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Body Contouring After Bariatric Surgery Changing Shape - Shaping Change With the growing popularity of
bariatric, or gastric bypass, surgery as a treatment for obesity, body
contouring after significant weight loss has become a focus of Dr. Revis’
practice. After developing an interest in this highly specialized area of
plastic surgery, he now dedicates 50% of his practice to this complex,
challenging, and extremely rewarding group of patients. By applying the latest
techniques in body sculpting individualized to each patient’s specific
needs and priorities, Dr. Revis can help you realize the new shape that is
hidden beneath the excess skin that remains after your goal weight has been
achieved. Dr. Revis is uniquely qualified
to help reveal the "new you" because he is a board certified
general surgeon as well as a board certified plastic surgeon. This means
that he has actually performed gastric bypass surgery and is board certified
to do so. Although he now practices exclusively on the cosmetic side of the
equation, his training and experience have equipped him to understand your
needs and deliver the solution in a safe, professional, and artistic manner. With significant weight loss
over a relatively short period of time (usually 12-18 months), the remaining
skin often does not retain the elastic qualities necessary to “shrink back
down” to your new underlying shape. This often leaves patients with
excessive amounts of hanging skin that creates a multitude of problems such
as daily hygiene and finding clothes that fit properly. Dr. Revis has developed a
comprehensive approach to bariatric patients who wish to achieve their
optimal shape following weight loss. One of the most important
considerations for a plastic surgeon to realize is that a bariatric patient
must be treated differently from non-bariatric body contouring patients.
What has worked well for many years on other patients simply does not
provide adequate shaping and contouring for the bariatric patient. Patients who have undergone
bariatric surgery and the subsequent significant weight loss have numerous
but similar areas of concern. These areas usually include: ·
Breast ptosis, or droopiness, as well as a loss of breast volume (See Mastopexy)
For women, mastopexy (breast lift
surgery) is a procedure to lift the breasts and may be performed with or
without the addition of breast implants to improve shape, fullness and
cleavage. For men, several breast reduction techniques are available,
depending on the degree of correction required. ·
Sagging of the facial skin (See Facelifting)
Rhytidectomy (facelift
surgery), forehead lifting and blepharoplasty (eyelid surgery) may be
necessary to achieve complete facial rejuvenation, or you may be a candidate
for an endoscopic or minimally invasive technique. · Excess abdominal skin and a laxity of the muscles of the abdominal wall (sometimes with an accompanying hernia) (See Tummy Tuck and Lower Body Lift) Abdominoplasty (tummy tuck surgery) or a lower body lift procedure can contour the abdomen, hips, outer and posterior thighs and buttocks. ·
Hanging skin under the arms (See Arm
Lift) Brachioplasty (arm lift
surgery) is a technique to lift and tighten the skin of the arms. ·
Wrinkling and excessive bagginess of the thighs (See Thigh
Lift) A medial thigh lift can
lift the inner thighs, whereas a lower body lift addresses the outer and
posterior portions of the thighs. Obviously all of these concerns
cannot be addressed simultaneously during one operation. However, two
procedures usually can be safely combined. During your consultation, Dr.
Revis will assess your anatomy as well as your own priorities to help you
develop a comprehensive plan or blueprint for your body contouring. It is
not uncommon to combine a tummy tuck with a breast lift (with or without the
addition of breast implants), or a thigh lift with an arm lift, as well as
other possible combinations of procedures. If you think you might be a good candidate for body contouring following significant weight loss, this page will give you a basic understanding of the procedures and the results you can expect. You are encouraged to read more about the specific procedures in greater detail which may also be found on this website. The cornerstone of Dr. Revis' approach is to individualize treatment to your specific circumstances and goals and to ensure that you have an adequate understanding of the issues involved so that you are able to make a fully informed decision. This will help you achieve the appearance you desire with the least invasive procedure(s) available, thus creating a mutually rewarding experience. Dr.
