Skin Reduction surgery is an essential and final component in the journey embarked upon by patients having post bariatric surgery. As Orange County post bariatric surgery patients lose their unwanted weight, they will universally observe decrease in total body fat but only minimal resolution of their unwanted, redundant skin. Skin redundancy can be minimal, moderate, or severe as observed by development of multiple skin rolls and/or rashes. Skin redundancy can be observed over the face and neck, arms, breasts, armpits, upper back (under the bra region), abdomen, lower back (above the buttocks), pubic region, lateral (outer) thighs, and medial (inner) thighs. Any of the above skin redundancies result in sagging of the breasts, buttocks, thighs, and genitalia. Over a one to two year period, weight loss over 100 pounds is routine for post bariatric patients who attend regular counseling and maintain a healthy lifestyle. Unfortunately accumulation of redundant skin eventually becomes an obstacle to physical activity and a burden psychologically. Patients who see Newport Beach, Los Angeles, Orange County based Plastic Surgeon Dr. Mowlavi in consultation for a post bariatric surgery, often complain that despite having been dedicated to losing incredible amounts of weight, they continue to carry large amounts of skin that precludes them from exercise, outdoor activities, and fitting into smaller sized clothes.

Over the last 10 years, Dr. Mowlavi has created a Total Body Lift procedure that is capable of removing all of your unwanted skin redundancies in a single operative session. Development of the Total Body Lift was prompted by patients that successfully tolerated a single or combination procedure and were found to still be dejected by other problem areas. Having to perform additional surgeries or serial surgeries resulted social and financial difficulties resulting in multiple recovery periods and loss of work time. After significant preparation and planning, we now have the ability to provide and complete a comprehensive surgical plan and design that allows our post bariatric patients to have all of their skin redundancies to be addressed in a single session. Total body lift ensures your safety and full body transformation and a tolerable recovery. Total body lift procedures that can be combined include:

  1. Extended tummy tuck with pubic region tuck
  2. Brachioplasty
  3. Breast lift with or without an implant
  4. Upper body lift
  5. Lower body lift with lateral thigh tuck
  6. Medial thigh tuck
  7. Fat grafting to the buttocks
  8. Face and neck lift

During your initial consultation with Dr. Mowlavi, you will prioritize all of our problem spots so that a comprehensive, customized surgical plan will ensure a complete body transformation. All surgeries are performed in under 7 hours to minimize anesthesia risks. Dr. Mowlavi has trained a team of professionals who have been working with him for years in order to ensure completion of above surgeries in a single session. Recovery from a Total Body Lift is made tolerable by using a specialized numbing medication that is placed into microspheres prior to injection so that you get 4 days of pain relief as the medication is slow released for several days. This has made recovery seemless and very tolerable. Lastly, by combining all of your surgeries into a single session, Dr. Mowlavi is able to save you nearly 50% on your surgical fees. In order to appreciate what Dr. Mowlavi’s total body lift transformation can do for you, please contact our office at (949) 499-4147 for a complimentary consultation.

Procedure: Elimination of redundant skin that may have accumulated over the abdomen, flanks, back, buttocks, breasts, arm pits, upper arms, inner thighs, and outer thighs.
Length: Approximately 2 hours per area (depends on extent of skin redundancy); may combine treatment of all areas as long as total operative time does not exceed 7 to 8 hours.
Anesthesia: General anesthesia.
Place of Treatment: Outpatient surgical suite or hospital operating room.
Side Effects: 1) Due to extent of redundant skin excised, patients may experience increased tightness surrounding skin incisions and should expect a longer period for incision redness to dissipate (on average 6 months). Despite attempts to remove all redundant skin, patients may develop recurrent skin laxity following surgery, described as “Recurrent skin laxity Syndrome.” This return of laxity is due to the loss of skin elasticity, a direct result of prolonged skin stretching throughout the years of obesity. Differences in laxity in local regions of the body may be responsible for slight asymmetry that develops following surgery. This phenomenon is responsible for more frequent revision surgeries although Dr. Mowlavi modifies previously described procedures to ensure minimizing risk of recurrent laxity

2) Prolonged swelling up to 3 months is not uncommon due to poor lymphatic drainage following extreme weight gain and loss. Lymphatic drainage is further compounded by extended surgical incisions required to remove the redundant skin. Lymphatic drainage is promoted by mechanical message, customized compression garments, and external ultrasound treatments when necessary.

