Selected Podcast
Body Contouring
Neal Goldberg, MD, FACS discusses who is a good candidate for body contouring, and how this simple procedure can change your outlook and help you complete your weight loss journey.
Featured Speaker:
Learn more about Neal Goldberg, MD
Neal Goldberg, MD, FACS
Neal Goldberg, MD graduated from NYU School of Medicine before continuing to train in plastic and reconstructive surgery. Prior to medical school, Dr. Goldberg graduated magna cum laude from the Wharton School of the University of Pennsylvania, where he concentrated on health care policy and economics. Dr. Goldberg completed training in plastic, aesthetic, and reconstructive surgery at Albert Einstein College of Medicine/Montefiore Medical Center.Learn more about Neal Goldberg, MD
Transcription:
Body Contouring
Melanie Cole (Host): Dramatic weight loss has many benefits, but after any substantial amount of weight loss due to weight loss surgery or lifestyle changes; the skin and tissues may lack the elasticity to conform to the reduced body size. Here to tell us about this is Dr. Neal Goldberg. He’s a plastic and reconstructive surgeon at St. John’s Riverside Hospital. Dr. Goldberg tell us about what happens to the skin after someone loses a large amount of weight.
Neal Goldberg, MD, FACS (Guest): Well you can imagine that at a certain point in your life, your skin is more like balloons. If you would deflate the balloon, the balloon would decrease in size to the size it was before you blew it up. Human skin is like that to a point, but past a point; it loses that elasticity and when you deflate that balloon, it’s more like deflating a plastic bag that doesn’t have elasticity, so an empty plastic bag will have redundancy and some of that will not improve with further diet and exercise. And that’s where surgery may be necessary.
Melanie: Tell us about that then. What is body contouring?
Dr. Goldberg: Well body contouring is the removal of extra skin also and removal of extra fat in certain areas in order to create the shape that you are looking for. I think it is best thought of as treating your shadow. It’s the outlines of your body that you are looking to address and sometimes there are scars that are required in order to achieve that but we place these scars in very hard to notice places, places that are typically concealed like panty line, or under the arms when we are doing breast contouring, we put the scar underneath the breast so in normal clothing; these scars would not be visible.
Melanie: Who is it for and who is a good candidate and are there some people for whom this is not an option?
Dr. Goldberg: Well sure there are always people who are not surgical candidates but most people who have undergone the surgery – bariatric surgery in order to lose the weight are also good candidates for the body contouring surgery that ensues. The body contouring is not just for people who have had massive weight loss. Liposuction is a body contouring procedure that’s done for patients that may not have had significant weight loss and again, it is for changing the shape of their outline of their body. Liposuction is really not for – a vehicle for weight loss; it’s really more of a vehicle for changing the contour.
An abdominoplasty is a common procedure that is done both for patients who have had massive weight loss and for patients who maybe have had a pregnancy that have left them with some loose skin on their abdomen. Pregnancy can also typically separate the muscles that ordinarily make up the abdominal wall. So, these laxities that are created by pregnancy, but not massive weight loss are also treated by a body contouring procedure and that’s abdominoplasty. That’s a procedure where extra skin that may be redundant on your abdomen, is removed, again, through an incision that sits on the panty line and the muscles that may have been separated or stretched from pregnancy are repaired. So, the muscles are now placed more centrally where they are in a better position of function and by doing that, you are also cinching the waistline so again, you are achieving a contour that is desirable.
Melanie: Is this considered major surgery Dr. Goldberg? How is it performed and what’s it like for the patient?
Dr. Goldberg: It can range from minor procedures, outpatient procedures that can be done in an office-based setting to larger procedures that are done in a hospital setting. An example of a minor procedure would be a brachioplasty where excess skin that can develop underneath the arms can be removed when it’s not a tremendous amount of skin, that excision can be done with a transverse excision that is hidden in the underarm. That is a procedure I do in my office. Sometimes a neck lift which is another form of contouring where extra skin that gathers underneath the chin after massive weight loss can be removed. That’s another procedure that can be done in the office. A larger procedure would be what’s called a lower body lift which is an abdominoplasty taking away skin on the front of the body and also continuing it all the way around to take up extra skin that may be on the back or the sides and achieve a thigh lift in the process. That of course is a much larger procedure that is done in the hospital setting and requires an overnight stay. So, it does really range depending on the procedure that we are talking about.
Melanie: Wow it certainly seems that it does. So, we know that there are risks with any procedure. But are there specific risks that go with body contouring?
Dr. Goldberg: Well you have the general surgical risks which apply to pretty much any case like you identified. And specific to body contouring; liposuction has the risk of a blood clot that could potentially form and can be problematic and we take every precaution to prevent that. Typically, when we do liposuction or liposuction in combination with another body contouring procedure; I will give you a blood thinner even before the operation which helps prevent the event of a blood clot forming. The risk of doing that of course, is that there may be a slightly higher risk of bleeding during the operation, but bleeding is a much easier problem to treat than the blood clot. So, that is a risk that is not specific to this operation; but is slightly higher. It’s also higher in the patient population if you are talking about patients who once were morbidly obese and are now looking for body contouring; these are patients that may have very dilated veins that are more likely to develop a problem such as a blood clot. So, we have to treat these patients as high risk for that problem.
