Dr Sally Ng offers a post-weight loss surgery

Post-weight loss surgery refers to a series of procedures performed after significant weight loss, typically following bariatric surgery or substantial weight loss through other means such as diet and exercise. These surgeries aim to address excess skin and soft tissue that arise due to significant weight loss. They can result in functional as well as aesthetic issues for the patient. 

Post-weight loss surgery generally encompasses removing excess skin and reshaping the body, it can be performed in isolation or as a combined procedure. This includes:

• Abdominoplasty: Removes excess skin and soft tissue from the abdomen, often Dr Sally will also repair any gaps between the rectus muscle in the same operation to reduce the central fullness. This may be supplemented by some additional liposuction to contour the flanks   
• Arm Lift (Brachioplasty): Removes excess skin under the inner arms to reduce the diameter of the arms and address the over hang when patients lift their arms up 
• Thigh Lift: Removes excess skin and soft tissue  from the inner thighs to improve contours and reduce the friction between the thighs 
• Breast Lift (mastopexy) or Reduction: Reshape and lift the breasts to address upper pole emptiness and bring the breast mound back to the original footprint above the inframammary fold. In general, Dr Sally prefers to reshape the breast without the use of implants. If additional volume is required, fat grafting is the preferred method. 

These surgeries are tailored to the individual’s specific needs and goals. They can improve both the aesthetics and functionality of the body, helping individuals to achieve a more proportionate and comfortable body shape after significant weight loss.

It’s important to note that post-weight loss surgeries are major procedures and involve certain risks, including potential complications and the need for proper post-operative care and adequate time to recover. Candidates considering these surgeries should consult with qualified plastic surgeons and thoroughly discuss the potential risks and benefits before making a decision. Dr Sally quite often requires  a number of long consultations to discuss their goals, priorities and set realistic expectations. 

Things to note

Collaborative Approach:

Dr Sally works very closely with medical and surgical colleagues who specialise  in bariatric surgery. Whether the weight loss is achieved purely through diet or exercise, or use of medications like ozempic or saxenda, or bariatric surgery such as gastric sleeve or bypass, it is important for Dr Sally to communicate with the patient’s GP, endocrinologist or bariatric surgeon to ensure that patients achieve their ideal goal weight, has remained in that goal weight for at least six months, and remains in a good nutritional status. It is not uncommon for patients who have a high BMI to have other medical conditions such as sleep apnoea, heart conditions, or diabetes, and it is important for Dr Sally to contact them and receive an update to ensure these conditions are fully optimised before any surgery. This collaborative approach with other specialists enhances the overall care and decision making process. 

BMI:

For patients who have not undergone bariatric surgery and have reached a stable weight through methods like medication, we often monitor the overall percentage of weight loss and changes in BMI. Sequentially tracking the BMI over various points of the intervention provides valuable insights into the effectiveness of the weight management approach. In many cases, the patient’s GP or endocrinologist may be involved in prescribing medications and overseeing their progress. To ensure a comprehensive understanding, it is crucial for Dr Sally to engage in conversations with the specialists or GPs involved in the patient’s care, confirming the stability of the weight and evaluating if the patient meets the criteria, including specific BMI figures, for consideration as suitable candidates for post-weight loss surgery.

Based on medical research and clinical experience, the higher the BMI, the higher the likelihood of post operative wound infection and complications. However, for some patients, the goal weight is still likely to be relatively high compared to others. As a general rule, a BMI of less than 30 is considered ideal and a BMI of between 30-40 considered to be at higher risk of postoperative complications. If BMI is above 40 and reaching a lower BMI seems unattainable, Dr Sally may still offer surgery but the focus shifts towards functional and symptom improvements which may help the patient to increase exercise capacity and contribute to further reduction in weight over time. 

When a patient reaches a stable BMI after conservative and surgical intervention, it is certainly an opportunity to engage in a conversation and assessment to discuss what can be offered to improve the patient’s quality of life. This discussion involves exploring whether the patient’s goals align with the potential outcomes of post-weight loss surgery and if they are ready to proceed to the next step in their weight management journey.

It is important to note that smoking significantly increases the risk of wound complications irrespective of BMI, and Dr Sally will require the patient to stop smoking at least 6 weeks prior to the surgery and abstain from smoking until all the wounds are fully healed.

Managing Expectations:

Visualising the potential outcome can be challenging. To aid in managing expectations, Dr Sally occasionally shares photos with patients during the consultation to provide a clearer understanding of the potential results. However, it is important to understand that each individual has a different distribution of skin excess and residual body mass, and clinical photos only provide a general guide and it certainly does not represent the final result for each patient. 

Multiple consultations before the final surgery, therefore, are crucial in addressing any concerns and ensuring that patients are well-informedRushing into surgery is actively discouraged, emphasising the importance of taking the time needed for thorough consideration and discussion. This approach ensures that patients have a realistic understanding of the potential outcomes and are fully prepared for the transformative process ahead.

Patient-Surgeon relationship:

Finding a surgeon with whom a patient  feels a strong connection is paramount, given the significance of the surgery. Plastic surgery is a principal based specialty, and it is not uncommon that each surgeon may offer a different opinion based on their experience and philosophies.  Patients should understand that seeking multiple opinions is entirely reasonable and not a betrayal. However, if you feel comfortable with Dr Sally’s explanation and approach, Dr Sally and her team will ensure your concerns are addressed and build a trusting relationship in this journey. 