Risks: 1) Deep vein thrombosis (DVT) may occur in the legs immediately following surgery. DVT refers to the clotting off of leg veins which may result in compromised blood flow return from the legs; a more critical consequence may develop from this clot if it is dislodged and travels to the lungs causing a pulmonary emboli. Although rare, pulmonary emboli are the leading cause of death following surgery. Several precautions are taken intraoperatively to avoid this complication

2) Wound breakdown is more common in these patients secondary to several metabolic and physiologic disorders. Diabetes and nutritional deficiencies are largely to blame for the difficult healing of these patients. Dr. Mowlavi will optimize your metabolic factors long before surgery to ensure healing of incision lines.

3) Seroma formation refers to the accumulation of plasma fluid in pockets created by surgical elevation of the soft tissue. This fluid accumulates due to a low blood count and protein deficiency both of which are often present in post bariatric patients. This fluid can be a nuisance to patients requiring several aspirations in the office prior to their resolution. More importantly, these plasma fluid pockets may harbor bacterial growth and result in a clinical infection.

4) Local skin infection is not uncommon in a patient who has diabetes, iron deficiency anemia (low blood count), and protein deficiency. 5) Pressure sores may develop in patients following prolonged surgical cases due to the increased weight of the patients on an operating room table. Fortunately, pressure sores rarely develop due to the precautions that are taken by the operating room staff to properly cushion all bony prominences.

6) Post bariatric patients are more susceptible to hypothermia (loss of body temperature) due to their larger body surface area to body volume ratio. Hypothermia may lead to arrhythmias and blood clotting difficulties in the operating room. Fortunately, patients’ body temperatures rarely fall due to the precautions taken in the operating room which include: heating of the room, heating of the intravenous fluids, and using special heating blankets.

Recovery: The recovery for skin reduction surgeries may be variable requiring as little as 2 weeks for upper arm reduction surgery to as long as 4 weeks for the Total Body Lift.
Duration of Results: Patients are extremely pleased with skin reduction surgeries which provide the final step towards reaching dreams of physical and mental confidence. Patients can expect the cosmetic results to last a lifetime as long as they avoid weight gain.

What does Total Body Lift surgery involve?

Several previously utilized surgical procedures have been tailored to address the severity of redundant skin that is observed in post bariatric patients. Total body lift refers to combining the most common surgeries offered today in a single session and include:

All of the post bariatric surgeries available have been modified specifically by adjusting surgical incision lines to compensate for the severity of skin redundancy. The tummy tuck incision is started lower on the mons pubis in order to provide a lift of this area since it is often sagging and the lateral incisions lines are extended beyond the anterior axillary line(most lateral abdmonimal area) in order to eliminate lateral skin folds(dog ears). The belt lipectomy incision line, is in essence a circumferential tummy tuck incision, and must be placed appropriately in order to allow for an aesthetically pleasing vertical ratio of buttock to lower back length. The inner thigh lift incision which has been traditionally placed horizontally in the groin has been reoriented in the vertical axis in order to account for the severity of the skin redundancy and to avoid distorting the genital area due to the abundant weight of the hanging tissue. The traditional brachioplasty (upper arm tuck) incision is extended onto the posterior axillary fold (upper lateral back region) depending on the sagging of this region (referred to as bat wings) and to effectively treat a sagging lateral inframammary crease (fold under the breast). Similarly, the traditional breast lift incisions have been modified to address an overly sagging breast contour as well as a distorted lateral inframammary crease (fold under the breast). Given the complexity of surgical incision line placement, we recommend surgical measuring and marking of lines to be performed the day prior to surgery.

Am I a good Candidate for Total Body Lift surgery?

