more quickly. Lycra or exercise wear can be substituted for the surgical compression garment for the last few weeks if desired. As long as caloric intake and caloric expenditure is balanced, the results of liposuction are permanent.
What to expect:
- Moderate pain which is well controlled with medication.
- Slight to moderate drainage through the incisions for 24 to 48 hours.
- Return to work within about a week.
- Mild to moderate bruising which typically resolves over 7 to 10 days.
- Temporary numbness at the surgical sites.
- A variety of unusual or distracting sensations such as itching, tingling, mild burning, all of which resolve over time.
- Occasionally, very minor surface irregularities may become apparent as the post-op swelling resolves.
- No change or correction of cellulite, stretch marks, loose skin or dimpling.
- Light exercise allowed after two weeks but full activity not allowed for six weeks.
- Final results are typically not apparent for at least 3 to 4 months, sometimes longer.
Medial Thigh Lift (Medial Thighplasty)
A thighlift is a surgical procedure designed to remove excess folds of redundant fat and tissue and tighten the skin of the inner thigh region. The procedure is most typically performed after significant weight loss has occurred, although some patients who have always been closer to their ideal weight can also be good candidates for this procedure if they have the combination of excess medial thigh fat and poor quality, inelastic skin. The objective is to produce more contoured, slimmer appearing thighs, proportional to the rest of the body. A thighlift is not a weight loss procedure in and of itself and is not designed to create firm sculpted thighs on a patient who still has significant weight to lose. The medial thigh skin is often of poor quality, is thin, and has lost elasticity and tone. Residual fat and poor quality skin can contribute to the formation of widened thickened scars as healing progresses. The procedure is best performed on patients who are relatively close to their goal weight but remain dissatisfied with the appearance of their inner thighs. This procedure can be performed separately or in conjunction with other body contouring procedures such as liposuction.
A medial thighlift is performed via incisions in the groin and pubic region, often tracking around into the fold below the buttock. Typically, incisions extend down the inner thigh region, often to the level of the knee. Excess thigh fat and redundant skin folds are removed, both in the horizontal and vertical planes. The underlying thigh tissue is tightened and contoured with permanent support sutures, and excess skin and fat is removed. The incisions are closed with dissolvable sutures. Occasionally, drains are placed to decrease the swelling and fluid accumulation in this area, but these are typically removed after a couple of days. Typically a compression garment is worn for several weeks to help minimize postoperative swelling and support the tissues.
The results of this procedure can be quite dramatic, and the long scars can be a highly acceptable trade-off for getting rid of the unsightly rolls of tissue following weight loss or the gravitational effects of aging. Patients should be prepared for a somewhat difficult and awkward recovery initially, and need to keep themselves motivated to be compliant with post-op instructions to achieve the optimal result. Patients need to understand that, with this procedure, scars can be long and may widen noticeably. There may be wound healing issues due to the thin quality of the skin. Small open areas may develop in the suture lines, given the very thin nature of the skin. Patients with better skin tone and elasticity and less sagging of the tissue will typically have a less complicated course of recovery. Some patients may have a nice result with only a horizontal crescent of excess skin and fat removed, keeping the incision in the groin crease. This more limited dissection eliminates the long scar extending to the knee, but is a less involved procedure, and cannot correct the hanging folds of skin and fat that usually occur in massive weight loss patients. It is much more typical to have long scars extending down the medial aspect of the thigh. However, this scar allows for removal of a fairly significant amount of redundant skin and fat, with a more noticeable overall improvement in thigh contour.
What to Expect
- A moderate amount of pain which can be controlled with medication and typically resolves by the third or fourth week.
- Minimize sitting for two weeks to avoid undue tension and stretch on the incisions. This requires the patient to primarily recline or stand during the early recovery period.
- Moderate bruising and swelling.
- Feeling of tightness of the skin.
- Numbness at the surgical site, which slowly resolves over several weeks.
- The skin of the remainder of the thighs may still be somewhat lax, and there may be problems with cellulite or residual loose skin.
- Scars for this procedure have a tendency to widen or migrate inferiorly out of the groin crease or develop wound healing problems due to the thin quality of the skin.
