Multiple Stage Treatment
Skin in virtually every area of the body may be affected by weight gain and subsequent loss, necessitating the use of surgical procedures to remove the excess skin and tighten deeper layers. These patients will typically undergo multiple staged operations with a number of procedures combined at each operation. It would be nice to get it all done the same day, but patient safety requires that operations be limited to not more than six hours.

It is not uncommon to combine a lower body lift with an arm reduction, followed a number of months later by a thigh lift and a breast procedure. Facial rejuvenation may be completed somewhere along the way, if desired by the patient. Dr. Murphy prefers not to combine an abdominal procedure with a medial thigh lift because of extreme tension created in the groin area.

Evalutation
During the evaluation of the weight loss bariatric surgery patient the concept of auto-augmentation comes into play, whereby excess tissue typically removed may be retained and rotated to augment adjacent areas. Lateral chest wall tissue may be rotated into the breast area to moderately increase fullness. Tissue across the lower back may be rotated into the buttock to establish a degree of fullness. Dr. Murphy will take all of these possibilities into consideration during your consultation.

Recovery
Patients need to be aware that these procedures are not subject to short-scar techniques. Although the scars are lengthy, they will fade significantly over time, and we do our best to hide them, for example, along the inside of the arm. Length of recovery and discomfort are related to the extent of the procedure. More involved procedures such as lower body lift and medial thigh lift may require up to two weeks to return to day-to-day activities and more strenuous activities, including heavy lifting will need to wait for up to two months.

Outline of Procedures:

Arm Reduction
Involves removal of excess skin between the armpit and the elbow but may on occasion extend to the armpit or lateral chest wall, or even beyond the elbow. It is relatively pain free and is frequently combined with other more significant procedures.

Thigh-Buttock Lift
Involves elevation and tightening of the buttock and lateral thigh tissues. It is frequently combined with lateral thigh liposuction. If more aggressive lifting of the thigh, including the skin of the medial thigh, is desired, the incision may be extended to the groin crease, simultaneously elevating the medial thigh. This is typically referred to as a total thigh lift.

Lower Body Lift
A thigh buttock lift is frequently combined with an abdominoplasty, and this is called a Lower Body Lift, a procedure very common among weight loss, bariatric patients. This involves a circumferential incision through which the excess lax skin of the buttock, lower back and hip areas is removed, elevating and tightening the buttock and lateral thigh skin while removing excess abdominal skin and tightening the abdominal wall muscles. Patients with more significant laxity of the anterior abdominal skin may also require a vertical midline incision to achieve a more three dimensional removal of skin.

Medial Thigh Lift
Excess medial thigh tissue can typically be removed through a groin crease incision. This will improve the contour of the upper inner thigh and relieve the feeling of the skin rubbing together. For some patients the degree of improvement required is so profound that an incision extending along the inside of the thigh, even all the way to the knee, is indicated.