The tummy is the part everybody plans for. It is the part they have been pinching in the mirror for years, the part the tummy tuck was invented for. So when a patient a hundred pounds lighter sits down across from me, they are ready for that conversation.
They are not ready for the rest of it. I said as much on a podcast last week, to a host 126 pounds down, and I have written up the timing half already. This is the other half.
“It’s a 360 thing. It’s the whole body, not just the tummy like most people expect.”
Start with the physics, because it explains everything after it.
“The skin envelope has been stretched out. It’s lost those connections with elastin, and you can’t make any new elastin. Once you deflate, just like a balloon, the outside wrinkles. We’re going to get some contracture, it’s just not as much as we would want.”
A balloon does not wrinkle in one spot. So, zone by zone.
The breasts, and I mean both sexes.
“The breast loses its fat content, and this is for both men and women, which is also surprising. You suddenly have saggy breasts, and that can affect a lot of patients mentally.”
The men are the ones blindsided. Fixable. Not the reward they pictured.
The buttock is the one I want you to understand, because it deflates twice.
“The same thing happens in the buttock area, and there we have a combination. A lot of these patients losing weight fast are not taking in enough protein, so they’re also losing muscle. About a quarter of the weight loss is going to be muscle mass. So the body loses muscle mass plus the fatty content, and then we have the sagging in the buttock.”
A quarter of it is muscle. The buttock is mostly muscle. So the weight-loss months matter here.
“It depends on the amount of weight you lose, how fast you do it, and how you take care of yourself during that time. Are you taking protein? Are you doing weightlifting and building muscle? The skin is going to react the way it does. We can’t do a lot about it. We can help it in some ways, but you shouldn’t feel bad if you have excess skin.”
Then the zones nobody mentions until I ask.
“Some patients have it in the inner thighs, the arms, the back.”
Inner thighs rub. Arms show in a short sleeve. The trunk I covered in the body lift post.
Will it come back if you wait? Some.
“Younger patients are going to retract better. Everybody retracts some, probably not as much as we would want, and it’s also sooner than people think. It really happens in the early stages, and I think at a maximum of a year it’s all done.”
A year is the ceiling.
Where do I start?
“If you’re losing 40 pounds, I think you’re going to need a surgical procedure. It depends: some people care about the face, some about the buttocks, so it’s very personal what gives the patient the self-confidence.”
The face changes first. You rank the rest, not me.
Timing, which I laid out here:
“What I’ve been seeing is about a six to nine month weight loss and then about a three month stabilization until we’re ready for surgery.”
“And the main thing is not to bounce back. When you stop taking it, if we have a bounce back, that can pretty much destroy everything we did, and the fat is not going to come back in the right places necessarily.”
One last thing, usually said as an apology.
“Patients lose the weight, the envelope stays, and some patients feel ashamed of it, like they did something wrong. That’s not the fact. It’s just the way things work. Skin stops producing elastin after puberty, so it just doesn’t contract like it does during puberty.”
You did the hard part. The skin is the part I do.
The full clinical version, with the zone-by-zone table and the procedure pages, is on agulloplasticsurgery.com.
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