Revis invites you to visit his office for a complimentary consultation to
discuss these procedures in greater detail. You are also invited to email
Dr. Revis with your questions, or we will mail you more detailed information
regarding these procedures. As
you consider plastic surgery, one of the most important decisions you will
make is choosing your surgeon. Our pledge to you is to provide the latest,
state of the art cosmetic plastic surgery in a safe, compassionate and
professional environment. Dr. Revis is a recognized expert in the field of
post-bariatric plastic surgery and is double board certified by the American
Board of Surgery and the American Board of Plastic Surgery, the only plastic
surgery board recognized by the American Board of Medical Specialties. Dr.
Revis is also a member of The American Society of Plastic Surgeons and The
American Society for Aesthetic Plastic Surgery and has been named among
"America's Top Surgeons" by The Consumers' Research Council of
America. He is also a member of the American Society for Bariatric
Surgery and the International Federation for the Surgery of Obesity as well.
Because of his
experience and dedication to this subject, Dr. Revis was also selected to
become a member of the Editorial
Board of Obesity Help magazine. Dr. Revis’ goal is to provide you with "the ultimate patient experience." Our well-trained staff (including two registered nurses fully licensed by the State of Florida) will help you understand your procedure, our financial policies, the scheduling of your surgery, and your postoperative care. We are available to assist you during our regular hours of 9:00 a.m. to 5:00 p.m. as well as Wednesday evenings until 7:15 p.m. Dr. Revis is also available 24 hours a day for emergencies, and he will give you his cell phone number after surgery so that you will always be able to reach him with any questions or concerns you may have. The Consultation During
your initial consultation, Dr. Revis will inquire about your medical
history, prior procedures, medications, allergies, and your motivations for
seeking plastic surgery. It is very important that you be thorough when
providing your medical history, as this information helps to prevent
complications during your care. When asked about medications, be sure to
include any vitamin or herbal preparations, as these can affect your blood
pressure and clotting ability. Honesty regarding your use of tobacco and
alcohol is also very important, as these may have a profound impact on your
recovery period and your ability to heal following your procedure. After
reviewing your medical history, Dr. Revis will discuss your concerns,
priorities and motivations for pursuing plastic surgery, as well as your
fears. After examining you, Dr. Revis will be able to offer advice and
options to help you achieve the appearance you desire. He will explain the
advantages and disadvantages of the different options you have before you. Where Your Procedure Will Be Performed Dr.
Revis has been granted staff privileges at five local hospitals and
outpatient surgery centers. In the interest of the safety of his patients,
he only performs surgery in fully accredited facilities with the proper
services and staff. Dr. Revis usually performs body contouring following
bariatric surgery at
Broward General Medical Center or Imperial Point Medical Center (fully accredited
hospitals) because the staff of
these facilities are very experienced in the
care of plastic surgery patients in general and specifically in the care of
Dr. Revis’ patients. Most
patients choose
to stay overnight following surgery. Sometimes an overnight stay is
required, depending on the procedure you choose and your overall health
status. Alternatively, we also have a private duty nurse available to care
for you in the comfort and privacy of your own home if you so choose. Type(s) of Anesthesia Anesthesia
is an essential part of any surgical procedure and must be performed safely,
therefore when you choose Dr. Revis as your surgeon, your anesthesia will
always be administered under the care of an M.D. anesthesiologist. General
anesthesia is the deepest form of anesthesia, and many consider it to be the
safest as well. You are asleep, feel no pain, and will not remember the
procedure. This is the most common type of anesthesia used for
post-bariatric body contouring because these procedures tend to be lengthy
and require full muscle relaxation for maximum tightening intraoperatively. Intravenous
sedation, called “twilight sleep,” is a combination of local anesthetic
administered at the surgical site by Dr. Revis and intravenous sedation
administered by the anesthesiologist. You breathe for yourself, but you are
in a deep sleep throughout the procedure. You should feel no pain, and you
will not remember the procedure. An
intermediate form of anesthesia, the laryngeal mask airway (LMA), is a
relatively new technique. This technique is similar to twilight sleep in
that you are breathing on your own, but the method of sedation differs. With
an LMA, you actually breathe anesthetic gases administered to you by the
anesthesiologist, rather than receive intravenous sedation via your
intravenous line. These
anesthetic gases cause you to sleep during the procedure. At the completion
of the procedure, the gases are turned off, and you wake up from your sleep.
