After bariatric surgery or major weight loss · New York and New Jersey
Body Contouring After Weight Loss
After major weight loss, loose skin often remains on the abdomen, back, arms, breasts or chest, and thighs. Body contouring surgery removes it, usually in a planned series of operations. Dr. Steven Ovadia is a board certified plastic surgeon who plans and performs this surgery for patients in New York City and New Jersey.
Overview
Why loose skin stays after weight loss
When weight is gained, the skin stretches to cover it. After a large weight loss, whether after bariatric surgery, with a weight-loss medication, or with diet and exercise, the skin has often stretched too far to spring back. Exercise builds the muscle underneath, but it does not tighten the skin, and the loose skin can hang in folds.
Those folds can cause rashes and skin infections, make exercise and walking uncomfortable, and make clothes hard to fit. For many patients they also hide the change their weight loss has made.
Body contouring removes the loose skin and tightens what remains. Because it usually affects several areas, the surgery is planned as a whole, from the arms to the thighs, and is usually done in stages.
Candidates
Who body contouring is for
Body contouring after weight loss tends to work well when:
- You have lost a large amount of weight, after bariatric surgery, with a weight-loss medication, or with diet and exercise
- Your weight has leveled off and has stayed stable, often for several months
- Loose skin causes rashes or skin infections, gets in the way of exercise or clothing, or bothers you
- You are in good general health, and your nutrition is back on track after weight loss
- You do not smoke or vape, or you are able to stop well before and after surgery
- You accept longer scars in exchange for a firmer, smaller shape
Getting ready for surgery
A stable weight
Surgery is planned once your weight has leveled off and stayed there. If you are still losing weight, more skin loosens afterward, and the result does not hold as well.
Nutrition
Healing takes protein, iron and vitamins, and these can run low after bariatric surgery or rapid weight loss. Dr. Ovadia may ask for bloodwork and work with your weight-loss team to correct them first.
Weight-loss medications
If you take a weight-loss medication, tell us at your consultation. You may be asked to pause it before surgery, as your anesthesia team directs.
Smoking and vaping
Nicotine reduces blood flow to the skin and raises the risk of wound healing problems, which matters more with longer scars. You need to stop well before and after surgery.
Areas
Areas treated
Each area has its own operation, and several of them have their own pages. Most patients have two or more of these, planned together.
Abdomen
Loose skin and a hanging fold at the bottom of the abdomen are often the first concern. A tummy tuck removes them and can repair separated muscles. When the fold causes medical problems, a panniculectomy removes it.
Tummy tuck pageWaist, hips, buttocks and lower back
When loose skin wraps around the whole lower trunk, a lower body lift removes it all the way around, in one operation, and lifts the buttocks and outer thighs.
Lower body lift, belowUpper arms
An arm lift removes the loose skin that hangs from the upper arm. After major weight loss, the scar can continue past the armpit onto the side of the chest.
Arm lift pageBreasts or chest
Weight loss often leaves the breasts deflated and low. A breast lift raises and reshapes them, with or without an implant. In men, loose skin and remaining breast tissue of the chest can be removed to flatten it.
Breast lift pageUpper back
Rolls of skin along the bra line and under the shoulder blades can be removed through a scar placed along the bra line, often together with an arm lift or breast surgery.
More belowThighs
A thigh lift removes loose skin from the inner thigh. The scar sits in the groin crease, and when the loose skin runs down toward the knee it continues along the inner thigh.
Thigh lift, belowLower body lift
When loose skin wraps all the way around
After major weight loss, loose skin often does not stop at the front of the abdomen. It continues over the hips and the flanks and onto the lower back, and the buttocks and outer thighs sag.
A lower body lift, also called a circumferential body lift, removes a band of loose skin and fat all the way around the lower trunk in one operation. The front is done like a tummy tuck, including muscle repair when it is needed. At the back, the skin is removed above the buttocks, which lifts the buttocks and the outer thighs.
The scar runs all the way around, low on the abdomen and across the lower back above the buttocks, where underwear and swimwear usually cover it. Dr. Ovadia marks its position with you standing, before surgery.
The gold line marks the scar.The shaded area is the skin that is removed.
