Massive Weight Loss / Buttock Procedures

Brachioplasty (“arm lift”)

A brachioplasty or “arm lift” is reserved for patients who have lost a significant amount of weight with deflation of their arm volume and excess skin. Some patients simply have excess skin, while others have a combination of excess skin and fat. I perform a simple pinch test in the office to determine the cause when a patient does not like his or her arm contour.

Depending on the cause, either direct excision, or liposculpture followed by direct excision, is used to improve the contour of the arms. I prefer to hide my incision in the posterior part of the arm as it tends to heal better in this area. For patients with significant laxity of tissue the area of removal sometimes extends across the armpit and down the lateral chest wall. During my training, I had the privilege of working with one of the world’s experts in massive weight loss body contouring, and many of my principles and techniques are derived from my years of experience with him.

A brachioplasty or “arm lift” is performed in an outpatient setting and patients go home the same day. In patients who have lost a significant amount of weight, I sometimes combine this procedure with breast or abdominal procedures as well. In addition, for massive weight loss patients I combine this with a breast and back procedure known as an Upper Body Lift, which is discussed in the Massive Weight Loss section.

Knee lift

A knee lift is performed for a unique subset of patients who dislike the contour of the tissue directly above their knee. In certain people, this skin hangs over the upper part of the knee with aging and can be distressing. This procedure is done in an outpatient setting and involved removal of excess skin to restore contour to the junction between the upper and lower leg at the knee.

Buttock procedures – large volume fat grafting/implants

Buttock procedures have gained popularity in recent years and are used to augment or contour your existing tissue. These procedures were once plagued with complications but thanks to new techniques, these procedures can be performed safely with a very low complication profile.

Implants can be used to augment the size of your buttock by placing a small incision in your gluteal cleft (the area between the buttocks). With a simple incision, a pocket is created below your muscle and a implant inserted whose size can be adjusted. Placement depends on the shape of your buttock and is something we discuss during your consultation.

Large volume fat grafting can also be used for buttock augmentation and involves liposculpture to contour one part of the body (flanks, hips, abdomen, etc) and redistribution of that fat to recontour your buttocks. Many patients like this option because it does not involve an implant. For some patients, adding volume in certain places and not others can enhance the shape and look of your backside.

These procedures (implant and fat grafting) are done in an outpatient setting and involve little downtime other than very limited pressure on the buttocks for several weeks. Patient are generally very pleased with this procedure and this can be an excellent adjunct to body contouring.

Massive weight loss (post – bariatric procedures) – Lower Body

Lift, Belt Lipectomy, Upper Body Lift, thigh lift

Body contouring for massive weight loss patients is an important component of my practice. During my years of training in General Surgery, I spent a great deal of time taking care of these patients and doing multiple procedures including Lap Band, sleeve gastrectomies and gastric bypass. In addition, during my Plastic Surgery training I had the opportunity to work with one of the world experts in body contouring after massive weight loss. My work with him as well as extensive experience taking care of these patients both at UCI Medical Center as well as the Veteran’s Hospital in Long Beach has enabled me to take care of these difficult problems with excellent results.

After massive weight loss, the excess of skin surrounding a patient’s body can be enormous. This can lead to social embarrassment as well as difficulty with sexual intercourse, going to the bathroom, exercising, and simply walking. Now that my patients are healthy and have lost weight, they wish to return to a normal physical appearance. Using complex techniques, this is possible. It is my preferred approach to begin with the abdomen and lower back, followed by the upper body including the breasts/arms/back/lateral chest wall, followed by the thighs, and finally the face. Depending on my patient’s concerns and wishes, we can do them in any order although oftentimes multiple procedures are combined. A Lower Body Lift or Belt Lipectomy is used to recontour the abdomen, flanks, lower back, and buttocks. An Upper Body Lift is used to recontour the breast, upper back, upper arms, and lateral chest wall. A thigh lift is done to contour the upper legs and groin.

If you have had a weight loss of greater than 75 pounds, either by diet or surgery, you fall into a special category and my preoperative work-up is extensive to assure the safety and efficacy of the operation. I will check multiple lab and nutritional values to assure that you surgery goes well. I also use special techniques in the operating room to assure your safety and often recruit the help of my partners to help with these operations to get your surgery done as efficiently as possible.

These procedures are done in an inpatient setting with either an overnight stay or sometimes a 2-3 day hospital stay. My number one priority is your safety, and a team approach must be used simply because such a large amount of tissue can be removed. This involves not only a knowledgable Plastic Surgeon, but also an experienced nursing/ancillary staff in the operating room and the recovery room.