South Florida Plastic Surgery Associates - Don R. Revis, MD











Body Contouring After Major Weight Loss

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. Revisí 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 patientís 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.

Common Concerns After Extreme Weight Loss

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 Facelift) 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 arm (See Arm Lift) Brachioplasty (arm lift surgery) is a technique to lift and tighten the skin of the arm.
     
  • 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.

Our goal is to provide you with the ultimate patient experience. Our well-trained staff will help you understand your procedure, our financial policies, the scheduling of your surgery, and your post-operative care. We are available to assist you during our regular office hours, Monday through Friday. Dr. Revis is also available 24 hours a day to post-surgical patients; 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 might have during your recovery.

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.

At the completion of your consultation, our Patient Coordinator will give you a written estimate of the cost of your procedure. At this time, you will also have the option to schedule your procedure if you so choose. The decision to undergo surgery is a very important one, and the final decision should be given very careful consideration. Dr. Revis realizes the importance of this decision, and at no time will you be pressured to make a decision. You are also encouraged to bring your spouse, significant other, family member, or a friend to your consultation.

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) or the Imperial Point Surgery Center (a fully accredited ambulatory surgery center). The staff of these facilities are very experienced in the care of plastic surgery patients in general and specifically in the care of Dr. Revisí 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.

Types 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 post-operative nausea and vomiting is also a focus of Dr. Revisí 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 post-operative 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.

Dr. Revis will discuss all of these options with you more thoroughly at the time of your consultation, and please ask him about anything you do not understand. You may also choose to meet with your anesthesiologist preoperatively to address any questions or concerns you may have.

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 post-operatively.

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.

At the completion of the operation, a sterile dressing is applied to the incisions, and a compression garment is applied to the body region being treated. This compression garment helps support your incisions during healing, decreases post-operative swelling, and helps decrease any bruising that may occur. This garment is typically worn for three weeks post-operatively or for one week after the last drain has been removed.

Products to Help You Heal

SinEcch Arnica Montana is a natural product from Sweden which has been shown in clinical studies to reduce post-operative bruising and swelling. Begun the evening prior to surgery, this product is continued for four days post-operatively.

Scarguard MD 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. Revisí 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 post-operative instructions and Dr. Revisí 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 post-operative 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 post-operative 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 24 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.

Approximately three weeks after surgery, Dr. Revis will recommend that you begin using the topical product ScarGuard on your incisions. Containing Vitamin E, silicone and hydrocortisone, this product is applied directly to your incisions with a small brush (like nail polish) on a daily basis and helps your scars fade more quickly and completely. Additionally, please avoid direct sun exposure of your incisions (by using a sunscreen with a high SPF even under your bathing suit) for 9-12 months post-operatively, because if your scars are allowed to tan, they will likely turn dark permanently.

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, a post-gastric bypass and extreme makeover patient

Above: Andy following his 550 pound weight loss, displaying his former wardrobe and anxiously awaiting his upcoming Lower Body Lift!

Now Available:

Body Contouring after Bariatric Surgery - Changing Shape - Shaping Change CD

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 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
4200 N. Federal Hwy.
Ft. Lauderdale, FL  33308

Body Contouring After Major Weight Loss Before & After Photos

Please call (954) 630-2009 or email Dr. Revis for further information or to schedule a complimentary consultation.

Email: DrDonRevis@hotmail.com

 

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