You will feel no pain, and you will not remember the procedure. The
prevention of postoperative nausea and vomiting is also a focus of Dr.
Revis’ approach to body contouring. To improve your overall experience and
ensure you feel better faster following your surgery, he has developed a
technique that has resulted in a very low incidence of postoperative nausea
and vomiting. You will be given an intravenous dose of Zofran at the
beginning of your procedure and again at the completion of your procedure.
Zofran is a new drug that is currently the best medication available to
prevent nausea and vomiting. Dr. Revis feels that Zofran is an essential
component of his overall approach to make sure that your experience is as
pleasant as possible. Details of the Procedures As
mentioned previously, Dr. Revis has developed a comprehensive approach to
the bariatric patient that has evolved into specialized techniques meant to
optimize your results. These include: ·
Developing a clear overall strategy during the consultation process
and reviewing this plan during the preoperative visit. This plan will be
reviewed thoroughly so that you have a full understanding of the procedures,
incisions, and results you can expect. ·
Precise preoperative skin marking prior to surgery. While you are
standing, Dr. Revis will make marks on your skin identifying certain
landmarks as well as the intended incisions. Not only does this provide him
with information necessary during the operation, but it also allows you to
review the operative plan one more time before undergoing the procedure. ·
Using various positioning techniques on the operating room table to
optimize visualization intraoperatively and enable Dr. Revis to provide
smooth, natural contouring from one body region to the next. ·
Precise cutting, redraping and sculpting techniques ·
Careful but considerable suture techniques to provide support to the
incisions during the healing process. By using multiple layers of strong
sutures beginning deep in the tissues and finishing superficially, the
resulting scar is optimized and heals into an acceptable thin line. Even
with this suture technique, Dr. Revis is able to use sutures beneath the
surface of the skin that do not require removal. Not having to undergo
suture removal has greatly improved patient comfort and satisfaction
postoperatively. Depending on the combination of procedures you choose, your surgery will probably require four to eight hours to complete. The longest operation Dr. Revis has performed was ten hours in length, during which he removed 48.5 pounds of skin from a bariatric patient during a lower body lift procedure. After you are properly anesthetized, a urinary (Foley) catheter will be placed to drain the bladder during the operation. This is used to monitor your fluid status during the operation, allows Dr. Revis to tighten the abdominal wall to maximum tension, and will prevent the need for trips to the bathroom during the night following surgery. Once
the skin has been prepared with a sterile solution to prevent infection, Dr.
Revis will make incisions necessary for the removal of excess skin and fat.
If liposuction is required to smoothly and evenly contour adjacent
anatomical regions, it may be performed at the beginning or at the end of
the procedure. After
the incisions have been made, Dr. Revis gently elevates the skin and fat off
of the underlying structures. For a tummy tuck, the muscles of the abdominal
wall are tightened using permanent sutures to restore the proper anatomical
relationship and maximize the efficiency of these muscles for future
exercise and other activities. Some patients have hernias of the abdominal
wall, and these may also be repaired during a tummy tuck procedure. Dr.
Revis removes excess skin and fat and redrapes the skin over the underlying
structures. One or more drains may be placed beneath the incision. These
slender, rubber tubes assist in draining any fluid that may accumulate
beneath the incision and delay your healing. Dr. Revis may also chose to use
a new product called Tissue Glue. This product helps your body heal and minimizes
the fluid that may empty into your drains, allowing the drains to be removed
earlier. Products To Help You Heal 1)
SinEcch -
Arnica Montana is a natural product from Sweden that has been shown in
clinical studies to reduce postoperative bruising and swelling. Begun the
evening prior to surgery, this product is continued for four days
postoperatively. 2)
Regenerin Surgical Support - Specially formulated for the
surgical patient, this antioxidant and vitamin preparation will provide your
body with the necessary nutrients and antioxidants to assist in healing your
surgical wounds. Begun seven days prior to surgery, this product is then
continued for one month postoperatively. Many patients find this product so
beneficial that they continue on the Regenerin Daily Dietary Supplement
Program after their healing is complete. 3)
Unjury - This protein powder contains 20 grams of protein per scoop, and
is taken twice daily beginning two weeks preoperatively and continued four
weeks postoperatively. It is an invaluable source of protein to provide your
body with the basic building blocks necessary to form strong healed wounds.
