Refining the Silhouette
Recontouring surgery is best performed when several stones of weight have been lost as the skin has usually become so stretched that it has exceeded its elastic limit. This can also be the case after pregnancy. Rather than shrinking, the skin simply hangs down in an unattractive way, potentially causing problems with hygiene and comfort.
Recontouring surgery post weight-loss is most usually thought of in terms of just the abdominal area, but in reality an entire raft of procedures can help patients to gain a better contour in the arms, thighs, buttocks, face, neck and breasts.
After weight loss the breasts often benefit from filling with an implant as well as undergoing an uplift. This procedure can sometimes be performed safely in one go but may need to be staged in certain cases (i.e. uplift first then implant later) for safety reasons. See Breast Procedures.
Face and Neck Lift
Massive weight loss also presents unique challenges due to disproportionately large deposits of skin and fat in the neck area that necessitate removal. Often extensive work to the platysma (neck) muscle is necessary in order to restore a satisfactory contour. See Face Procedures.
This procedure is best thought of as pulling the lower abdominal tissue down towards the pubic area.
Childbirth, weightloss, caesarean section or hysterectomy scars can all contribute to a fatty bulge developing in the lower abdominal area. The amount of excess tissue present, its composition and its distribution, determines the procedure of choice. If there is a significant quantity of fat and skin to be removed then an abdominoplasty is performed.
Fatty deposits under the skin can be reduced and reshaped through this ingenious technique which was first described around 40 years ago. Liposuction is most often used as part of other procedures, such as neck liposuction in a facelift, or to the abdomen and flank regions in abdominoplasty.
The main limitation of liposuction is not simply the absolute volume of fat cells that can be removed but rather being unable to predict how elastic the overlying skin is. If the skin is not sufficiently elastic an unattractive contour may result. Not every patient desiring liposuction is a suitable candidate for it and any concerns regarding unpredictability of skin shrinkage should be frankly addressed with patients at consultation.
Loose and excess wrinkly skin in the upper arm can result from weightloss and textural changes associated with the ageing process.
This skin can be removed, and in combination with liposuction the arms can be rejuvenated.
Weightloss, aggressive liposuction and age related loss of elasticity in the skin can contribute to sagging excessive skin in the thigh area.
Excess skin can be excised to recontour the upper leg area and achieve improved shape.
Functional Hand Surgery
Mr McDiarmid is a fellowship trained hand specialist. For many years he ran the hand service at Derriford Hospital in Plymouth as the only fellowship-trained specialist. He undertook this training at the world famous Christine M Kleinert Instutute for Hand and Microsurgery in Louisville, Kentucky, USA in 1999/2000. He offers treatment for carpal tunnel syndrome (surgical and non-surgical), cubital tunnel syndrome, dupuytren’s contracture (palmar fibrosis) and basal thumb joint osteoarthritis.