Weight loss is a process that can prove long and arduous for many people. Patients with morbid obesity sometimes choose bariatric surgery to rapidly put an end to significant excess weight. While this drastic treatment dramatically reduces the number on the scale, it is very often accompanied by insufficient skin retraction, leaving localised excess skin. Post-obesity surgery is then often necessary to achieve a uniform body contour and finally regain self-confidence.

Skin sequelae after major weight loss

While weight loss (whether following a diet or bariatric surgery) helps slim the body contour, regain mobility and overcome certain insecurities, it is generally accompanied by skin sequelae, in particular:

excess skin resulting from expansion during weight gain;
significant skin laxity and a loss of elasticity, the skin being unable to retract after being stretched. This phenomenon can appear notably at the abdomen (creating an abdominal apron), at the thighs (the appearance of skin folds) or as sagging arms (bat wings);
a lack of skin tone (loose, damaged skin);
sagging of the chest (drooping, deflated breasts, breast ptosis);
difficulty getting dressed due to the unevenness of the body areas caused by localised excess skin;
irritation caused by the friction of skin folds (intertrigo) and even infections following repeated rubbing combined with moisture.

Generally speaking, major slimming can cause overall skin ptosis that creates new insecurities, particularly at the beach, at the gym or in intimate situations. Plastic surgery after weight loss (post-bariatric or bariplastic surgery) is then a solution to finally restore a harmonious, even body contour. It is the finishing touch that brings out the full value of all the efforts made to get back in shape.

Sleeve, bypass, gastric band: what impact on the skin?

Bariatric surgery has considerably revolutionised weight loss. It has come to complement all the procedures used until then to treat morbid obesity (calorie deficit, dietetics, physical exercise). In particular, it has made it possible to achieve spectacular results through various slimming techniques:

sleeve gastrectomy, which involves removing two-thirds of the stomach, including the area that secretes the hormone responsible for the sensation of hunger (ghrelin);
a gastric bypass, creating a shortcut around part of the intestine and stomach in order to limit the capacity to ingest and absorb food;
a gastric band placed around the upper part of the stomach (via laparoscopy) in order to create a pouch that restricts the passage of food through the digestive tract.

Whatever slimming technique is used, it causes very rapid fat loss (spectacular with the bypass, more gradual with the gastric band), with several dozen kilos lost in a few months — a pace that is often too fast for the skin’s capacity to retract. This fat loss then frees up space onto which the stretched skin settles under the weight of gravity. It thus leads to differences in skin firmness and in tissue proportions between the various areas of the body.

Bariatric surgery also results in a reduction in the quantities of food ingested and therefore in potential deficiencies in proteins and vitamins, as well as difficulties absorbing nutrients (malabsorption). All of these factors can weaken the tissue quality of the skin and make healing more delicate. This is why the support of a nutritionist is essential when considering surgery after weight loss.

Post-bariatric surgery procedures available in Paris

Paris and the Île-de-France region are home to many recognised specialists in post-bariatric surgery, most of whom are members of the SOFCPRE (French Society of Plastic, Reconstructive and Aesthetic Surgery) and/or the SOFCEP (French Society of Aesthetic Plastic Surgeons). Among them, the Rive Droite Paris Étoile practice, located near the Arc de Triomphe, offers premium procedures with harmonious, natural results that overcome the skin sequelae resulting from rapid weight loss.

Various post-obesity surgery procedures can be performed by Dr Hunsinger and Dr Henri Derhy, the specialist surgeons of the CERDPE practice operating in the 17th arrondissement of Paris, namely:

abdominoplasty (or tummy tuck) to remove excess skin at the abdomen and re-tighten the abdominal wall. The abdominoplasty can also be combined with a repair of abdominal diastasis recti in order to bring the rectus abdominis muscles back together and overcome the « round belly » effect;
the lower bodylift (or body lift) to reshape the abdominal belt and redefine the lower part of the body contour. It generally combines the abdominoplasty with liposuction of the buttocks, hips or thighs;
the upper bodylift to treat the skin and fat excess on the lateral part of the chest (armpits, back);
brachioplasty (arm lift) to treat skin laxity of the upper limbs, slim the arms and re-tighten their inner surface;
cruroplasty (thigh lift) to treat skin laxity and remove excess fat from the thighs through lipoaspiration. This procedure can be extended to the knees, the hips and even the banana roll beneath the buttocks;
breast surgery, which mainly takes the form of a breast lift (ptosis correction) in order to raise drooping breasts. Depending on the case, a breast augmentation (with implants or with fat transfer) can be combined for a deflated chest. In rarer cases, a breast reduction treats breast hypertrophy, that is, a chest disproportionate to the new body contour. For men, an adipo-gynecomastia procedure is often performed to remove chest swelling and make way for more prominent, more masculine pectorals;
facial surgery can also be performed when weight loss has emaciated the patient’s face (skin laxity of the cheekbones, the presence of jowls). It generally takes the form of a facelift and neck lift, although aesthetic medicine procedures are increasingly common for restoring volume (hyaluronic acid injections or other fillers in particular).

Abdominoplasty or bodylift: what’s the difference?