This product is also accompanied by a number of recipes for using this
product with coffee, tea, milk, Crystal Lite, and Jell-O. 4)
ScarGuard - A combination of hydrocortisone, silicone and
Vitamin E, this product is painted on your scars topically like nail polish
beginning three weeks after surgery, and it helps your scars fade so that
they fade as much as possible. After Your Procedure If
you are staying overnight in the hospital, you will be transported from the
recovery room to your own room. Dr. Revis’ patients are almost always
provided with a private room, and your family and friends may visit you
during the afternoon and evening hours following your surgery. Additionally,
if your spouse, significant other or parent wishes, they may spend the night
in your room in a recliner or in an extra bed (if available on the nursing
unit at that time). You
will have a PCA pump (Patient Controlled Analgesia) available so that you
will only need to push a button to self-administer narcotic pain medications
when needed. You will also be administered intravenous fluids (to maintain
proper fluid balance), intravenous antibiotics (to prevent infection) and
intravenous Zofran (to prevent nausea). Dr. Revis will visit you in your room the evening following surgery to check and make sure everything is going well and that you are comfortable. He will also visit you the morning after surgery to change your dressing and complete the discharge instructions so that you may be discharged that afternoon. You will also be provided with thorough postoperative instructions and Dr. Revis’ cell phone number so that you may reach him directly at any time with any questions or concerns you may have. Most patients choose to stay one night in the hospital following surgery (although sometimes a second night is requested for larger procedures or for patients who live alone), and you can expect to be discharged at approximately 4 or 5 PM the following afternoon by Dr. Revis. Alternatively,
if you decide to go home in the company of a private duty nurse or your
family or friends, you will be discharged after spending one to two hours in
the recovery room. The
antibiotics that were prescribed during your preoperative visit (usually
Augmentin) should be taken twice daily beginning on the evening prior to
surgery. Continue this medication until it is finished. Dr. Revis will
prescribe you four Zofran tablets that dissolve under your tongue to prevent
postoperative nausea. Once you arrive home, you should take these pills
every four hours until they are gone. If you are having muscle repair work done on the abdomen, you will be prescribed Flexeril (cyclobenzaprine), a muscle relaxer. You should take these every six hours, as they will probably be more helpful than the pain medicine in providing relief from your discomfort, they will lightly relax you, and they do not cause nausea or constipation (like the narcotic pain medications commonly do). The pain medication prescribed by Dr. Revis (usually Lortab or Vicodin) should be taken only if needed, every four hours or so (when you are not asleep, of course). The disadvantage of these medications is that they may be habit-forming, may cause constipation, and may cause or aggravate nausea, therefore their use should be limited to the initial few postoperative days only. Most patients find that they are able to transition to Tylenol after four to five days.It is not safe to drive a car within twenty-four hours of taking pain medication or muscle relaxer, as your reflexes and alertness may be altered. You should plan to take it easy following your surgery. No strenuous activities, heavy lifting (over 20 pounds), aerobic exercises, swimming, contact sports, tennis, or golf should be planned for the first three weeks. As Dr. Revis monitors your recovery, he will advise you when it is safe to resume specific activities. You should plan to wear the compression garment for three weeks following surgery. Dr. Revis will remove the drainage tubes within 5-14 days following surgery as the drainage decreases to an acceptable level. The Results You Can Expect You
should plan to take it easy following your surgery. No strenuous activities,
heavy lifting (over 20 pounds), aerobic exercises, swimming, contact sports,
tennis, or golf should be planned for the first three weeks. As Dr. Revis
monitors your recovery, he will advise you when it is safe to resume
specific activities. You
should plan to wear your surgical garment(s) for three weeks following
surgery, or until Dr. Revis instructs you that they are no longer necessary
or beneficial. If at first you feel uncomfortable when not wearing the
garment(s), you may gradually wean yourself off of the garment(s) by wearing
them for 18 hours a day for one week, then 12 hours a day for one week, then
6 hours a day for one week, and then discontinue their use altogether. The
drainage tubes will be removed after the drainage decreases to an acceptable
level. Please call (954) 630-2009 for further information or email Dr. Revis. Read what patients have to say about Dr. Revis Email: DrRevis@SouthFloridaPlasticSurgery.com
Extreme Makeovers in Progress Dr. Revis is currently in production of two extreme makeover programs featuring patients who have previously undergone bariatric surgery. Andy and Kelvin, both weighing over 700 pounds prior to their gastric bypass surgery, are approaching their goal weight and will soon undergo a series of body contouring procedures. Andy's journey will be featured on the Maury Povich Show, while Kelvin's will be featured on Channel 10/ WPLG. Check back frequently for updates on these exciting programs!