Tummy tuck, extended tummy tuck, or lower body lift
| Tummy tuck | Extended tummy tuck | Lower body lift | |
|---|---|---|---|
| Loose skin removed from | The front of the abdomen | The abdomen, the hips and the flanks | All the way around: abdomen, hips, flanks, lower back and buttocks |
| Scar | Low, from hip to hip | Low, continuing onto the hips and flanks | All the way around the lower trunk, low on the back |
| Also lifts | The front of the abdomen | The front and sides | The buttocks and the outer thighs |
| Usually for | Loose skin limited to the front | Loose skin that reaches the sides | Loose skin that wraps around to the back |
When the loose skin is limited to the front, a tummy tuck or an extended tummy tuck may be all that is needed. More about tummy tuck surgery, including the panniculectomy.
Upper body
Arms, breasts or chest, and upper back
Above the waist, loose skin collects on the upper arms, the breasts or chest, and the upper back. These areas are often treated together in one operation, sometimes called an upper body lift, because the loose skin runs from one to the next.
Upper arms
An arm lift removes the loose skin of the upper arm. After major weight loss, the scar can continue past the armpit onto the side of the chest.
More about arm lift surgeryBreasts or chest
A breast lift raises and reshapes deflated breasts, with or without an implant. In men, loose skin and remaining breast tissue are removed and the chest is flattened.
More about breast lift surgeryUpper back
Rolls of skin along the bra line and under the shoulder blades are removed through a scar placed along the bra line, where a bra strap or swimsuit usually covers it.
Weight loss can also leave the breasts smaller. Breast augmentation can be added to a lift to restore volume.
Thigh lift
Loose skin of the inner thighs
A thigh lift removes loose skin from the inner thighs, which can rub and chafe when walking. The length of the scar follows the loose skin. The outer thighs are lifted by a lower body lift instead.
Thigh lift in the groin crease
For loose skin limited to the upper part of the inner thigh. The scar sits in the crease where the thigh meets the groin, where underwear usually covers it.
Thigh lift along the inner thigh
For loose skin that runs down the inner thigh toward the knee, as it often does after major weight loss. The groin scar continues down the inner thigh, where it is seen less from the front.
Liposuction is often used in the same operation to reduce fat in the thigh before the skin is removed. On its own, liposuction does not remove loose skin. More about liposuction.
Planning
Planning your surgery in stages
Treating every area at once would make one very long operation, and the risks of surgery rise with its length. Most patients have two or three operations, several months apart, so each one stays a safe length and the body can recover in between.
At your consultation, Dr. Ovadia looks at every area and sets out a full plan, including which areas go together and in what order. A common order is below. Yours depends on what bothers you most and on your health.
Lower body
Often first: the abdomen, with a tummy tuck, extended tummy tuck or lower body lift, because the hanging fold of the abdomen is usually the biggest concern.
Upper body
Then the arms, the breasts or chest, and the upper back, which are often done together in one operation.
Thighs and refinements
The inner thighs, and any touch-ups, once the earlier surgery has settled. The thighs are sometimes done with the lower body instead.
Every surgery has risks. For body contouring these include bleeding, infection, blood clots in the legs or lungs, fluid collecting under the skin, incisions that are slow to heal or open in places, scars that are wide or raised, numbness, an uneven contour, differences between the two sides, and the possible need for a revision. Smoking and vaping raise the risk of healing problems. Dr. Ovadia goes over the risks with you at your consultation.
Recovery
What to expect after body contouring
Walking starts right away
Short walks begin the day of surgery or the next morning. Walking helps circulation and lowers the risk of blood clots. After surgery of the abdomen, you walk slightly bent at the waist for the first several days.
Compression is important
You wear compression garments on the areas that were treated. The compression helps prevent and minimize swelling and supports the skin while it heals.
Drains are commonly used
Drains are commonly used after body contouring to remove fluid under the skin. If Dr. Ovadia places them, you are shown how to care for them before you go home, and they are removed in the office.
Swelling and bruising are normal and expected
The treated areas are swollen and bruised at first, and often numb or tight. Swelling goes down gradually over the following weeks and months, and feeling returns slowly.
