Some of the most rewarding consultations at Southwest Plastic Surgery are with patients who have lost sixty, eighty, even a hundred pounds, whether through bariatric surgery, a GLP-1 medication, or sheer discipline. They did the hard part. What remains, Dr. Frank Agullo explains, is skin that lost its elasticity and will not bounce back, no matter how much they exercise.
Here is how he talks patients through it, offered as education rather than a plan for any one person.
Why the Skin Will Not Go Back
Once skin has been stretched that far for that long, Dr. Agullo says, the elastic fibers are spent. A patient can be at a great weight with a tiny waist and still have skin hanging from the breasts, the abdomen, the inner thighs, and the arms. That is not a discipline problem, it is a tissue problem, and the only thing that removes loose skin is surgery. That is exactly what body contouring after major weight loss is built to address.
The Breasts After Weight Loss
After massive weight loss the breast usually still has volume, Dr. Agullo notes, it is just hanging very low. Most of the time a lift alone gives a beautiful result, without an implant. He brings the nipple up, removes the excess skin, and places a mesh on the inside so the result does not rely on skin that has lost its elasticity. When the breasts are extremely low, he often advises against an implant in the same operation, because moving the nipple a long way up while adding an implant can compromise its blood supply. An implant is an easy second step later.
Tummy Tuck or All the Way Around?
With a standard tummy tuck, Dr. Agullo makes a low incision, removes the excess skin, pulls everything down tight, and repairs the muscles up the middle and along the sides for a corset effect and a smaller waist, combined with liposuction.
After massive weight loss, a lot of the looseness wraps around the sides and the back, so he often recommends the circumferential procedure, also called a lower body lift. The incision continues all the way around, letting him pull the skin down in front and lift the outer thigh and buttock at the same time. It is the most complete option when the laxity is not just in the front.
| If the laxity is | Dr. Agullo usually recommends |
|---|---|
| Mostly in the front | A tummy tuck with liposuction |
| Wrapping around the sides and back | A circumferential lower body lift |
| At the breasts | A lift, often with internal mesh |
| On the inner thighs | A thigh lift, staged carefully |
The Honest Tradeoffs
Dr. Agullo is upfront about the limits. The circumferential lift pulls everything down and in, but heavy side-to-side laxity can leave some looseness up top, and removing that completely requires a vertical scar most patients prefer to avoid. He almost always leaves that as an optional second stage.
The thigh lift, he tells patients, is the hardest of these to recover from. Right where the tension pulls upward, the incision tends to open a little, almost every time. It is simply kept covered with gauze, closes on its own in about two to three weeks, and often needs no scar revision at all.
A procedure like this removes roughly ten pounds, so Dr. Agullo advises patients to reach a stable weight first, then maintain it for the best, longest-lasting result.
About Dr. Frank Agullo
Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and a Mayo Clinic plastic surgery fellowship alum. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years. Body contouring after massive weight loss, he says, is not one operation for everyone. It is a plan.
Ready to Talk?
If you have lost the weight and you are ready to deal with the skin, the team at Southwest Plastic Surgery will help you build a plan together.
For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing version, see the companion post on agulloplasticsurgery.com.
Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.
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