Andy following his 550 pound weight loss, displaying his former wardrobe and anxiously awaiting his upcoming Lower Body Lift! Now Available on CD-ROM:
The latest video lecture series, entitled "Body Contouring after Bariatric Surgery - Changing Shape - Shaping Change" features Dr. Revis' presentation to a packed audience at the annual U.S. Bariatric conference where he covers all of the key issues - when body contouring can be performed, safety concerns, surgeon selection and the cost of body contouring procedures. The CD-ROM contains many photos of patients who have had breast lifts, tummy tucks, arm lifts and combination procedures performed by Dr. Revis and illustrates the remarkable results that can be achieved with body contouring following bariatric surgery. Stop by our office today to pick up your complimentary copy of this video, or we will mail you a copy for your viewing pleasure. To receive your copy by mail, please send a check or money order for $9.95 to cover postage and handling to: Don Revis, MD, 2500 N. Federal Hwy., Suite 301, Ft. Lauderdale, FL 33305
Patient Examples-Body Contouring Following Significant Weight Loss Patient 1 - Full Breast Lift with Breast Implant Placement and Tummy Tuck (1st Procedure), Brachioplasty (Arm Lift) and Medial Thigh Lift (2nd Procedure)
Age: 46, 5”8", Preoperative weight 145 pounds following 170 pound weight
loss, First Procedure: Full Mastopexy (Breast
Lift) with Implants (Mentor round smooth saline implants filled to 450cc ) and Free
Nipple Graft and Full Abdominoplasty (Tummy Tuck),
Second Procedure: Arm Lift (Brachioplasty) and Medial Thigh Lift, Preop and
1 year postop Patient 2 - Donut Breast Lift with Breast
Implant Placement and Tummy Tuck (1st Procedure), Brachioplasty (Arm Lift)
and Medial Thigh Lift (2nd Procedure)
Age:
31, Height:
5’4”, Preoperative weight 162 following 100 pound weight loss, First Procedure: Donut Mastopexy (Breast
Lift) with Implants (Mentor round
smooth saline implants filled to 475cc right breast, 500cc left breast) and Full Abdominoplasty (Tummy Tuck) with
Liposuction,
Second Procedure: Arm Lift (Brachioplasty) and Medial Thigh Lift,
Preop and 3 Months
Postop Patient 3 - Lower Body
Lift (1st Procedure), Brachioplasty (Arm Lift) and Vertical Breast Lift with Implants
(2nd Procedure) (Significant
Preoperative Breast Asymmetry)
Age: 47, 5’2”, Preoperative weight 154 pounds following 115 pound weight loss, Procedure: Lower Body Lift (18 pounds of excess skin removed), Arm Lift (Brachioplasty) and Vertical Breast Lift with Implants (510cc right breast, 525cc left breast), Preop and 3 months postop Patient 4 - Lower Body Lift
Age: 41, 5’2”, Preoperative weight 135 pounds following 130 pound weight loss, Procedure: Lower Body Lift (12 pounds of excess skin removed) and Donut Mastopexy (Breast Lift) with Implants (Inamed round smooth saline implants filled to 475cc, Preop and 3 months postop Patient 5 - Full Breast Lift with Breast Implant Placement and Tummy Tuck (1st Procedure), Flankoplasty (Completion Lower Body Lift), Medial Thigh Lift and Lateral Breast Skin Tightening (2nd Procedure)