Morbid obesity is an epidemic in the United States affecting nearly 9 million Americans. Approximately 100,000 patients undergo bariatric surgery each year under the supervision of a multidisciplinary team. Over the course of a year or more, compliant patients achieve their weight loss goals and seek plastic surgeons to remove the ensuing redundant skin. Several surgical procedures have been modified to specifically address the severity of remaining skin observed in post bariatric patients. These include: abdominoplasty (tummy tuck), lower body lift/belt lipectomy (circumferential body lift), mastopexy (breast lift) with or without implants, inner thigh lift(medial thigh tuck), and brachioplasty (arm lift). You may be a candidate for one or all of these surgeries depending on which regions of your body demonstrate redundant skin and this will be determined on your initial consultation with Dr. Mowlavi.

How do I plan my Total Body Lift surgery?

On your initial visit, Dr. Mowalvi will evaluate your health status, determine the amount of skin redundancy, and check your blood work. Expect to have iron and Vitamin B12/Folate deficiencies. The iron deficiency will result in a low blood count, which must be corrected before surgery. The correction of the low blood count will take at least 1 month and require taking daily iron pills. If you are a smoker, then you should quit for 1 month prior to post bariatric surgery in order to allow your body adequate time to rid itself of any residual nicotine. Nicotine in your system results in shutting off of small blood vessels which carry nutrients to the skin; this event could be catastrophic in post bariatric surgeries resulting in extensive wounds requiring months to heal.

How do I prepare for Total Body lift surgery?

Since your surgery will require general anesthesia, you must take several precautions prior to surgery. First, you will have to avoid eating and drinking after midnight on the day before surgery. This precaution ensures that your stomach is clear of digested foods that could potentially be aspirated and contaminate your lungs during induction of anesthesia. Since, you will have anesthetic medications administered throughout the case, you will remain groggy for some time and will require a ride to and from the surgery center if you elect not to commit to an overnight stay on the premises. You should choose a caretaker who is conscientious and who can spend the first several nights with you.

What results can I expect after Total Body Lift surgery?

Over all, post bariatric patients should be commended for their due diligence to lose their excess weight. By providing these patients a final skin reduction procedure, we are able to finally attain for them the desired outcome of all their efforts. Patients are extremely satisfied with their surgery and their new physical autonomy. By providing a thorough preoperative workup, safe intraoperative course, and frequent postoperative visits, patients should expect a speedy recovery and return to a more aesthetically pleasing physique and more productive lifestyle. Patients are extremely pleased with skin reduction surgeries which provide the final step towards reaching dreams of physical and mental confidence.

Where will my post bariatric surgery be performed?

Since your surgery will require general anesthesia, it must be performed in an operating room that is part of a hospital institution or outpatient surgery center.

What type of anesthesia will be used for my Total Body Lift surgery?

Since your surgery requires removal of large amounts of skin, it will require general anesthesia. This is because skin possesses a large number of sensory nerves (pain fibers) that would be triggered during cutting of the redundant skin; general anesthesia ensures that these pain fibers are shut down during the operation.

What should I expect after Total Body Lift surgery?

You should expect to feel sore throughout the early postoperative period. The soreness is minimized by use of long acting numbing medication that is placed into slow release microspheres and injected in areas of sensory nerve fibers. Soreness is also minimized by continuous wearing of the customized compression garments. In general, the compression garments should be worn for at least 4 weeks in order to prevent development of any contour abnormalities. Surgical incision lines are sealed for 2 to 4 weeks with external glue and tape, called Steri-strips, thus minimizing risk of bacterial infections. In addition, exercise should be limited for the first 4 weeks until the incision lines have completely healed. Pre-existing conditions such as diabetes, sleep apnea, anemia, and morbid obesity (basal metabolic index of greater than 35) place patients at risk postoperatively for fluid collection (seroma formation), prolonged swelling (poor lymphatic drainage), wound problems, and infection. Fluid collection (seroma formation) is the most common complication and usually located in the posterior hip area. Seroma risk is minimized by preserving fat on the muscle, placing superficial to deep stitches underlying the skin, instilling fibrin glue prior in all surgically created pockets, maintaining output drains (JP drains) for an extended period (as long as 3 weeks) and infusing antibiotics (Doxycycline 100mg in 10cc of saline) through the JP drains twice weekly. Lymphatic drainage compromise is most common over the mons pubis area as well as in the limbs. Lymphatic drainage is promoted by performing mechanical massage, customized compression wraps, and external ultrasound treatments when necessary.