- Minor asymmetries between the thighs can occur.
Brachioplasty (Arm Lift)
With the aging process, and due to the effects of gravity and weight fluctuations, excess fatty deposits tend to build up along the undersurface and the back of the upper arms. This adds excess weight and heaviness to the arm tissue, which in turn increases the laxity and drooping of the skin in this area. As the skin thins and loses more elasticity, the tissue can droop more. Once the skin is thinned out, weight loss efforts may decrease the overall circumference of the arm, but the droopy tissue remains. This creates a “bat wing” deformity of the upper arms, with excess upper arm fat and poor quality inelastic skin. Rarely, the skin of the upper arms retains enough elasticity that it can retract over the tissues if lipoplasty alone is performed. Lipoplasty may occasionally contour the upper arms in a younger person, but typically with the aging process and the development of loose inelastic skin and excess fat, a brachioplasty procedure offers a superior result in contouring the upper arm.
The goals of brachioplasty are to decrease the excess tissue of the upper arms and excise the lax and sagging skin and fat to recreate a smoother, sleeker, and younger looking arm silhouette. The improvement in arm contour and the decrease in bulkiness of the arms is accomplished with tissue resection through a long incision running the length of the upper inner arm, often reaching the elbows. Most patients who present with a noticeable “bat wing deformity” are willing to exchange the bulky arm tissue for the scar, which eventually fades and results in a nice overall contour correction of the upper arm.
Brachioplasty is typically performed as an outpatient under a general anesthetic. A brachioplasty is performed by removing the loose and hanging soft tissues and skin from the undersurface of the upper arms. This redundant tissue develops as a result of weight gain, significant weight loss or gravity, and the aging process. Although change in arm contour can be dramatic following a brachioplasty, patients must have realistic expectations and acceptance of the long scar running the full length of the upper arm to the elbow level. However, the scar is positioned so as to make it nearly inconspicuous while the arms are at one’s side. In addition to excision of excess redundant skin and fat, contouring lipoplasty can be performed of the outer surface of the arms to give a sleeker overall appearance. The underlying supportive tissue in the arm is also tightened before the skin is re-draped to assist in contouring the arms. Occasionally, a separate incision is required in the axilla (armpit region) to remove excess skin from the axillary region as well. Compression sleeves are typically worn for 2–3 weeks to help minimize swelling and support the underlying tissue.
What to Expect
- Mild pain, typically well controlled with medication.
- One week or so off of work unless the job requires substantial arm motion, in which case two or three weeks off work may be necessary. There are certain arm motion restrictions required for six weeks on every patient.
- Standard activities can be resumed at six weeks.
- There may be prolonged swelling in the arms and hands.
- There may be mild bruising and slight drainage from the incisions.
- There may be minor sensory loss which typically resolves although there can be patches of numbness that may be permanent.
- The biggest unknown is the scarring, which may be fairly significant due to the thin inelastic quality of the skin in this area. There may be small areas of suture line separation and slow wound healing, which can lead to a widened or more obvious scar. The scars will fade over time, although it may be a year or two before the scar is fully faded. Even with a widened scar, most patients are quite accepting of the scar once it has fully faded and consider the scar an acceptable trade-off to be rid of the “bat wing” deformity.
Body Contouring After Massive Weight Loss
Bariatric surgery, and the increasing number of “massive weight loss” patients are now creating a large population of patients interested in body contouring. Dramatic weight loss, often in the range of 75-150 pounds or more, are life altering, and result in significant health and body image benefits. However, after massive weight loss, the skin and soft tissues often lack the necessary elasticity to conform to a reduced body shape and size. The resultant folds of loose skin and residual fat often detract from the “transformed” body beneath the redundant tissue folds. Self-esteem and self-confidence can suffer, and patients’ quality of life may be diminished, due to these excess folds of skin and fat which are not responsive to ongoing efforts at diet and exercise.
Usually multiple body contouring procedures are recommended for the massive weight loss patient to achieve the best overall results. Recovery from these sometimes extensive body contouring procedures can be stressful, and often multiple surgical interventions are required. The patient must be healthy and of a stable weight at, or near, their goal weight. Patients who still have substantial weight to lose typically will have an overall more flattering outcome if they continue to lose weight until they are closer to their goal weight.
