Body Contouring

DRAMATIC WEIGHT LOSS, WHETHER ACHIEVED BY PROPER NUTRITION AND EXERCISERS THE RESULT OF BARIATRIC SURGERY, OR FROM OTHER FORMS OF MEDICAL TREATMENT, HAS MANY BENEFITS. However, once you reach your weight loss goals, you may find that you still dont have the fit and healthy body image you desire. Skin may be loose, sagging and in many cases, your body contours may appear irregular and disharmonious.
If you have undergone dramatic weight loss that has resulted in excess sagging skin, surgical body contouring may be right for you. In general, body contouring following major weight loss reduces excess fat and skin that has developed in multiple areas of the body. The result of surgery is a smoother, more attractive body contour. Body contouring after major weight loss is an important and rewarding phase of your challenge to have a healthier, more proportionate body, and can help you further enhance your body image and self-confidence.
This brochure presents an overview of body contouring procedures following major weight loss. The best way to learn how body contouring following major weight loss can help fulfill your personal goals is a consultation with a plastic surgeon.

Before the operation make sure that:

• Your surgeon is a licensed physician to practice medicine in the country you are having the procedure
• Your surgeon has completed extensive training and examinations in plastic surgery
• Your surgeon is a member of a national plastic surgery society that is recognized by the International Confederation of Plastic, Reconstructive and Aesthetic Surgery (IPRAS)

What is body contouring following major weight loss?

The condition of being significantly overweight can cause stress on your health in many ways. If your physical activity has been limited due to your overweight condition, you may have weak muscle and skin tone, and your skin may be severely stretched.
Bariatric surgery, sometimes called gastric bypass surgery, is one method of major weight loss for individuals clinically defined as obese. Following weight reduction surgery, or any substantial amount of weight loss, the skin and tissues often lack elasticity and cannot conform to the reduced body size. As a result, skin that has been severely stretched now is unsupported, and begins to sag in pockets that most commonly develop around the

• Face, neck and jowls, resulting in a droopy, sad appearance
• Upper arms, resulting in a bat-wing like appearance
• Breasts, causing them to flatten and hang with nipples pointed downward
• Abdominal area, extending around the sides and into the lower back area, resulting in an apron-like overhang
• Buttocks, groin and thighs, causing hanging pockets of skin

Weak and sagging skin that becomes macerated (wet or infected) is not only unattractive, it is also a serious threat to your health that must be treated.

Surgical body contouring following major weight loss improves the shape and tone of the underlying tissue that supports fat and skin, and removes excess sagging fat and skin. The result is a more normal appearance to the body, with smoother contours. This is, in essence, the final phase of your total weight loss experience.

However, before you decide to undergo body contouring following major weight loss, it is important to understand that your weight loss must have stabilized. If you continue to lose weight, sagging pockets will redevelop. If you rapidly regain the weight you have lost, you will traumatically stress your already weakened and thinned skin, causing further stress to the skin, visible stretch marks and wide scars.
If you have had weight reduction surgery, your plastic surgeon will work closely with your physician to determine when it is appropriate for you to begin body contouring.

In general, good candidates for body contouring are:

• Adults of any age whose weight loss has stabilized
• Healthy individuals who do not have medical conditions that can impair healing or increase risk of surgery
• Non-smokers
• Individuals with a positive outlook and realistic goals for what body contouring can accomplish
• Individuals committed to leading a healthy lifestyle including proper nutrition and fitness

Where do I begin?

A consultation with your plastic surgeon is the first step to learn how body contouring following major weight loss can help you achieve better health and an improved appearance. A consultation is designed to fully educate you about body contouring in a non-pressured environment, and will include:

• A discussion of your goals and an evaluation of your individual case
• The options available in body contouring surgery
• The likely outcomes of body contouring procedures and any associated risks or potential complications
• The course of treatment recommended by your plastic surgeon

Your plastic surgeon will also answer your questions.

Evaluation

Overall health and personal outlook can greatly impact the outcome of your surgery. These will be carefully evaluated in your consultation with your plastic surgeon. The success of your procedure, safety and overall satisfaction require that you:

• Honestly share your expectations
• Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
• Commit to precisely following all of your plastic surgeons instructions

Safety

By making the decision to consult with your plastic surgeon and following all the instructions given, you are taking an important step in helping to assure your safety.
Your plastic surgeon should have completed surgical training and examinations in plastic surgery which uniquely qualifies them to perform cosmetic and reconstructive procedures of the face and entire body..

