When you lose a lot of weight, such as 100 pounds or more, your skin may not be elastic enough to shrink back to its natural shape. This can cause the skin to sag and hang, especially around the upper face, arms, stomach, breasts, and buttocks. Some people don't like the way this skin looks. In some cases, extra or hanging skin can cause rashes or sores. It may make it hard to get dressed or do some activities. One way to fix this problem is to have plastic surgery to remove the excess skin.

Body-contouring surgery; Contouring surgery; Body lift; Belt lipectomy; Panniculectomy; Brachioplasty

Plastic surgery to remove extra skin is not right for everyone. You will need to meet with a plastic surgeon to see if you're a good candidate. Your surgeon will talk with you to make sure you're ready for this type of surgery. Some things to think about before having this surgery include:

• Your weight. If you are still losing weight, your skin may sag more after the surgery. If you gain the weight back, you could stress the skin where you had the surgery, and compromise the result. Your surgeon will talk with you about how long after losing weight you should wait before having surgery. In general, your weight should have been stable for at least a year or longer.
• Your overall health. As with any surgery, plastic surgery has risks. If you have a health condition, such as heart disease or diabetes, you may have a higher risk for problems after the surgery. Talk with your surgeon about whether you are healthy enough for surgery.
• Your smoking history. Smoking increases your risk of problems during and after surgery and can make you heal more slowly. Your surgeon will likely suggest you quit smoking before having this surgery. Your surgeon may not operate on you if you continue to smoke.
• Your expectations. Try to be realistic about how you will look after surgery. It can improve your shape, but it won't get your body back to how it looked before your weight gain. Skin naturally sags with age and this surgery will not stop that. You may also have some scarring from the surgery.

In general, the benefits of this surgery are mostly psychological. You may feel better about yourself and have more confidence if you like the way your body looks. In some cases, removing extra skin may also reduce your risk for rashes and infection.

As with any surgery, there are risks with plastic surgery after weight loss. There is also a chance you may not be happy with the results of the surgery.

Your surgeon will review the full list of risks with you. These include:

• Scarring
• Bleeding
• Infection
• Loose skin
• Poor wound healing
• Blood clots
• Fluid collections that may require drainage

Plastic surgery after weight loss can be done on many different areas of the body. Depending on what areas you want to treat, you may need several surgeries. Common areas include:

• Abdomen
• Thighs
• Arms
• Breasts
• Face and neck
• Buttocks and upper thighs

Your surgeon will talk with you about what areas are best for you to treat.

Many insurance plans do not pay for plastic surgery after weight loss. They also may not cover any treatment you need if you have a problem with the surgery. Make sure to check with your insurance company before the surgery to find out about your benefits.

The cost of plastic surgery after weight loss can vary depending on what you have done, your surgeon's experience, and the area where you live.

You should notice results from the surgery soon after it's done. It takes about three months for swelling to go down and wounds to heal. It can take up to two years to see the final results of the surgery and for scars to fade. Although everyone's results are different, you will get the most from your surgery if you maintain a healthy weight and get regular exercise.

Contact your surgeon right away if you have any of these symptoms after surgery:

• Shortness of breath
• Chest pains
• Unusual heartbeat
• Fever
• Signs of infection such as swelling, pain, redness, and thick or bad-smelling discharge at the incision site

Also contact your surgeon if you have any other questions.

Nahabedian MY. Panniculectomy and abdominal wall reconstruction. In: Rosen MJ, ed. Atlas of Abdominal Wall Reconstruction. 2nd ed. Philadelphia, PA: Elsevier; 2017:chap 13.

Neligan PC, Buck DW. Body contouring. In: Neligan PC, Buck DW eds. Core Procedures in Plastic Surgery. 2nd ed. Philadelphia, PA: Elsevier; 2020:chap 7.