When will I be able to return to work following Total Body Lift surgery?

Patients can expect to return to work within 1 week to 4 weeks. The broad range for postoperative recovery durations is due to the variable extent of redundant skin reduction and dependent on how many areas you are going to correct. Patients are advised to gauge their return to work by their overall soreness which dictates the tasks which they may perform.

Are there any side effects associated with Total Body Lift surgery?

Due to extent of redundant skin excised, patients may experience increased tightness surrounding skin incisions and should expect a longer period for incision redness to dissipate (on average 6 months). Despite attempts to remove all redundant skin, patients may develop recurrent skin laxity following surgery, described as “Recurrent skin laxity Syndrome.” This return of laxity is due to the loss of skin elasticity, a direct result of prolonged skin stretching throughout the years of obesity. Differences in laxity in local regions of the body may be responsible for slight asymmetry that develops following surgery. This phenomenon is responsible for more frequent revision surgeries. Prolonged swelling up to 3 months is not uncommon due to poor lymphatic drainage following extreme weight gain and loss. Lymphatic drainage is further compounded by extended surgical incisions required to remove the redundant skin.

Are there any risks associated with Total Body Lift surgery?

Surgical treatment of post bariatric patients requires specific precautions not only because patients are often compromised physiologically but also because the surgeries can be quite extensive. Patient safety is the most critical consideration when managing these patients whose hemodynamics and ionic balances have been altered. Surgery should be limited to 7 hours and patients should be offered an overnight stay with a nurse. This surgical time limit, necessitates the patient prioritizing the areas they would like to treat first and to develop a multi-staged surgical plan. Patients are encouraged early ambulation in order to minimize the risk of developing vein clots which can then embolize (travel) to vital organs. Intraoperatively, patients are also provided safe guards against vein clots with pneumatic compression garments and anti-thrombotic medication through the veins. Another consideration involves correcting ionic imbalances resulting in iron deficiency anemia and B12/Folate deficiencies. Early blood work evaluation allows the surgeon to correct all abnormal parameters in preparation for surgery. Other intraoperative measures include safe guarding against pressure sores with generous cushioning of the axilla (arm pits), knees, heels, pelvis, and elbows. Finally, since patients have a larger ratio of surface area to volume they are at risk for hypothermia (cooling of core body temperature) and should be provided a warm room and warm fluids by vein. Surgical incision lines may present healing difficulties. Wound breakdown is more common in these patients secondary to several metabolic and physiologic disorders. Diabetes and nutritional deficiencies are largely to blame for the difficult healing of these patients. Seroma formation refers to the accumulation of plasma fluid in pockets created by surgical elevation of the soft tissue. This fluid accumulates due to a low blood count and protein deficiency both of which are often present in post bariatric patients. This fluid can be a nuisance to patients requiring several aspirations in the office prior to their resolution. More importantly, these plasma fluid pockets may harbor bacterial growth and result in a clinical infection. Local skin infection is not uncommon in a patient who has diabetes, iron deficiency anemia (low blood count), and protein deficiency.

When can a Total Body Lift be performed?

Patients undergoing bariatric surgery will have to attain their ideal or near ideal weight and demonstrate a stable weight for at least 6 months prior to being considered for post bariatric surgery.

Does everybody undergoing gastric bypass need to undergo skin reduction surgery?

Patients who lose extensive weight will notice deflation of their skin due to the loss of fat cell volume. The redundant skin can be quite extensive and may be aesthetically unsightly and even physically prohibitve. This redundant skin may have the capacity to resorb itself if it still maintains a “recoil” protein called elastin. Unfortunately, after the age of 40 years of age, the elastin protein is lost from the skin resulting in non-elastic and non-resorbable skin. For those under 40 years of age and those who are patient, the redundant skin will tighten back down over several year period. For those patients older than 40 years of age, skin reduction surgery is the only option for eliminating the unsightly redundant skin. To compound this, severe stretching out of skin may result in destruction of the elastin protein regardless of age. If you are struggling with redundant skin, then a total body lift will be able to definitively and permanently eliminate all skin redundancies.