My body contouring

Your body contouring following major weight loss will be individualized to your specific conditions and the regions to be treated. The procedures necessary to achieve your goals will be defined along with a plan for the timing of these procedures.
Specific plastic surgery procedures that may be recommended for your body contouring include:

• Facelift: to reduce sagging of the mid-face, jowls and neck
• Breast lift: to correct sagging, flattened breasts
• Tummy tuck: to correct the apron of excess skin hanging over your abdomen
• Lower body lifts: to correct sagging of the abdomen, buttocks, groin and outer thighs
• Medial thigh lift: to correct sagging of the inner, outer and mid thigh
• Brachioplasty: to correct sagging of the upper arms

Information on all of these procedures is available. Ask your plastic surgeon for information on any procedure recommended for you.
You must accept that all body contouring requires incisions to remove excess skin. In many cases, these incisions may be extensive. Incision length and pattern depend on the amount and location of excess skin to be removed, as well as personal preference and surgical judgment. Advanced techniques usually allow incisions to be placed in strategic locations where they can be hidden by most types of clothing and swimsuits, but this is not always the case.
Body contouring following major weight loss is often performed in stages. Your conditions, goals, health, safety and comfort as well as the surgical judgment of your plastic surgeon will define a surgical plan for you. While it may have taken you two years or more to lose all the excess weight, it may take equally as long for the results of your body contouring to be complete.
In addition to preparing yourself for stages of contouring and recovery following procedures, you must also accept that a single procedure to treat a specific area may not achieve your results. Uneven contours can develop following your body contouring surgery, and in some cases, skin elasticity is so poor that relapse of sagging skin is possible.

Preparing for surgery

Your plastic surgeon will carefully explain your body contouring plan. Prior to any surgery, you will be given specific instructions that may include:

• Pre-surgical considerations, diagnostic testing and medications
• Day of surgery instructions and medications
• Specific information related to the use of anesthesia
• Postoperative care and follow-up

In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the procedure or procedures you will undergo and any associated risks or potential complications.
Possible risks of body contouring following major weight loss include bleeding, infection, fluid accumulations, delayed or poor wound healing, skin loss, blood clots, excessive or widened scars, numbness and other changes in skin sensation, and irregular or asymmetric contours or scars. Any surgery carries risks associated with anesthesia. These risks and others will be fully discussed prior to your consent.
It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcomes or preoperative stress. Discuss these feelings with your plastic surgeon.

What to expect

Body contouring may be performed in your plastic surgeons accredited office-based surgical facility, an ambulatory surgical facility or a hospital. The decision for anesthesia will be based on the requirements of your specific procedure and considerations of patient and surgeon preference. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.
Following surgery

Once your procedure(s) are completed, dressing or bandages may be applied to your incisions. Areas of the body that have been treated may be wrapped in an elastic bandage to minimize swelling and to support your new contours as you heal. Small, thin tubes may be temporarily placed under the skin to drain excess fluid or blood that may collect. Before you are released, you and an accompanying caregiver will be given specific instructions that may include:

• How to care for the surgical site and drains
• Medications to apply or take orally to aid healing and reduce the potential for infection
• Specific concerns to look for at the surgical site or in your general health
• When to follow up with your plastic surgeon

Progress and healing

Initial healing will include swelling at the incision sites. Discomfort is common and can be controlled with medication. You will be instructed to return to light walking as soon as possible to minimize the potential for blood clots and other complications.
In many cases, you will be instructed to avoid bending, straining or lifting for several days to weeks. Where tightening of the abdomen or thighs is involved, your plastic surgeon may also instruct you to avoid standing fully upright and stressing any internal sutures as they heal, and to sleep with pillows elevating your knees. Follow all instructions carefully - this is essential to the success of your outcome.
Initial wound healing may take 7 to 14 days, after which time sutures will be removed if necessary. You will be ready to return to work and normal activity in a few weeks, so long as you do not engage in any heavy lifting or vigorous exercise.
Healing will continue for many weeks as swelling resolves and incision lines continue to improve. Numbness and a firm feeling over the skins surface will improve over time. Once you have completely recovered from one series of procedures, it may be time to begin preparing for additional procedures to target other areas of the face or body. You must practice diligent sun protection until the healing process is fully complete. It may take a year or more following a given procedure for incision lines to refine and fade to some degree. Continue to follow your plastic surgeons instructions and attend follow-up visits as scheduled.