Beyond that, there are potentially certain risks with regard to the positioning of certain patients with extra skin folds that may cause pressure problems, so especially the patients where we are rotating them on a table in order to achieve a certain contour; positioning becomes a very specific and particular concern that we have and we have to again, take every possible precaution to make sure that positioning is done properly and these risks are minimized.
Melanie: What about after the procedures? What is life like for the patient and how long does it take for them to see results?
Dr. Goldberg: Again, it depends on the case. Liposuction alone, we are talking about not the massive weight loss population can take several months for you to see the results because you are relying on the skin elasticity to retract and that can take several months in order to see the results. When we are talking about removing extra skin, such as an abdominoplasty or a thigh lift or a breast lift; the results are to a large degree immediate but that doesn’t mean that the recovery is immediate; it may take several weeks for you to be fully recovered. But if you were take a phot of yourself even on the operative table; you would see a pretty dramatic improvement. As far as what life is like after it; sometimes it is really life changing. I show patients photos of what they looked like before I did the procedure and then a month later show them the after picture and it’s hard for them to believe. In fact, many patients block out what they looked like before the operation. Now it’s not only even just a question of what they looked like, functionally, removing excess redundant weight that may be hanging down or getting in the way of your walking or running or whatever other activities; having that removed even something as common as a breast reduction can impact your quality of life dramatically and the patient satisfaction is extremely high.
Melanie: Wrap it up for us Dr. Goldberg what you would like the listeners to know about body contouring, the many different types that are available and what questions that you would like them to ask their doctor if they are considering doing these types of procedures.
Dr. Goldberg: Well I think that patients need to be aware that body contouring may be necessary after a massive weight loss or and also is an option for people who haven’t had massive weight loss. Body contouring can be extremely satisfying even life altering like I said. I think it is definitely important to try to get your information from a consultation with me or some board-certified plastic surgeon where you can get direct answers that apply to you, rather than general information that may either not be correct or not be directly applicable for your case from the internet. I think if you are looking to do this, this is something you have to be committed to even the minor procedures are still surgery and you need to understand that there is a healing curve with surgery. I think that the questions that are probably best asked are best asked in direct consultation with a plastic surgeon in their office rather than some remote fashion.
Melanie: Thank you so much Dr. Goldberg for coming on today and sharing your expertise explaining what body contouring is and who might be a candidate for this type of procedure. You’re listening to Riverside Radio HealthCast with St. John’s Riverside Hospital. For more information please visit www.riversidehealth.org, that’s www.riversidehealth.org. This is Melanie Cole. Thanks so much for listening.
Body Contouring
Melanie Cole (Host): Dramatic weight loss has many benefits, but after any substantial amount of weight loss due to weight loss surgery or lifestyle changes; the skin and tissues may lack the elasticity to conform to the reduced body size. Here to tell us about this is Dr. Neal Goldberg. He’s a plastic and reconstructive surgeon at St. John’s Riverside Hospital. Dr. Goldberg tell us about what happens to the skin after someone loses a large amount of weight.
Neal Goldberg, MD, FACS (Guest): Well you can imagine that at a certain point in your life, your skin is more like balloons. If you would deflate the balloon, the balloon would decrease in size to the size it was before you blew it up. Human skin is like that to a point, but past a point; it loses that elasticity and when you deflate that balloon, it’s more like deflating a plastic bag that doesn’t have elasticity, so an empty plastic bag will have redundancy and some of that will not improve with further diet and exercise. And that’s where surgery may be necessary.
Melanie: Tell us about that then. What is body contouring?
Dr. Goldberg: Well body contouring is the removal of extra skin also and removal of extra fat in certain areas in order to create the shape that you are looking for. I think it is best thought of as treating your shadow. It’s the outlines of your body that you are looking to address and sometimes there are scars that are required in order to achieve that but we place these scars in very hard to notice places, places that are typically concealed like panty line, or under the arms when we are doing breast contouring, we put the scar underneath the breast so in normal clothing; these scars would not be visible.
Melanie: Who is it for and who is a good candidate and are there some people for whom this is not an option?
Dr. Goldberg: Well sure there are always people who are not surgical candidates but most people who have undergone the surgery – bariatric surgery in order to lose the weight are also good candidates for the body contouring surgery that ensues. The body contouring is not just for people who have had massive weight loss. Liposuction is a body contouring procedure that’s done for patients that may not have had significant weight loss and again, it is for changing the shape of their outline of their body. Liposuction is really not for – a vehicle for weight loss; it’s really more of a vehicle for changing the contour.