Patients recovering from these sometimes very complex procedures should consider themselves an active partner in their own care, and follow all instructions and postoperative recommendations to the letter to minimize any potential for complications.
Surgical Options for Massive Weight Loss Patients
These body contouring procedures are typically performed as the patient approaches their goal weight. These procedures are not intended to be actual weight loss procedures themselves, but rather they are contouring procedures designed to remove redundant folds of skin and fat after the patient has lost the majority of their planned weight. These procedures can be extensive, and scars can be quite long and are prone to healing issues, although the change in appearance is often dramatic and the scars are typically not overly troublesome to patients. Ultimate scar quality and healing ability are maximized when patients are in good health and have achieved an optimal nutritional status. We strongly recommend daily intake of 80–100 grams of protein a day during the recovery period to aid in tissue healing.
These body contouring procedures are typically done on an outpatient basis, under general anesthetic. Dr. Nygaard’s surgical goals and objectives are to improve every patient’s body contour, excise excess skin and fat, tighten the underlying tissue where possible, and leave the patient with scars that are as inconspicuous as possible. Specific procedures and possible combination surgeries are individualized for each patient, based on the body habitus and tissues that the patient brings to the operating table, blended with patient desires and preferences. Most patients find the scars from these various procedures a highly acceptable trade-off to be finally rid of the redundant folds of skin and fat.
Surgical body contouring following massive weight loss can remove excess hanging folds of sagging fat and residual loose skin, while also improving the shape of the underlying support tissue. This results in more normal body contours and appearance, with smoother and more streamlined face and body contours. These surgical procedures can finish the body transformation begun by massive weight loss. These procedures also bolster the self confidence that patients should feel after achieving substantial weight loss. Many procedures are available to assist in contouring the body following massive weight loss. A brief description of body contouring procedures offered at Renaissance are listed below. Additional details can be found at the appropriate section in this website for each of these procedures.
- Abdominoplasty (tummy tuck) – This procedure involves excision of the hanging folds, or apron, of excess skin and fat that typically develops in the lower abdomen. Additionally, a vertical ellipse of tissue can often be removed from the upper abdomen to address excess skin in the upper abdominal region as well. The abdominal wall will be tightened to help create a flatter overall abdominal shape. The belly button is repositioned to a more appropriate level on the abdominal wall. The scar is kept low, where it can be concealed by underwear, but typically extends laterally well out onto the hip region in order to remove all of the redundant skin.
- Extended tummy tuck or lower body lift – These procedures are more complex extensions of a typical abdominoplasty and may result in incisions that extend all the way around the lower abdomen, outer thigh, and buttock region in a variety of procedures termed “belt lipectomy” or “lower body lift.” These more extensive procedures result in removal of sagging skin and fat from the abdomen, upper-outer thigh, and buttock region, providing a more dramatic contouring of these areas in an extended fashion.
- Thigh lift (medial thighplasty) – This procedure addresses the redundant folds of skin and fat often found on the inside of the thighs following massive weight loss. With lesser degree of skin laxity, the scar may be placed in the upper thigh or groin region alone, where the scar is hidden in the panty line. However, in the typical massive weight loss procedure, a long vertical scar is usually necessary, extending along the entire length of the inner thigh, often to the level of the knee. This more extensive procedure is typically necessary to treat the degree of laxity or sagging of the inner thigh tissue that occurs following weight loss. However, a very significant inner thigh contour change can be achieved with this procedure making the long scar very acceptable.
- Arm lift (brachioplasty) – This procedure removes the hanging, sagging, excess skin and fat along the upper arm and armpit region. This corrects the “bat wing” deformity of the upper arm, which is often seen following excessive weight loss. The length of the scar depends on the amount of skin and soft tissue laxity that the patient has developed following weight loss. The scars are typically located in the axilla (armpit region) and can extend the entire length of the arm to the elbow. The scar is positioned so as to be very inconspicuous when the arms are at the patient’s side. Occasionally, patients are offered an extended arm lift, where the incision is continued across the armpit region and onto the upper chest wall, removing excess skin and fat in this region as well. This results in a more complete rejuvenation of the upper arm and upper chest wall region.