Results and outlook

The results of a body contouring following aggressive weight loss are visible almost immediately; however, it may take as much as one to two years, or more, for the final results of all the recommended body contouring procedures to fully develop. Visible scars are something you must accept in your goals to achieving a body contour that matches your new body weight and proportion. The results of body contouring following major weight loss generally are long lasting, provided that you maintain a stable weight and general fitness. As your body ages, it is natural to lose some firmness. However, most of your initial improvement should be relatively permanent.

Injectable Fillers

THE VISIBLE SIGNS OF FACIAL AGING OCCUR OVER TIME AS A RESULT OF MANY FACTORS INCLUDING SUN EXPOSURE, HEREDITY AND LIFESTYLE. One of the earliest signs of aging is a loss of facial fullness and the development of expression lines - wrinkles that appear as a result of the repeated movement of facial muscles. Softening of these facial lines and creases, and the restoration of volume and fullness in the face can often be achieved non-surgically through treatment with injectable fillers.
If you wish to enhance or restore facial contours, or reduce the appearance of lines and creases, injection therapy with soft tissue fillers may be right for you. Injectable fillers can plump thin lips, enhance shallow contours, soften facial creases and wrinkles, and, in some cases, improve the appearance of recessed scars.

The result is a smoother, fuller and more youthful facial appearance.
This brochure presents an overview of soft tissue augmentation with injectable fillers. The best way to learn how this type of therapy can help fulfill your personal goals for facial rejuvenation is a consultation with a plastic surgeon.

Before the operation make sure that:

• Your surgeon is a licensed physician to practice medicine in the country you are having the procedure
• Your surgeon has completed extensive training and examinations in plastic surgery
• Your surgeon is a member of a national plastic surgery society that is recognized by the International Confederation of Plastic, Reconstructive and Aesthetic Surgery (IPRAS)

What are injectable fillers?

Injectable fillers are substances that enhance the fullness of soft tissues, primarily in the face. Some fillers are based on natural substances derived from the human body, others are synthetic forms of these substances, and some may contain synthetic, biocompatible compounds. Injection therapy may also be performed using ones own fat cells. The differences among facial fillers is not only in their composition, but also in their preferred application and the duration of their results.
Collagen is a natural protein that supports the skin. Injectable collagen formulas derived from human dermis include Cosmoderm® or Cosmoplast®. Zyderm® and Zyplast® are forms of bovine collagen that, unlike human-derived collagen, require prior allergy testing. The results of treatment with injectable collagen may last 2 to 4 months.
Restylane® is a form of hyaluronic acid, a natural substance found in our bodies. It is well suited to plump thin lips and fill facial creases such as nasolabial folds. It may also be appropriate for some surface wrinkles and concave scars. The fullness achieved from Restylane treatment may last 6 months or longer.
Radiance® is a form of hydroxylapatite, a mineral-like compound found naturally in human bones, suspended in a gellike formulation. It is the heaviest of facial fillers and is recommended to fill deeper creases such as nasolabial folds, marionette lines and frown lines, as well as to enhance fullness of the cheeks and other facial contours. Radiance lasts 2 years or longer and is presently "off-label" in its use as a facial filler.
Human fat, harvested from your own body can be reinjected to enhance facial fullness, fill deep creases and to build up shallow contours. Fat injection requires a more extensive procedure than other injectable fillers because it uses liposuction techniques to extract the fat prior to injection. Treatment results last up to a year or more in some cases and are highly variable. Fat can be stored for your own future treatment. The duration of results from preserved fat is not as favorable as fat used at the same time it is harvested.
The options discussed in this brochure are among the current fillers preferred by plastic surgeons. Your plastic surgeon will have the latest information and will be able to advise you on the options currently available.

Where do I begin?

A consultation with your plastic surgeon is the first step to learn how treatment with injectable fillers can enhance facial fullness, and improve the appearance of facial creases, wrinkles and scars. A consultation is designed to fully educate you in a non-pressured environment, and will include:

• A discussion of your goals and an evaluation of your individual case
• The options available for facial augmentation with injectable fillers
• The likely outcomes, duration of results and potential risks associated with the use of specific fillers
• The course of treatment recommended by your plastic surgeon

Your plastic surgeon will also answer all of your questions.