Small wound problems are common
With long scars, a small area of the incision may heal slowly or open, most often where two scars meet. These areas usually heal with dressing care in the office.
Scars take time
Scars are red and firm at first. They fade and soften over a year or more. Protect them from the sun while they heal.
Normal swelling comes on slowly. A rapid increase in swelling is something to watch for, and it should be brought to your physician's attention right away. The same is true of severe pain, spreading redness, a fever, or swelling or pain in one leg. For chest pain or trouble breathing, call 911.
A general timeline for each stage
This is a general guide. Everyone heals differently, and recovery depends on which areas are treated. During your recovery, Dr. Ovadia will review your timeline with you.
Cost
Cost and insurance
Body contouring done to improve the shape of the body is unlikely to be covered by insurance. Some plans cover parts of it when the loose skin causes a documented medical problem. That is most often a panniculectomy, which removes the hanging fold of skin at the bottom of the abdomen, and some plans may also cover an arm or thigh lift.
The cost depends on which areas are treated and how many stages are planned. We go over it with you once your surgical plan is set.
Common criteria for coverage
- Loose skin that causes rashes, skin infections, or sores that keep coming back
- A problem that has continued despite treatment prescribed by a physician
- Loose skin that gets in the way of walking, hygiene, or daily activities
- A stable weight, often for several months, after major weight loss
- Photographs and medical records that document the problem
Every plan sets its own criteria. Coverage is not guaranteed.
If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Your surgeon
Board certified and double fellowship-trained
Dr. Ovadia is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
He performs body contouring after weight loss, including tummy tuck, lower body lift, arm lift, thigh lift, and breast lift, and works with your weight-loss team on timing. He sees patients in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about body contouring after weight loss
How long after weight loss surgery should I wait?
Surgery is planned once your weight has leveled off and stayed stable, often for several months. After bariatric surgery, that is commonly a year or more from the operation. Your nutrition should also be back on track. Dr. Ovadia can see you before you reach that point to plan ahead.
I lost weight with a medication such as Ozempic or Mounjaro. Is that different?
The loose skin is the same, and so is the approach: surgery is planned once your weight is stable. Tell us about the medication at your consultation, because you may be asked to pause it before surgery, as your anesthesia team directs.
Can everything be done in one operation?
Usually not. Surgery of the whole body at once would make one very long operation, and the risks rise with the length of surgery. Most patients have two or three stages, several months apart. Some areas are commonly combined, such as the arms and the breasts.
Which area should I do first?
Most patients start with the area that bothers them most, which is often the abdomen. Dr. Ovadia goes over a full plan with you at your consultation, including the order of the stages, so each one fits with the next.
What is the difference between a tummy tuck and a lower body lift?
A tummy tuck removes loose skin from the front of the abdomen. A lower body lift removes it all the way around the lower trunk, including the hips, the lower back and the buttocks, and also lifts the buttocks and outer thighs. The scar runs all the way around.
How big are the scars?
The scars are longer than in surgery for loose skin from pregnancy or age, because there is more skin to remove. They are placed where clothing usually covers them, along the low abdomen and back, the inner arm, the bra line and the groin. They fade and soften over a year or more.
Can liposuction remove the loose skin instead?
No. Liposuction removes fat. It does not remove or tighten skin, and after major weight loss it can leave the skin looser. It is sometimes used during skin removal surgery to shape an area.
Is body contouring after weight loss covered by insurance?
Surgery done to improve the shape of the body is unlikely to be covered. Some plans cover parts of it when the loose skin causes a documented medical problem, such as rashes or skin infections that keep coming back despite treatment. That is most often a panniculectomy, which removes the hanging fold of the abdomen. Every plan sets its own criteria, and coverage is not guaranteed.
Will the result last?
The skin that is removed does not come back. The result lasts best when your weight stays stable. Skin continues to age, and a large weight gain or a pregnancy can stretch it again.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey.
Next step
Start with a consultation
Dr. Ovadia will examine each area, go over what bothers you most, and set out a plan: which operations, in what order, and where the scars would sit. You are welcome to come in before your weight has leveled off, to plan ahead.
225 Broadway, Suite 3100, New York, NY
377 Jersey Ave, Suite 440, Jersey City, NJ
90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com