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Weight Loss Surgery/Reconstruction

Abdominoplasty/Tummy Tuck

Abdominoplasty, known more commonly as a “tummy tuck”, is a surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall.

Surgical procedure

This type of procedure is performed under a general anaesthetic and requires at least one night’s hospitalisation and often three to four days in hospital. The length of skin incision and therefore the type and position of the final scar will be determined by the deformity you have and the need to tighten the abdominal muscles to achieve a flat abdomen. The looser the abdominal skin and the more pendulous the fatty tissue apron of the lower abdomen, the longer must be the scar across the abdomen. This is so because of the geometry of the operation and has to do with the relative lengths of the base and hypotenuse of a right-angled triangle.

Dr Kane will explain this because you need to appreciate why the transverse scar may need to be as long as it is. All efforts are made to keep this scar as short as possible and to locate it low on the abdomen. It is sometimes not possible to reduce the fullness of the fatty tissue in the upper abdomen for fear of decreasing the circulation to the lower abdominal skin. In the interests of safety, this may need to be done at a subsequent procedure by liposuction. However, in most cases where less undermining of the skin is required, reduction of all fatty tissue may be possible.

The wounds on the abdomen and around the umbilicus are sutured and often only dissolving sutures are used. This wound is supported with plastic skin or micropore tape for up to six weeks to give it every chance to develop a fine scar.

Risks and Complications

Risks and complications include:

  • Scarring
  • Numbness
  • Bleeding
  • Swelling
  • Skin death or necrosis
  • Wound healing problems
  • Vein thrombosis
  • Seroma (collection of fluid beneath the skin)

Body Lift

Body lift is a cosmetic procedure to shape and tone the underlying tissue, supporting the excessive fat and skin in the region of the breast, abdomen, buttocks, and thighs. Body lift involves removal of the excessive fat and sagging skin that results in poor tissue elasticity and hampers the personal appeal of the individual. The various procedures employed for body lift can be broadly categorized as:

  • Lower body lift: It includes lower body parts such as tummy, thighs, buttocks, and back
  • Upper body lift: It includes upper body parts such as breasts, chest and middle back

If the treatment includes both upper and lower body lift, it is collectively known as total body lift.

Ideal candidates for body lift

Body lift procedures can be performed on the following candidates:

  • Those participating in exercise and dietary programs
  • Patients who have undergone gastric bypass, lap band or other gastric restrictive procedures ( with minimum 1 year gap required)
  • Women to reduce excessive post-pregnancy weight

Procedure

The common steps involved in body lift procedure are as follows:

  • The procedure is performed under general anaesthesia.
  • An incision is made over the skin; the length and pattern of which depends upon the location and amount of excess skin to be removed as well as personal preference and surgical judgment.
  • The combination of liposuction and surgical body lifts are employed for toning the body.
  • Deep support sutures, within the underlying tissues, help in forming new contours.
  • A small, thin tube is placed under the skin for the drainage of excessive blood or accumulated fluid.
  • Finally the incisions are closed either by sutures, skin adhesives or tapes.

Risks and complications

The possible risks and complications associated with body lift surgery include:

  • Inauspicious scarring
  • Bleeding
  • Blood clots
  • Skin loss
  • Skin discoloration
  • Looseness of skin
  • Fluid accumulation
  • Infection
  • Induced asymmetry
  • Persistent pain
  • Relentless swelling of the legs
  • Poor wound healing
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Possibility of revision surgery

Post-operative care

The basic post-operative instructions after body lift surgery include:

  • Keep the incisions dry and clean.
  • Regular dressing of the incisions to help in healing
  • Regular intake of prescribed medications
  • Avoid heavy activities, for a specified period during recovery, as recommended by Dr Kane.
  • Avoid excessive force, or motion during the healing of the surgical incisions.

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Brachioplasty/Arm Reduction

Brachioplasty is a surgical procedure to remove excess skin and tissue that has accumulated around the arm, mostly, as a result of massive weight loss. This procedure can be used to achieve better definition of the arm, the armpit and the side of the chest.

The procedure entails are incisions that extends along the inside of the upper arm with a zigzag extension into the armpit and variably, onto the side of the chest depending on the amount of excess skin and tissue. Liposuction may also be utilised during this procedure. Following the procedure, drains exiting at the elbow are inserted and typically remain in place for one to two days and clients should remain in hospital for 3-5 days.

Thigh Reduction

A thigh reduction is performed to remove excess fat and skin that hangs from to the inner thigh, usually after massive weight loss. Dr Kane performs this procedure by utilising liposuction. Then Dr Kane will create a horizontal incision along the skin fold where the groin and thigh meet in conjunction with a vertical incision along the inner thigh from the groin to the knee to remove the excess skin and tissue under controlled tension.

Liposuction

Liposuction will reduce excessively stubborn localised fatty areas where dieting and exercise have failed. Liposuction can also be used in combination with other procedures such as abdominoplasty (tummy tuck) where specific fatty areas can also be contoured. Facelift can also be improved by liposuction by removing fat from under the chin and neck and to enhance the jawline.

Surgical procedure

A small incision is made in the skin for each area to be treated. A narrow metal tube (cannula) is inserted through the incision into the fatty area and by working the tube back and forth; the fat is shaved off in tunnels and evacuated through attached tubing to a suction machine or suction syringe. The suctioned tunnels and spaces are then collapsed by the use of a compression garment to create the new contour.

When fat tissue is suctioned from under the skin, it leaves small tunnels and empty pockets. The purpose of a compressive dressing or girdle is to collapse these spaces to allow healing to take place.

The area treated with liposuction may be strapped with elastic tape or a girdle will be applied. This will minimise bruising and swelling and provide a degree of support for the skin which will be relatively loose after the operation, particularly when the swelling settles down.

The elasticised material of the girdle helps to keep even pressure on the areas treated, minimise bruising and swelling and “even out the skin”. This process will help the skin to redistribute itself more evenly and minimises the risk of skin sagging and irregularities.

Following surgery you may be quite bruised and the areas can be discoloured and even purple. There can be swelling of the ankles, particularly if liposuction has been carried out in the abdomen or legs and a girdle is worn. This can be aggravated by hot weather. Minimise standing if there is swelling of the ankles and elevate your legs on a foot stool when sitting. The bruising tends to track down the leg or the abdomen and in some cases the patient can experience some swelling of the labia or scrotum. The bruising usually starts to settle after a week and is usually well faded by two weeks. It may, however, take six weeks for all the bruising to resolve. When a figure fault is sculpted away, the fullness in the area is temporarily replaced by swelling which resolves slowly. It is understandable, therefore, that the patient may underestimate the improvement in the first few weeks and wonder if the operation has been successful.

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