Evaluation

Your plastic surgeon will review your medical history and your goals for improvement in consultation prior to any treatment with facial fillers. The success of your procedure, safety and overall satisfaction require that you:

• Honestly share your expectations
• Discuss any past treatment with injectable fillers, facial shaping or Botox® therapy or other facial rejuvenation procedures
• Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
• Commit to precisely following all of your plastic surgeons instructions

Safety

By making the decision to consult with a plastic surgeon and following all the instructions given, you are taking an important step in helping to assure your safety.
Your plastic surgeon should have completed surgical training and examinations in plastic surgery which uniquely qualifies them to perform cosmetic and reconstructive procedures of the face and entire body.
My soft tissue augmentation

Your plastic surgeon will carefully evaluate your facial appearance and skin tone, and examine the areas of your face to be augmented with injectable fillers. Strategic points on your face may be marked as guides to the appropriate injection sites for the filler recommended in your individual case. The injection sites are cleansed with an antibacterial agent and icing or a topical numbing agent may be offered to make more sensitive patients comfortable. In some cases, the filler itself will contain an anesthetic agent. In other cases local anesthetic may be administered to the treatment site.
Injection takes only a few moments per site and a few minutes for a course of treatment. Following injection, any markings will be cleansed and icing may be offered to alleviate any temporary, minor discomfort. Make-up may be carefully re-applied so long as care is taken not to apply pressure to the treatment area.
An improved appearance is visible almost immediately, although minor swelling or bruising may appear at the injection sites. With some fillers, a slightly "over-filled" appearance may be initially present. Any of these conditions will dissipate within a few hours, or at most a few days; however the duration may be as long as a few weeks with injection of ones own harvested fat.
The use of facial fillers may further enhance the outcomes of other rejuvenation procedures such as facial rejuvenation and shaping, and wrinkle reduction by injection (Botox® therapy), or surgical rejuvenation such as a brow lift or facelift. In addition, ones own fat may be extracted in conjunction with liposuction (to remove localized excess fat) and prepared for injection, or preserved for later injection.

Preparing for soft tissue augmentation

Your plastic surgeon will carefully explain:

• Your course of treatment
• The type and brand of filler recommended in your case and why
• The results you can expect
• How long you might expect results to last

In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the procedure and effects of soft tissue augmentation and any risks or potential complications.
Reported risks associated with the use of injectable fillers in soft tissue augmentation vary depending on the specific filler used and the relative permanence of the filler substance. Fillers derived from non-human sources may require a pre-treatment allergy test. Infection at the injection site is also possible. Complications from fillers generally are reported to be uncommon and temporary.
Those fillers that are not completely fluid and contain microscopic granular substances, carry a risk of "clumping" as a result of facial movement and the natural aging process. Over time, these can result in lumps or nodules that may require surgery to treat. Risks will be fully discussed prior to your consent.
It is important that you address any questions about soft tissue augmentation with injectable fillers directly with your plastic surgeon.

What to expect

Injection therapy with soft tissue fillers is performed in a plastic surgeons office. Your initial treatment will include a complete consultation. Subsequent follow-up procedures may take only a few minutes, as the full process of consultation is not necessary to repeat, although consent is required at each visit..

Following treatment

Once your procedure is completed, you will be instructed on how to care for the treated areas of your face. You will also be reminded about:

• The expected duration of your results
• Specific concerns to look for at the injection site or in overall health
• When to follow-up with your plastic surgeon

Progress and healing

You may experience temporary numbness, redness, swelling and minor bruising at the injection sites. These can be alleviated with topical icing and should resolve within a few days. The results of your treatment are visible immediately; however, they will lessen over time as fillers are absorbed. The post-treatment side-effects of fat injections last longer than other filler substances, from several weeks to several months, in some cases.
The results of soft tissue augmentation with injectable fillers are not permanent, even though a filler substance may be considered permanent. The continued aging of your face and variables in the absorption of fillers will affect just how long your results last. The results of non-permanent fillers will diminish over time. Should you choose not to repeat treatment, your appearance will return to its original condition. Plumped lips will lose volume and improved wrinkles, creases and scars will visibly recess and fully reappear in time.
The results of permanent fillers can change over time; as you age naturally, these fillers may shift or clump. Surgical removal may be necessary to correct these conditions and could result in visible changes in appearance and noticeable changes in the texture of soft tissue.

Results and outlook

You may find yourself surprised at how such a relatively quick in-office procedure can produce a marked improvement in restoring facial fullness and a more youthful appearance. However, injection therapy to augment soft tissue is by no means simple.
Effective and safe use requires a physician with specialized training and a thorough understanding of facial anatomy to recommend and inject an appropriate filler. Choosing a plastic surgeon to treat your face with injectable fillers means that your treatment will be performed by someone who not only has training in injection therapy, but in all types of non-surgical and surgical facial rejuvenation.Restylane Vital