Do patients need to be monitored by a nurse overnight following a Total Body Lift?

Patients undergoing total body lift are evaluated much in the same manner as other surgical patients. If patients have medical illnesses other than the redundant skin they are trying to eliminate, then they will require an overnight stay at one of the local overnight stay houses near our office. In addition to identified medical illness, patients are evaluated with respect to their body mass index. The body mass index (BMI) is a parameter that measures the degree that you are overweight. When the BMI is greater than 30 and even despite having lost a 100 to 200 pounds, the patient is considered a high risk candidate and recommended to spend the night with one of our registered nurses. Until recently, most total body lift patients were recommended an overnight nurse or a night at a stay center. However, the recent introduction of Exparel, a long acting medication that is placed into microspheres, has provided our total body lift patients a tolerable recovery with minimal discomfort over the first 4 days; as a results many are choosing to forego a stay care center.

Does the skin redundancy come back after a Total Body Lift??

The redundant skin will not return unless the patient relapses from his/her bariatric surgery and regains the extra weight and then loses the weight again. There is an early postoperative side effect called “Recurrent skin laxity syndrome” which is associated with early return of apparent skin redundancy which appears within 1 month of surgery. This complication is related to the fact that post bariatric patients in contrast to routine cosmetic patients desiring skin reduction, have lost the elasticity component of their skin; as a result total body lift patients undergo a more aggressive excision of redundant skin to counter this recoil effect. For example during tummy tuck surgery, the routine cosmetic patient is flexed to approximately 20 to 25 degrees when trying to trim out the extra skin whereas the typical total body lift patient is flexed between 35 to 45 degrees in order to trim out even more redundant skin.

Is there a limit to the number of areas that can be treated with Total Body Lift??

For patients undergoing total body lift, there is a safety time limit of 7 to 8 hours duration within which surgeries should be completed. As such, it is important to prioritize the regions such that problem areas may be treated in an optimal and expedited manner without going over the safe time allotted parameters. Most patients are able to combine multiple if not all of their problem spots during a single session surgery.

How our patients feel about us:

Made me feel comfortable from the very beginning... Dr. Mowlavi and his entire staff are the best. My reconstruction surgery was a year long journey and I could not be happier with the results. Dr Mowlavi is a compassionate and caring surgeon. He and his staff have become like an extension of our family. I had a bilateral mastectomy with reconstruction in a single surgery. Dr Mowlavi answered all my questions and made me feel comfortable from the very beginning.

Anonymous Laguna Beach, CA

The procedure brought back years of confidence in myself... From the moment I stepped into the office I was pleasantly surprised by the friendly disposition of all the staff... After the procedure I was floored! I was surprised that such a great result could be achieved without the use of an implant which I did not want to get. As I admired myself in the mirror 2 weeks post op, Dr. Mowlavi smiled and said modestly, "Its all you!" I nearly cried as I had not perceived of my natural body looking truly beautiful in over 20 years. This procedure brought back years of confidence in myself that I had lost 90 lbs, 20 years and 2 children ago. For anyone considering plastic surgery but has fears and feelings such as I did you owe it to yourself to consult with Dr. Mowlavi and his staff. They are truly the best at what they do.

Lorene B.

Dr. Mowlavi is the best choice in Orange County... My highest recommendations go out to Dr Mowlavi for the skilled and fantastic work he performed on me... Being post bariatric surgery and not being the easiest of cases, Dr Mowlavi made sure we addressed the areas that I would gain the best results, made me fully aware of what to expect from the surgery, recovery and results. From my consultation to my post-surgical appointments... the entire Mowlavi staff treated me with special care, always making me feel like I was family, greeting me with hugs, smiles and ensuring I am doing well from the many follow up calls to all of the post-operative visits. I can not say enough to express how thankful I am to Dr. Mowlavi and his staff, and to let people know that if you are post cancer, bariatric or just need to have work performed to improve your appearance and quality of life, Cosmetic Plastic Surgery Institute with Dr. Mowlavi is the best choice in Orange County. You are all the BEST!

Jenifer D. Irvine, CA

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