- Breast lift (mastopexy) – This procedure is designed to correct the drooping, sagging appearance of the breasts following loss of volume with weight loss. Excess breast skin is removed and the breast mound is reshaped and elevated. The nipple complex is elevated to a more youthful and central position on the breast mound. Occasionally, a breast lift alone will rejuvenate and enhance the breast region, but if there has been significant volume loss, breast implants can be placed at the time of the mastopexy to add additional breast volume and contour, and create more lasting upper pole breast fullness. The anchor shaped scars associated with a standard breast lift are typically a very satisfactory trade-off to achieve a more youthful, elevated breast appearance.
- Facelift / Necklift – These procedures can tighten the sagging skin of the midface, jowl, and neck region, creating a more youthful, contoured, and slender appearance to the facial region and defining the neck region. Facial contouring surgery following massive weight loss can be a significant confidence-boosting undertaking, since the face is so highly visible and sets one’s first impression. Often, a significantly more youthful and toned facial visage is achieved with facelift or necklift following massive weight loss.
- Liposuction – Liposuction can address residual diet and exercise resistant fatty deposits and can often be combined with other body contouring procedures. Liposuction alone is typically not indicated in massive weight loss procedures, since skin elasticity is often quite compromised and the skin will not re-drape smoothly. However, liposuction can help to reduce residual unwanted fatty tissue in conjunction with other surgical procedures.
The exact body contouring surgical procedures, tailored to each patient’s presenting body habitus expectations, are individually customized for each patient. These are often staged procedures, performed over a period of time, to keep the surgical times safe, the recovery periods manageable, and the patient’s nutritional status optimal. Dr. Nygaard will help each patient design and customize their surgical options to complete their body transformation following massive weight loss. Additional details about each of these procedures are available elsewhere in the website.
MONS PUBIS LIFT OR REDUCTION
With weight gain or the aging process, the mons pubis (the area of fatty tissue in the pubic region) can develop progressive bulkiness, sagging, or drooping. Increased fullness in this area may cause patients to feel self-conscious or uncomfortable with their appearance, or the problem may be noticeable in clothing or bathing suits. Occasionally, this area is overlooked in abdominoplasty procedures, and the woman is left with a flat abdomen but unattractive fullness in the mons region, which detracts from the abdominoplasty results.
There are a variety of surgical options to address sagging tissue and excess fat in the mons region. With the simplest option, if skin quality is good and there is no significant droop of the mons region, liposuction alone can de-bulk the area and restore a very acceptable contour. More often, there is excess skin, in addition to the excess fat, and the entire mons pubis is bulky or droopy. This combination requires both liposuction and resection of a strip of redundant skin and fat, thereby reducing the bulk of the mons and lifting the tissue to a more appropriate position. The resultant scar runs in the bikini line or can be hidden as part of an abdominoplasty scar. With the most severe form of mons redundancy or droop, such as typically occurs with massive weight loss, a significant degree of elevation of the mons tissue may be required. Contouring lipoplasty can also be performed, but in this case, with more severe droop, a more significant portion of skin and excess fat must be removed, necessitating a longer scar. The length of the scar is dependent on the amount of tissue removal required to achieve a flatter, smoother, more natural mons contour. If a C-section or an abdominoplasty scar is present, the monspexy scar can be hidden along this same scar location. After the redundant skin and fatty tissue are removed, sutures are used to elevate or suspend the mons tissue, tacking it to the support layers of the lower abdomen. Often a single drain is used to minimize swelling and speed recovery. All sutures used in the monspexy are absorbable. A monspexy results in an often very significant improvement in the bulk and droop in the mons region and restores considerable comfort in appearance. Surgical procedures for this condition can typically be performed as an outpatient and are usually done under IV sedation. More extensive procedures may require a general anesthetic.
What to expect:
- Mild discomfort, typically well controlled with medication.
- Residual swelling which can last for a couple of months.
- The drain is usually in place for 3 to 4 days.
- There may be some bruising, including “trickle down” bruising of the labia.
- An elastic support panty or liposuction compression garment can provide gentle compression to this area, helping to minimize swelling.