Age: 54, 5’5”, Preoperative weight 165 pounds following 150 pound weight loss, First Procedure: Full Mastopexy (Breast Lift) with Breast Implants (Mentor round, smooth saline implants filled to 450cc) and Free Nipple Graft and Full Abdominoplasty (Tummy Tuck) with Liposuction, Second Procedure: Flankoplasty (Completion Lower Body Lift) and Medial Thigh Lift, Preop and 3 months postop Patient 6 - Full Breast Lift with Breast Implant Placement and Brachioplasty (Arm Lift) (1st Procedure), Lower Body Lift (2nd Procedure)
Age:
33, Height:
5’4”, Preoperative weight 265 following 205 pound weight loss, First Procedure: Full Breast Lift with Implants (Mentor
smooth round high profile, 600cc right breast, 650cc left breast) and Arm Lift
(Brachioplasty),
Second Procedure: Lower Body Lift
(28 pounds of excess skin removed),
Preop and 3 Months
Postop Patient 7 - Lower Body Lift
Age:
39, Height:
5’5”, Preoperative weight 183 following 195 pound weight loss, Procedure: Lower Body Lift
(18 pounds of excess skin removed),
Preop and 3 Months
Postop Patient 8 - Full Tummy Tuck and Full Breast Lift
Age: 51, 5’7”, Preoperative weight 170 pounds following 180 pound weight loss, Procedure: Full Mastopexy (Breast Lift) and Full Abdominoplasty (Tummy Tuck) with Liposuction, Preop and 3 months postop Patient 9 - Full Tummy Tuck and Brachioplasty (Arm Lift)
Age: 24, 5’6”, Preoperative weight 170 pounds following 150 pound weight loss, Procedure: Brachioplasty (Arm Lift) and Full Abdominoplasty (Tummy Tuck) , Preop and 3 months postop Patient 10 - Full Tummy Tuck and Donut Mastopexy with Breast Implant Placement
Age: 27, 6”1", Preoperative weight 160 pounds following 130 pound weight loss, Procedure: Full Abdominoplasty (Tummy Tuck) and Breast Lift (Donut Mastopexy) with 425cc breast implants following , Preop and 1 year postop Patient 11 - Full Tummy Tuck
Age: 47, 5’7”, Preoperative weight 171 pounds following 170 pound weight loss, Procedure: Full Abdominoplasty (Tummy Tuck) with Liposuction, Preop and 3 months postop Patient 12 - Full Tummy Tuck and Vertical Breast Lift with Implants
Age: 29, 5’9”, Preoperative weight 160 pounds following 100 pound weight loss, Procedure: Vertical Mastopexy (Breast Lift) with Breast Implants (430cc) and Full Abdominoplasty (Tummy Tuck) with Liposuction, Preop and 3 months postop Patient 13 - Full Tummy Tuck and Donut Breast Lift with Implants
Age: 48, 5’9”, Preoperative weight 146 pounds following 150 pound weight loss, Procedure: Crescent Mastopexy (Breast Lift) with Breast Implants and Full Abdominoplasty (Tummy Tuck) with Liposuction, Preop and 3 months postop Patient 14 - Full Tummy Tuck and Donut Full Breast Lift
Age: 27, 5’6”, Preoperative weight 165 pounds following 150 pound weight loss, Procedure: Full Mastopexy (Breast Lift) and Full Abdominoplasty (Tummy Tuck) with Liposuction, Preop and 3 months postop Patient 15 - Full Tummy Tuck and Full Breast Lift
Age: 42, 5’2”, Preoperative weight 140 pounds following 105 pound weight loss, Procedure: Full Mastopexy (Breast Lift) and Full Abdominoplasty (Tummy Tuck) with Liposuction, Preop and 3 months postop Patient 16 - Full Breast Lift with Implants
Age: 54, 5’7”, Preoperative weight 180 pounds following 149 pound weight loss, Procedure: Full Mastopexy (Breast Lift) with free nipple graft and breast implants (500cc's right, 550cc's left), Preop and 3 months postop
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