Sydney

Excess Skin Removal (Body Contouring after Weight Loss)

Arms and thighs, mostly. An arm lift is called a brachioplasty, a thigh lift a thigh lipectomy, and between them they account for most of the requests. Loose skin turns up on the abdomen, chest, back and buttocks too. Each of those has its own operation and is not something that gets tacked onto an arm or thigh lift.

For a brachioplasty, the loose skin between elbow and shoulder is marked out and taken away through an incision that runs from the armpit down towards the elbow. Roughly three hours, usually with a night in hospital afterwards. A thigh lift uses an incision on the inner thigh, one sitting in the groin crease, or both together, placed so that it stays hidden when your legs are together. Which areas get treated, and in what order, is worked out with you at consultation.

Once your weight has held steady for six months or more. That is the clinical advice, and where a Medicare item is in play it is also a written eligibility rule. Operate while the weight is still coming off and you can be left with fresh looseness, which then needs more surgery to correct.

Still losing, whether through lifestyle change, medication or bariatric surgery? Wait until it levels off. Six months of stability is the usual mark. There is no upper limit on how long you can leave it, and skin does not get meaningfully harder to treat because you waited. Nutrition comes into it as well, so get reviewed beforehand rather than assuming everything is in order.

Sometimes. The Medicare lipectomy items cover skin and fat that has become redundant as a direct result of significant weight loss, and that takes in non-abdominal areas like the arms and thighs. If the surgery is cosmetic, no benefit is payable. Every criterion has to be met, not most of them.

Medicare treats significant weight loss here as a drop of at least five BMI units. Beyond that, the criteria generally ask for intertrigo or another skin condition that puts skin integrity at risk and has not responded to three months of non-surgical treatment, redundant skin and fat that gets in the way of daily activities, and six months of stable weight beforehand. Circumferential lipectomy sits under its own item, 30179. Here is the part that surprises people: where several areas are excised, the benefit is payable once only, and the schedule fee does not change with the number of excisions. Ask which item number is being claimed, then check cover with your fund against that number before you book.

Yes, and your team needs to know you are on it. Semaglutide, tirzepatide and drugs like them slow the stomach down, which raises the risk of stomach contents getting into the lungs while you are under anaesthetic. Anaesthetic guidance is to withhold them for a period beforehand. Your surgeon and anaesthetist will tell you the timing that applies to you.

The American Society of Anesthesiologists put out guidance in 2023 suggesting daily formulations be stopped at least 24 hours before a procedure and weekly ones at least a week out. Practice varies and the evidence is still moving, so follow what your surgeon, anaesthetist and prescribing doctor tell you rather than stopping or adjusting anything yourself. Two other things worth knowing. There is emerging evidence of more wound healing complications in patients taking these medications around the time of body contouring surgery, and weight lost on them can include muscle as well as fat, which affects the quality of the tissue being operated on. Tell your team the drug, the dose and the date of your last one.

It does not rule you out. It does change the preparation. Some bariatric procedures reduce how much you absorb, which can leave you low in protein, iron, vitamin B12, vitamin D or zinc, and every one of those matters when a wound is trying to heal. Blood tests beforehand are worth doing for that reason.

There is usually more skin to remove as well, spread across more areas, so the operations run longer and the wounds are bigger. A review with your bariatric team or GP before body contouring makes sense. A deficiency picked up then can be corrected in advance, rather than being discovered later when a wound is slow to close. Smoking, diabetes and a weight that keeps moving all push in the same direction. None of it stops surgery going ahead, but it does shape the timing and how smoothly you recover.

Long, and permanent. They are also among the harder scars in plastic surgery to get looking tidy. The arm lift scar runs from the armpit towards the elbow. The thigh lift scar sits in the groin crease, along the inner thigh, or in both places.

Incisions are put where clothing covers them, though an arm scar shows in short sleeves and a thigh scar shows when you are undressed. Both sites are under tension and moving all day, which makes the scars there more likely to widen, thicken or sit raised than scars elsewhere. Plenty fade a good deal over 12 to 18 months. Some do not, and revision is occasionally considered further down the track. This really is the heart of the decision, so ask to be shown where the incisions will run, and be comfortable with the scar before you agree to the operation.

The list is a long one. Bleeding, infection, delayed wound healing and wound breakdown, fluid collections, poor or widened scarring, loss of skin sensation, damage to the nerves and blood vessels underneath, changes in skin colour, asymmetry, blood clots, complications of anaesthesia, and the possibility of needing further surgery.

Wound healing is the one to watch here. These incisions are long, and they sit in areas that are under tension and prone to moisture, so breakdown and fluid collection happen more often than with many other operations. Thigh lifts carry a couple of extras: swelling of the leg, and distortion of the surrounding area where tension has not been managed well. Smokers, people with diabetes and anyone whose nutrition has not been sorted out sit at higher risk. Increasing pain, spreading redness, fever, a wound that separates, calf pain or breathlessness all mean get medical help, not wait and see.

Brachioplasty: around two weeks off work, arm and shoulder exercises kept limited for those two weeks, nothing strenuous for six. Thigh lift: two to three weeks off work, gentle walking encouraged over the first fortnight, and again no strenuous activity for six weeks.

You will be in a compression garment for four to six weeks to help with swelling. Line up someone to drive you home and to lend a hand for the first few days. Swelling goes down slowly and the final shape takes months to show itself. Those figures above are for one area; treat several in the same operation and recovery stretches out. Ask for timelines built around your operation, covering driving, lifting, work and exercise, rather than working off general advice.

Sometimes. It also makes the operation longer and the risk higher. Combining procedures is associated with more complications, and time on the table is itself a risk factor for problems such as blood clots. Splitting the work across separate operations is often the more cautious path.

After a large weight loss there are often several areas someone would like dealt with, and getting it all over with in one hit has obvious appeal. The counterweight is that every extra area adds operating time, wound length and blood loss. Where surgery is staged, the order usually comes down to which area bothers you most and which is likely to heal more predictably. Worth asking at consultation: how long would the proposed operation run, is staging an option in your case, and what will be done to prevent clots.

If the surgery is being done for cosmetic reasons, then yes. The Medical Board of Australia’s cosmetic surgery guidelines apply, and they include a cooling-off period of at least seven days after informed consent before the surgery can be booked or a deposit paid. A GP referral is needed to see A/Prof Bish Soliman either way.

Those guidelines ask for several other things as well: a referral from an independent medical practitioner, at least two pre-operative consultations with one of them face to face with the surgeon who will be operating, and screening for psychological conditions using a validated tool. Anyone under 18 needs independent evaluation and a cooling-off period of at least three months. Where the surgery is medically justified, skin removal that meets the criteria for a Medicare lipectomy item for instance, the guidelines do not apply in the same way. Ask at your first appointment which pathway you are on.

Loose skin left after major weight loss does not tighten on its own, and no cream, massage or device reliably removes it. Skin has a limited ability to retract once it has been stretched over a long period, and surgery is currently the only way to remove a significant amount.

Some tightening does continue for a while after your weight stabilises, which is another reason for waiting six months before making a decision. Strength training can change the shape of the muscle underneath, which sometimes alters how an arm or thigh looks, though it removes no skin. Non-surgical skin tightening devices are marketed for this purpose and may produce modest change where laxity is mild, but they do not address the degree of excess seen after major weight loss. Treat any treatment promising surgical results without surgery with scepticism.