An abdominoplasty is a common procedure that is done both for patients who have had massive weight loss and for patients who maybe have had a pregnancy that have left them with some loose skin on their abdomen. Pregnancy can also typically separate the muscles that ordinarily make up the abdominal wall. So, these laxities that are created by pregnancy, but not massive weight loss are also treated by a body contouring procedure and that’s abdominoplasty. That’s a procedure where extra skin that may be redundant on your abdomen, is removed, again, through an incision that sits on the panty line and the muscles that may have been separated or stretched from pregnancy are repaired. So, the muscles are now placed more centrally where they are in a better position of function and by doing that, you are also cinching the waistline so again, you are achieving a contour that is desirable.
Melanie: Is this considered major surgery Dr. Goldberg? How is it performed and what’s it like for the patient?
Dr. Goldberg: It can range from minor procedures, outpatient procedures that can be done in an office-based setting to larger procedures that are done in a hospital setting. An example of a minor procedure would be a brachioplasty where excess skin that can develop underneath the arms can be removed when it’s not a tremendous amount of skin, that excision can be done with a transverse excision that is hidden in the underarm. That is a procedure I do in my office. Sometimes a neck lift which is another form of contouring where extra skin that gathers underneath the chin after massive weight loss can be removed. That’s another procedure that can be done in the office. A larger procedure would be what’s called a lower body lift which is an abdominoplasty taking away skin on the front of the body and also continuing it all the way around to take up extra skin that may be on the back or the sides and achieve a thigh lift in the process. That of course is a much larger procedure that is done in the hospital setting and requires an overnight stay. So, it does really range depending on the procedure that we are talking about.
Melanie: Wow it certainly seems that it does. So, we know that there are risks with any procedure. But are there specific risks that go with body contouring?
Dr. Goldberg: Well you have the general surgical risks which apply to pretty much any case like you identified. And specific to body contouring; liposuction has the risk of a blood clot that could potentially form and can be problematic and we take every precaution to prevent that. Typically, when we do liposuction or liposuction in combination with another body contouring procedure; I will give you a blood thinner even before the operation which helps prevent the event of a blood clot forming. The risk of doing that of course, is that there may be a slightly higher risk of bleeding during the operation, but bleeding is a much easier problem to treat than the blood clot. So, that is a risk that is not specific to this operation; but is slightly higher. It’s also higher in the patient population if you are talking about patients who once were morbidly obese and are now looking for body contouring; these are patients that may have very dilated veins that are more likely to develop a problem such as a blood clot. So, we have to treat these patients as high risk for that problem.
Beyond that, there are potentially certain risks with regard to the positioning of certain patients with extra skin folds that may cause pressure problems, so especially the patients where we are rotating them on a table in order to achieve a certain contour; positioning becomes a very specific and particular concern that we have and we have to again, take every possible precaution to make sure that positioning is done properly and these risks are minimized.
Melanie: What about after the procedures? What is life like for the patient and how long does it take for them to see results?
Dr. Goldberg: Again, it depends on the case. Liposuction alone, we are talking about not the massive weight loss population can take several months for you to see the results because you are relying on the skin elasticity to retract and that can take several months in order to see the results. When we are talking about removing extra skin, such as an abdominoplasty or a thigh lift or a breast lift; the results are to a large degree immediate but that doesn’t mean that the recovery is immediate; it may take several weeks for you to be fully recovered. But if you were take a phot of yourself even on the operative table; you would see a pretty dramatic improvement. As far as what life is like after it; sometimes it is really life changing. I show patients photos of what they looked like before I did the procedure and then a month later show them the after picture and it’s hard for them to believe. In fact, many patients block out what they looked like before the operation. Now it’s not only even just a question of what they looked like, functionally, removing excess redundant weight that may be hanging down or getting in the way of your walking or running or whatever other activities; having that removed even something as common as a breast reduction can impact your quality of life dramatically and the patient satisfaction is extremely high.
Melanie: Wrap it up for us Dr. Goldberg what you would like the listeners to know about body contouring, the many different types that are available and what questions that you would like them to ask their doctor if they are considering doing these types of procedures.
Dr. Goldberg: Well I think that patients need to be aware that body contouring may be necessary after a massive weight loss or and also is an option for people who haven’t had massive weight loss. Body contouring can be extremely satisfying even life altering like I said. I think it is definitely important to try to get your information from a consultation with me or some board-certified plastic surgeon where you can get direct answers that apply to you, rather than general information that may either not be correct or not be directly applicable for your case from the internet. I think if you are looking to do this, this is something you have to be committed to even the minor procedures are still surgery and you need to understand that there is a healing curve with surgery. I think that the questions that are probably best asked are best asked in direct consultation with a plastic surgeon in their office rather than some remote fashion.
Melanie: Thank you so much Dr. Goldberg for coming on today and sharing your expertise explaining what body contouring is and who might be a candidate for this type of procedure. You’re listening to Riverside Radio HealthCast with St. John’s Riverside Hospital. For more information please visit www.riversidehealth.org, that’s www.riversidehealth.org. This is Melanie Cole. Thanks so much for listening.