While the abdominoplasty and the bodylift each aim to treat skin laxity at the abdomen and trunk, they differ in their treatment areas and the scope of the procedure:

the abdominoplasty focuses solely on the front of the belly, removing the excess skin located at the abdomen. It therefore aims to eliminate the abdominal apron that has formed following weight loss at the pubis (a pubic (mons pubis) liposuction can moreover be complementary). It also aims to re-tighten the abdominal muscles with, when necessary, a repair of rectus abdominis diastasis. The procedure ends with a repositioning of the navel for aesthetic purposes via an umbilicoplasty;
the bodylift, also called circumferential trunk surgery or dermolipectomy, is a far more comprehensive procedure. It acts on the entire circumference of the trunk, unlike the abdominoplasty, whose scope is limited to the front of the abdomen. The bodylift is generally the essential procedure in post-bariatric surgery, since it delivers 360° results all around the abdominal belt (belly, flanks, hips, back, buttocks). The surgeon removes a circular band of skin to carry out a resection of the tissue all around the waist, then a re-draping of the remaining skin for an even re-tightening across the whole body contour (abdomen, pubis, lower back, treatment of the saddlebags and drooping buttocks in particular).

How to choose between an abdominoplasty and a bodylift?

The bodylift is a major procedure, but one whose results can be spectacular despite a longer recovery. It is recommended in cases of marked circumferential laxity, whereas the abdominoplasty is sufficient when the laxity is mainly abdominal.

Arm lift, thigh lift and breast lift: which area to treat first?

The order in which to treat the sequelae of bariatric surgery depends on each patient’s physical specifics and degree of discomfort, as everyone may feel self-conscious about one part of their body or another. In general, however, specialist surgeons recommend prioritising the procedures as follows:

As a priority, it is often relevant to treat the area that bothers the patient the most, regardless of theoretical recommendations. This approach centred on how the patient feels quickly improves quality of life, both functionally and psychologically, while respecting the patient’s expectations and personal priorities;
Next, prioritise treating skin laxity of the belly, through an abdominoplasty or a bodylift (lower and/or upper). This is indeed the most visible part of the body, one that clothing cannot always conceal. These major procedures produce the most spectacular results, quickly overcoming the physical and psychological discomfort linked to excess skin on the abdomen;
In a second stage, chest surgery can be considered, notably to raise drooping breasts in women (breast lift or mastopexy), or to correct a pre-existing chest in men (gynecomastia) highlighted by the weight loss. Breast surgery can sometimes be performed at the same time as the abdominoplasty or take place a few months later;
Finally, the arm lift and the thigh lift are comfort procedures, generally less of a priority because their skin sequelae are less disabling day to day. They can, however, be considered to refine the contour or the body shape and regain self-confidence, particularly at the beach or in intimate situations.

Not all of these procedures are necessarily required, and only the most damaged areas should be treated first. In any case, it is recommended to space the procedures at least 3 months apart (or rather 6 months) to limit blood loss, ensure optimal healing and avoid any tension on the treated areas.

When can surgery be performed after bariatric surgery?

Post-obesity surgery procedures require a certain protocol to be followed in order to avoid the risk of complications and optimise the aesthetic results. The Haute Autorité de Santé (HAS) and the National Union of Plastic, Reconstructive and Aesthetic Surgery (SNCPRE) broadly agree in their recommendations on the following key principles:

a sufficiently long delay after bariatric surgery (at least 12 to 18 months after a bypass or a sleeve);
maintaining a stable weight for a period of at least 6 months (weight stability). A BMI below 30 is generally required to consider the procedure;
regular nutritional follow-up to avoid healing problems: blood tests should be carried out to detect and remedy any deficiencies;
stopping smoking 2 months before the procedure and aspirin in the 10 days preceding it;
the absence of medical contraindications such as diabetes or coagulation disorders.

Insurance coverage in France: what is reimbursable

Most post-bariatric surgery procedures can give rise to at least partial insurance coverage by the French national health insurance. They are indeed considered reconstructive procedures that overcome disabling conditions. They must, however, meet the criteria for coverage set by the CPAM (the primary health insurance fund):

follow a very significant weight loss;
a stabilisation of weight for at least 6 months;
the presence of a disabling physical discomfort day to day (abdominal apron, irritation, friction, difficulty walking, for example);
the observance of a certain delay after the bariatric surgery procedure (at least 1 year).

The practitioner must submit a prior agreement request to the CPAM so that, in particular, the national health insurance’s medical adviser can assess the extent of the functional discomfort.

The procedures generally eligible are the following:

abdominoplasty;
bodylift;
cruroplasty (rarer);
brachioplasty (rarer).

Procedures on the chest (gynecomastia, breast lift) and facial surgery, on the other hand, are most often considered purely aesthetic. They therefore do not qualify for insurance coverage.

FAQ

How long is the recovery after post-bariatric surgery?
The length of recovery varies depending on the procedure performed and the extent of the area to be treated. It is generally 2 to 4 weeks, the bodylift being usually the most major procedure.

What is the post-operative recovery like after post-obesity surgery?
Depending on the procedure, it can take the form of swelling (edema), bruising, pain of variable intensity or a certain degree of fatigue.

What are the post-operative recommendations?
Plastic surgery procedures after weight loss generally involve wearing a compression garment (girdle or panty) in order to limit swelling and improve healing, the application of ointment to reduce inflammation, and lymphatic drainage. Post-operative consultations at progressively wider intervals must also be observed (1 week, 1 month, 3 months, 6 months, 1 year, etc.).

Is the result of post-bariatric surgery stable over time?
Yes, provided you maintain a healthy lifestyle and a balanced diet. Too large a change in weight is indeed likely to stretch the remaining tissue again, and may even compromise healing if it occurs in the first few months.

Can several procedures be performed at the same time?
Yes, possibly, depending on the scope of the procedures. It is, however, generally advised to leave several months between each operation. Talk to your surgeon to establish a realistic, safe treatment plan that meets your expectations.

Plastic surgery after weight loss: how to restore your body contour

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