- With extremely redundant mons regions, such as occurs with significant weight loss, there occasionally is a degree of recurrence of the droop over time, but it is far less noticeable than preoperatively.
- Physical activity should be limited for three or four weeks.
- There is no sensory loss or interference with sexual sensation.
LABIAPLASTY (LABIAL REDUCTION)
A labiaplasty is a surgical procedure designed to trim, contour, or reduce excessive or elongated labial tissue around the vaginal opening. Most typically the inner labia are addressed, but on occasion, extremely bulky labia majora, (the outer labia) can be reduced as well.
Labial size, length, color and symmetry are extremely variable and individualized. The exact cause of enlarged labia is not known. Occasionally large labia are present from birth, sometimes they develop at puberty, or following pregnancy and childbirth. Regardless of the cause, excessively large labia can cause embarrassment and physical discomfort. Large labia can create embarrassment and pain with sexual activity, or cause pain during activities such as bike riding, horseback riding or other physical activities. Tight clothing, bathing suits and underwear can create irritation, awkwardness, or limit clothing choices. Occasionally the enlarged labia create no physical problems, but the woman simply dislikes their appearance.
Most women seeking labiaplasty are very active, and the elongated labia interfere with various physical activities and cause embarrassment and discomfort with sexual activity. Occasionally, hygiene issues are a concern, The goal of surgery is to reduce the length and the width of the labia, and to create a more natural female form, and create better balance in the appearance of the surrounding tissues.
Most typically, patients request that the labia minora to be hidden by the outer labia. The exact surgical technique and the extent of surgical intervention depends on both the patient’s pre-existing anatomy and the patient’s desired end result. A variety of options exist, including the wedge excision, which utilizes a vertical incision, or a transverse incision with resection of tissue in a horizontal fashion. The best option depends on multiple factors. This procedure is always a customized procedure, based on anatomy individual and expectations. The goal of surgery is to create a more harmonious balance of labial shape, contour, and color match, so that the patient experiences reduced irritation, pain or sensitivity, as well as a more aesthetic natural labial contour.
What to expect:
- A quick general anesthetic; or occasionally IV sedation, performed as an outpatient procedure.
- Stinging, burning, discomfort for a few days, which can be readily controlled by medication and ice packs.
- Slight bloody drainage for a day or two.
- Moderately severe swelling, which resolves fairly quickly, although a degree of swelling can persist for several weeks.
- Minimal to moderate bruising which resolves in about two weeks.
- Avoid sitting for prolonged periods of time for a few weeks.
- Return to work in a few days unless prolonged periods of sitting are involved. Lubrication and moisture in topical agents such as Aquaphor ointment or KY jelly can help with overall comfort.
- Avoid aggressive physical activity or sexual activity for 4 to 6 weeks depending on comfort.
- All sutures dissolve on their own.
COMBINATION BODY CONTOURING PROCEDURES
Combining multiple procedures to contour the body, under a single anesthetic, is quite common as this results in one recovery time frame, as well as a single anesthetic, a single surgical session, and a single time off of work. Often, similar medications are utilized, and many of the postoperative instructions are similar, whether a single procedure or a combination of procedures is performed. In addition, there is usually a slight financial advantage to doing multiple procedures at the same time.
However, combining surgical procedures must be planned out judiciously and surgical operating times must be kept at a safe level, depending on overall patient health and concomitant risk factors. Very long surgical procedures can result in increased anesthesia issues, hypothermia, fluid shifts, increased blood loss and in some literature, an increased risk of infection. Appropriate patient selection and preoperative patient evaluation and review of medical history are of paramount importance. Patients need to be motivated and compliant with all perioperative instructions to help maintain reduced postoperative surgical risk. Typically, longer operative procedures require use of a daily injectable blood thinner for several days postoperatively, to minimize the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) which can be an inherently higher risk in longer surgical cases. However, patient safety is always paramount at Renaissance Center, and longer surgical procedures can very safely be undertaken by healthy patients, when the combination of procedures selected is appropriate and operative time is taken into consideration. If you are considering having multiple surgical procedures done, Dr. Nygaard will help determine what is appropriate, keeping patient safety as the paramount objective.