Body Contouring after Bariatric Surgery

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Patients often find after their bariatric surgery that they have empty skin on many places of their body. Typically, this affects the arms, breasts, face, stomach area and thighs. This occurs especially in patients who could loose more than 50 kilograms of their former weight after bariatric surgery.

Effects of bariatric surgery

An operation that restricts food to the stomach can have several adverse effects. One of them is loose, hanging skin all over the body. Since the previous body mass has extremely stretched the skin of the patient, the skin suffered and lost its natural elasticity. The skin can not rebound anymore. The now slim patient is confronted with layers of hanging and loose skin. This includes an overhanging panniculus. Quite often, there is also a large amount of skin hanging from the abdomen and covering the pubic and groin areas.

This flaccid skin can hang from the upper arms, chest, stomach, thighs and buttocks. These rollers and skin layers can rub against each other, which can lead to irritations and hygiene problems. They can also make movement more difficult.

Some of the areas most affected are:

  • The upper arms can sag and appear loose and full.
  • The breasts can become flat and hang with nipples pointing downwards.
  • The abdominal area can extend into the lower back area and around the sides. This is creating an overhang which is apron-like.
  • The buttocks, groin and thighs can sag and cause drooping skin pockets.

How plastic surgery works for body contouring

Body contouring after massive weight loss are procedures performed by plastic surgeons to eliminate and/or reduce excess post-barian procedures. Plastic surgery modifies the shape and tone of the underlying tissue. It also removes any excess flaccid fat and skin. The results are smoother body contours and a normal, attractive appearance.

While body contouring can be performed in one session, it is usually performed in stages under general anesthesia. If the patient is or used to be a smoker, is suffering from deep vein thrombosis or coagulation disorders, additional precautions are required. The same applies for patients with a high BMI or other risk factors.

Below you will find some examples of common procedures for body contouring:

Arm lift or brachioplasty. The additional skin on the arms of obese patients typically appears on the bodyside of the upper arm. This loose skin is sometimes also referred to as the non-medical expression of “bat wings”. To remove this skin, surgeons make incisions from the armpit to the elbow. This process allows to create a beneficial contour. Consequently, the surgeons open the arm at its underside so that the scar is well hidden. In brachioplasty, liposuction can be performed after the incision. The skin is pulled tight in the first step before the excess skin is being cut off. This can be up to one pound of skin per arm or more, depending on the patient.

Breast lift or mastopexy. The surgeon can bring sagging breasts into a more upright and fuller position by trimming excess tissue from the upper breasts. The procedure also often requires an implant to compensate for the loss of fat and tissue in the breast. Scars in women are almost always hidden in the area of the bra.

Abdominoplasty or Belly-embowectomy lift. Excess skin hanging over the pubic area is worrying and disturbing for most patients. The stomach pannus keeps moisture close to the body and causes skin rashes by rubbing against itself. This quite often leads to poor hygiene despite the efforts of the patient. While surgical removal is referred to as panniculectomy, patients suffering from large amounts of sagging skin often require more effort. To improve the contours of the back, flanks, and waist, surgeons sometimes perform a process described as belt lipectomy (other medical expression are toroplasty or circumferential lipectomy). The incision at the lower waist runs around the middle of the patient. The surgeon performs more liposuction on the abdomen and flanks while removing excess skin from the back and sides of the patient. The abdominoplasty and the belt ectomy are placed in a way that the resulting scars are hidden under the underwear.

The lower body lift removes excess skin from the buttocks and thighs. In an internal thigh lift, the surgery starts with an incision high up the inner side of the legs. The incision starts near the groin and moves on to the knees. Liposuction can be used to remove some fat. In the next step of the surgery, excess skin is removed and the remaining skin retracted before closing the long incision. This gives the patient firmer and more attractive thighs. The buttocks and outer thigh can be raised above the back, above the buttocks, by a hip-to-hip cut.


Bariatric surgery generally achieves a sustained decline in the Body Mass Index (BMI). However, the remaining flaccid skin is reminiscent of the patient’s previous obesity. Body contouring after bariatric surgery aims to correct this and restores a sense of serenity. By transforming the body into its ideal proportions, the patient will finally realize the success of weight loss surgery.