Video Transcription

Dr. Brian Pinsky: Hello, I’m Dr. Brian Pinsky with the New York Plastic Surgical Group. I wanted to talk about different types of procedures that are available for trunk contouring following weight loss. Again, this can be weight loss done either naturally through diet and exercise or with medication assistance or even post-surgery. Patients come in from all different experiences.

First of all, congratulations. Achieving weight loss to this level is impressive and is a life-changing experience. And this can really be the crowning part of that achievement, is removing all the excess skin and bringing your body to where you really want it to be.

There’s many types of different procedures that are available that we will discuss in a consultation.

Just to start off from sort of least complicated to most complex, the first is what’s called a panniculectomy. This is really a functional operation that are reserved for people with significant lower hanging skin. Most insurances require the [inaudible 00:00:58] to be hanging below their pubic bone with significant issues such as constant rashes, difficult with mobility, other functional complaints.

It’s important to understand this is not a cosmetic procedure. It really involves removing only the skin below the belly button. Sometimes we even have to remove a patient’s belly button if it’s in the way of the closure for hygiene purposes and to prevent decreased chances of wound complications.
It tends to give the belly a rounded appearance. There can often be kind of step off in thickness between the upper and lower tissue. So, again, this is a functional surgery, not a cosmetic operation.

Most patients that want to improve the cosmetic contour of their abdomen and trunk would require something more. This can be most commonly an abdominoplasty or what we call extended abdominoplasty, where the scars can reach further around the back, depending on the amount of extra skin.
And what this does is often combined with liposuction will address the excess tissue of both the upper and lower abdomen, contour any fatty deposits that might be in the lateral trunk or flank areas, will tighten up the abdominal muscles, repair any diastasis or separation that might be present, make somebody a new position for their belly button. This is really where the cosmetic portion comes in.

In patients that have a lot of excess tissue both down below and up top, we’ll often opt for something called a fleur de lis abdominoplasty. What this does is it creates a lower scar normal to a tummy tuck, but also adds the addition of a vertical scar, which extends up usually to the xiphoid process of the lower part of the sternum. And this allows us to really bring in the waist and address that excess that lies vertically as well as horizontally in the lower abdomen.
And finally, it’s also important to understand that the issues or deformities that occur with weight loss are not just in the front. It’s really a circumferential issue because of the way weight loss occurs.

And that usually achieves the best cosmetic outcome, which would be something called a lower body lift. This is where we circumferentially remove the amount of excess tissue, both in the back, the lateral aspects, as well as the front. This will give you a lift to the buttock, which we can augment with your own tissue, a lift to the lateral thighs, as well as contour the abdomen in an abdominoplasty. This is obviously the most extensive surgery with the longest recovery and the highest out-of-pocket cost, but does usually end up with the best cosmetic result.