Body Contouring

This is exemplified by our approach to body contouring, which gets rid of excess skin and fat while contouring the body so it has a nice shape. Our precise methodology for body contouring is to individualize the surgical technique while optimizing aesthetic outcome, safety, and downtime.

GENERAL INFORMATION
Body contouring is a collection of surgical procedures to remove excess skin and fat. Some of the common body contouring procedures include liposuction, abdominoplasty, panniculectomy, lower body lift, buttock lift, breast lift with or without breast augmentation, back lift, brachioplasty (arm lift), and thighplasty (thigh lift) among other procedures. Body contouring is not a surgical treatment for being overweight. Individuals who intend to lose weight should postpone all forms of body contouring surgery until they have reached a stable weight. In fact, one of the most common reasons to undergo body contouring is because of massive weight loss, like after bariatric surgery.

With significant weight loss, patients sometimes lose fat but not skin. This can result in severe excess skin that does not get tighter with exercise and diet, including the in the abdomen, back, arms, thighs, breasts, and face/neck. Body contour deformities may involve one single region or extend to multiple body regions. They may be treated by a one-stage operation or may require more complex staged procedures. Planning and final results must be carefully discussed with the patient, including the location and extent of scars.

THE BEST CANDIDATES FOR BODY CONTOURING
The best candidates for body contouring are men or women who have had a stable weight for at least six months and do not plan on losing or gaining any weight in the near future (for example, during pregnancy). The patient has attempted diet and exercise to improve the areas of concern but has not been successful. Patients should be medically and nutritionally optimized. Excellent nutrition is important because these procedures usually involve large skin excisions that require extra protein and nutrients to heal satisfactorily.

PLANNING YOUR SURGERY
During the consultation your areas of concern, expectations, previous treatments, and your weight should be discussed in great detail. A thorough physical examination of your areas of concern will be performed, including an analysis of the amount of excess skin and fat.

Any major medical problems will be evaluated and should be optimized prior to surgery to minimize complications. Your current nutritional status should be evaluated. Dr. Elswick will ensure your questions are answered and your goals are understood. Patient expectations are important to discuss at the consultation. Surgical technique is individualized for each patient based on location of concern.

Our practice offers the Renuvion skin rejuvenation system which is commonly paired with this surgery. Renuvion is a minimally invasive procedure that is used to tighten and smooth your skin.  Areas of treatment include the neck, stomach, back, arms and legs.  It works by delivering a precise stream of Helium plasma energy underneath the skin using a long thin tube called a cannula. Renuvion causes collagen to contract and skin to tighten, enhancing the appearance of the skin.  More Information About Renuvion

PREPARING FOR YOUR SURGERY
It is important to maintain a healthy diet prior to your surgery to optimize the healing capabilities of your body. Dr. Elswick will give you specific instructions to prepare for the procedure, including guidelines on diet and medications. Patients using tobacco or other nicotine-containing products must stop at least four weeks before and after surgery. Carefully following these instructions will help your surgery and your recovery proceed more smoothly.

WHERE YOUR SURGERY WILL BE PERFORMED
Your surgery can be performed at Columbia Surgery Center (our private outpatient surgical suite adjacent to our office) or at one of the local hospitals. Dr. Elswick has privileges at William Beaumont Hospital of Royal Oak, William Beaumont Hospital of Troy, and McLaren Macomb Hospital. The location of your surgery will depend on the procedure(s) you are having done, your other medical problems, and your preference. Sometimes you may require an overnight stay in the hospital.

TYPES OF ANESTHESIA
Body contouring procedures are usually preformed under general anesthesia.

THE SURGERY
There are various types of body contouring procedures, some of which are outlined below.

LIPOSUCTION:
Please refer to our liposuction web-page

ABDOMINOPLASTY (TUMMY TUCK):
Please refer to our abdominoplasty web-page 

PANNICULECTOMY:
A panniculectomy is similar to an abdominoplasty except the underlying muscles are not tightened. An incision is made at or below the natural fold in the lower abdomen and extends from hip to hip. The excess skin and fat is freed and excised. If needed, a new opening for the umbilicus (belly button) is made. Sometimes insurance will cover this procedure if certain criteria are met.

LOWER BODY LIFT:
The lower body lift is usually a single surgery but it can be performed in separate surgeries. A complete lower body lift treats the sagging buttocks, abdomen, waist, hips and outer thighs. This involves a circumferential incision around the lower body to remove the “belt” of excess skin and fat. Some of this skin and fat can be used to augment or add volume to the buttocks if needed.

BUTTOCK LIFT:
A buttocks lift removes excess skin and fat of the lower back and upper buttocks, which lifts the sagging buttock and outer thighs. Some of this excess skin and fat can be used to enhance the volume and shape of the buttock for patients with severe loss. This can be done in conjunction with fat grafting. Projection of the buttock region has become a sign of a well-sculpted body, and often is a goal of individuals who seek body contouring procedures. The scar usually extends across the upper portion of the buttocks.