Research, including online reviews, is valuable resources but it is important to ensure the information is unbiased and well presented. Dr Sally and her team will be happy to advise a number of online resources if you wish to read more about the support that patients can access.

Things to Consider Before Proceeding with Surgery

Before proceeding, one will have the chance to go through a thorough consultation with Dr Sally to understand your weight loss journey, your priorities, discuss surgical options, understand the procedure’s implications, and ensure you are fully informed about what to expect before, during, and after the surgery. When considering post-weight loss surgery, there are several crucial factors to take into account:

1. Health Status: Ensure that you are  in good overall health. Prioritise discussions with your GP and other healthcare providers to evaluate any underlying conditions that might affect surgery or recovery. In particular, it is important to ensure your blood count, iron, B12 and folate levels are within normal range as some of these micronutrients can be low after bariatric surgery.

2. Stable Weight:  It is recommended that you have reached a stable weight and maintain it for at least six months before considering post-weight loss surgery. This stability ensures better surgical outcomes. Often, when determining this stable weight or goal weight, specific guidance may be provided by your bariatric surgeon or endocrinologist. In terms of the BMI limit, for Dr Sally, it is more about the relative changes in the BMI rather than setting a specific numerical target. While a BMI of less than 30 is considered ideal, it may not always be achievable. If the patient’s BMI is above 30 at the time of body contouring surgery, it is important to recognise the higher surgical complication risk and Dr Sally will explain the steps involved to minimise complications. 

3. Realistic Expectations: Understanding what the surgery can and cannot achieve is critical. Have clear, realistic goals about the outcomes. When considering post-weight loss surgery, it’s essential to set realistic expectations, and for Dr Sally, it’s more about scars.

4. Scars: Discussing the placement and impact of scars is a crucial aspect of any  pre-surgery conversation. Dr Sally always emphasises to patients that if concerns about scars are significant, then this type of surgery might not be the right choice for them. It is essential to understand that resection surgery inevitably leaves scars. Whilst most of the scars from abdominoplasty and breast lift are generally well hidden, the scars from brachioplasty (arm) and thighplasty (thigh) can be more obvious depending on the choice of clothings.  In general scars take 6 to18 months to reduce in redness, and it is important to incorporate scar management routines in the day to day setting. Occasionally the scar can become thick and raised (hypertrophic or keloid scar), and it is important to understand the potential implications and treatment required. Liposuction alone is often not an appropriate treatment option in post weight loss surgery as it will simply create more redundant skin folds.

5. Recovery and Downtime: Post weight loss surgeries often require significant recovery periods. As a general rule, patients will require 4 to 6 weeks of activity modification and possible time off work depending on the nature of their job. In the first 4-6 weeks, most patients will need to avoid lifting and minimise driving. Dr Sally also advised against arranging the surgery just prior to travelling as Dr Sally will need to allow for adequate follow up appointments post surgery to ensure there are no complications.. 

6. Commitment to Lifestyle Changes: Maintain a healthy lifestyle post-surgery. Continuing healthy habits including diet and exercise is crucial to sustaining results and minimising weight fluctuations.

7. Emotional Readiness: Consider the emotional impact of these surgeries. Significant physical changes may also bring about emotional adjustments. Be prepared for the psychological aspects of the transformation.

Possible Risks and Considerations

Post-weight loss surgery, like any surgical procedure, carries certain risks.These risks vary depending on the specific type of post-weight loss surgery performed and individual health factors. It is  crucial to discuss these risks thoroughly with Dr Sally beforehand and ensure you understand the potential complications and how they might affect you personally. Dr Sally takes numerous precautions to minimise risks, but being aware and prepared is an essential part of the decision-making process. Some of these include:

• Infection: Surgery poses a risk of infection at the incision sites. Precautions such as antibiotics and appropriate dressing regime are taken to mitigate this risk.

• Bleeding: Excessive bleeding during or after surgery is a potential risk. Dr Sally takes precautions during the procedure. All the surgeries require at least overnight stay in the hospital in order to monitor for any postoperative bleeding. Occasionally post operative bleeding can occur after the patient is discharged from the hospital and if this occurs, patients are advised to contact the Dr Sally office immediately if it is during office hours or via the hospital switchboard if it is out of hours.

• Scarring: While efforts are made to minimise scarring, any surgical procedure can result in visible scars. Occasionally, the scars can overgrown and become hypertrophic or develop into a keloid scar. The extent of scarring can vary depending on individual healing processes.

• Anaesthesia Risks: Anesthesia carries its own set of risks, including allergic reactions, adverse effects, and in rare cases, more serious complications. The anaesthetist will discuss this with the patient thoroughly prior to the operation.

• Fluid Accumulation: Fluid buildup (seroma) under the skin might occur, requiring drainage. Compression garments are often used post-surgery to reduce this risk of seroma development

• Blood Clots: Prolonged surgery and reduced mobility increase the risk of developing blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism). Dr Sally took precautions to minimise this risk by giving blood thinner injection in the early postoperative period and encouraged early mobilisation post-surgery.

• Poor Wound Healing: In some cases, wounds might heal poorly, leading to delayed healing, increased scarring, or wound complications.

• Numbness or Sensation Changes: Temporary or permanent changes in sensation, including numbness or altered sensitivity, will  occur in areas where the surgery was performed.

• Skin Contour Irregularities: Despite efforts to create smooth contours, irregularities in skin texture or contour might occur.

• Revision Surgery: Sometimes, additional surgeries might be needed to address unexpected outcomes or to fine-tune the results, increasing the overall risk associated with multiple procedures.