After bariatric surgery, weight loss usually progresses dramatically until a plateau is reached. Once at the plateau for about 12-18 months postoperatively, these patients become candidates for body contouring and other aesthetic plastic surgery procedures.
Due to the rapid loss of weight, the decrease in subcutaneous fat results in skin laxity, with skin that has been overstretched and with little potential to retract. The excess skin is usually noted over the abdomen, buttocks, chest/breasts, thighs and arms.
Most centres insist on a BMI of 28kg/m2 or less and the patient must be a non-smoker and in good general health. These patients tend to have a normal fat distribution however have excess skin that may hang as folds. Treatment usually starts with the lower body, then followed by the upper body (chest, breasts, arms) and lastly the face. Typically 3 months between each operation is suggested to allow for adequate recovery and healing. Whole body procedures are rarely done as there is high potential for blood loss, infection and hypothermia. Ultimately a treatment plan is individualised for each patient.