BREAST LIFT WITH OR WITHOUT BREAST AUGMENTATION:
Please refer to our web-pages on breast lift and breast augmentation

BACK LIFT:
A back lift helps get rid of back rolls and helps define the posterior waist. Excess skin and fat are removed, generally through a horizontal incision near the tip of the shoulder blade. In women, this can be hidden nicely underneath a bra strap. This can be extended to the side of the chest, under the arms, to get rid of excess skin and fat in this area as well.

BRACHIOPLASTY (ARM LIFT):
There are multiple techniques for brachioplasty. In patients with excess fat and good skin tone, liposuction may be adequate to shape the upper arm. If you have excess skin and fat limited to the proximal upper arm (near the armpit), sometimes the incision can be hidden in the armpit. If you have excess skin and fat throughout the upper arm, an incision extending the length of the upper arm will be required. The scar can be placed along the inner aspect of the arm, which conceals the scar in the standing upright position with arms at the side, and is generally the preferred location. Another option is to place the scar on the back of the arm; this is not as evident to the patient but can be seen if someone is looking at the back of your arm.

THIGHPLASTY (THIGH LIFT):
There are multiple techniques for thighplasty. If most of your excess skin and fat is located in the upper inner thigh, a horizontal thighplasty may be adequate, which places the scar in a transverse manor along the groin and upper thigh crease. If you have excess skin and fat throughout your inner thigh, a vertical thighplasty will be required, which places the scar along the length of the inner aspect of the thigh; this conceals the scar in the upright position with the legs together. Sometimes the scar for the thighplasty also extends horizontally near the groin and thigh crease so it has an L or T shape.

FACE/NECK:
Please refer to our web-pages on face lift

AFTER YOUR SURGERY
The incisions are usually closed with sutures under the skin which are absorbed by the patient’s body so there is no need for suture removal post-operatively. Dressings typically consist of surgical glue and tape which remain in place until they begin to fall off in the first 2-4 weeks post-operatively. Alternatively, you may be sent home with an incisional wound VAC dressing. This dressing is composed of a special sponge and tape that is connected to a suction device. It will stay in place for 7 days and is easy to remove.

You will also be given a special compression garment or ACE bandages, which can be washed and re-used. The garment should be worn for at least 2-4 weeks post-operatively depending on the surgery you had. From there, you can switch to a Spanx or similar light compression garment for a total of 6 weeks after surgery (or longer if desired for comfort). The compressive garments are an essential component of the surgery as this minimizes fluid buildup in the surgical sites, which facilitates skin contraction, limits scarring, and speeds up the healing process.

Almost all body contouring procedures require at least one drain. A drain is comprised of a long tube, one end of which is placed in the area where the surgery was performed and the other connected to a bulb that collects the fluid that you body produces after surgery. The instructions on how to care for your drains will be reviewed by the nursing staff prior to leaving the hospital. Usually drains come out 1-2 weeks after your surgery. Since the incisions are covered, it is okay to shower the first day after your surgery.

Mild to moderate discomfort and pain is to be expected after surgery, which will usually subside in the first few days to weeks after your surgery. You will likely to feel tired and sore for a few weeks after any body contouring procedure. Most of your discomfort can be controlled by medication prescribed by your doctor in addition to taking regular Tylenol.

Bruising and swelling is expected after surgery. Generally the major bruising and swelling subsides 1-2 weeks after surgery. However, the final result of your body contouring procedure will not be evident until 6 months after surgery.

You should not participate in any strenuous exercise, heavy lifting, or repetitive activities in your operated extremities for 4-6 weeks after surgery. Strenuous exercise includes any activities where your heart rate exceeds 100 beats per minute. We highly encourage our patients to remain active post-operatively, doing activities such as walking. You should not lift anything heavier than 10 pounds (about a gallon of milk). It is okay to type and work at a computer. You can slowly work back into your normal activities at 4 weeks post-operatively and should be back to your normal self at 6-8 weeks post-operatively.

When you can return to work depends on how you are healing post-operatively and what you do for work. Patients with sedentary jobs can return to work as early as two weeks post-operatively, although generally at least four weeks off is recommended. If you do a lot of lifting, you will require six weeks off or modified duties at work.

We highly encourage you to maintain a stable weight, healthy diet, and consistent exercise plan after surgery to maintain your aesthetic outcome.

YOUR NEW LOOK
The removal of the excess skin and fat may help your self-esteem and improve your confidence. The scars can usually be placed to minimize visibility, but if you require a large excision you need to consider the trade off of the scar with getting rid of the excess skin and fat. Your clothes will fit better. You should wait at least 6-12 weeks after surgery before purchasing new clothing because this will give time for the majority of the swelling to resolve.

RISKS ASSOCIATED WITH BODY CONTOURING
Every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them. In addition, every procedure has limitations. An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit.

Body contouring, especially after massive weight loss, is usually associated with a high rate of complications, although these are generally very treatable. Potential complications after body contouring include bleeding, infection, seroma (fluid accumulation), wound healing problems requiring dressing changes, unfavorable scarring, contour irregularities, asymmetry, and damage to surrounding structures (such as nerves). You may require additional surgeries to address these complications.

INTERESTED IN SETTING UP A CONSULTATION?
Dr. Elswick is highly trained and skilled in Body Contouring surgery. She personally meets with all of her patients in our office located in Troy, Michigan.

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