Plastic surgery after bariatric surgery

Why doesn’t the skin shrink back after bariatric surgery?

Stretched for years, the skin has lost some of its elastic fibres and collagen. When fat melts away quickly, the skin does not shrink back at the same pace. The excess skin then forms folds: an abdominal apron covering the pubic area, skin that “flaps” on the inner arms and inner thighs, deflated and sagging breasts, folds on the back and flanks.

These folds make dressing and exercise difficult. They can also lead to irritation and fungal infections in the skin folds. Physical activity strengthens the muscles, but it does not tighten the skin: only surgery removes excess skin.

When should you see a plastic surgeon after a sleeve or bypass?

Surgery is considered once your weight has been stable for at least 6 months. This point is generally reached 12 to 18 months after bariatric surgery. If your weight continues to fall after the procedure, the skin becomes loose again and the result is less good.

You can come for a consultation earlier, to review the areas to be treated and plan the stages. Before the procedure, your nutritional status must be satisfactory and you must stop smoking at least one month before and one month after the procedure.

Which procedures for which areas?

Area	Procedure	Scar	Price
Abdomen only	Abdominoplasty (tummy tuck)	Lower abdomen, within the knickers line, and around the navel	€5,000 to €10,000
Abdomen, hips, buttocks, outer thighs	Lower body lift	Around the waist, within the swimsuit line, and around the navel	€6,000 to €15,000
Arms, sides of the chest, back, chest	Upper body lift	Inner arm, extended along the side of the chest, under the breasts or on the back	€6,000 to €12,000
Arms	Arm lift (brachioplasty)	Inner arm, from the armpit to the elbow	€3,500 to €7,500
Inner thighs	Thigh lift	Groin crease and inner thigh, down to the knee	€4,000 to €8,000
Breasts in women	Breast lift, with or without implants	Around the areola, vertical or inverted T	€4,000 to €7,500 (€6,000 to €8,500 with implants or lipofilling)
Chest in men	Gynaecomastia	Around the areola, more extensive if there is excess skin	€2,500 to €5,000

The abdomen: abdominoplasty or body lift

When only the abdomen is affected, an abdominoplasty removes the abdominal apron and tightens the abdominal wall. After major weight loss, the laxity often extends beyond the abdomen: a lower body lift tightens the abdomen, hips, outer thighs and buttocks in a single procedure. All about the body lift

The arms and upper body

An arm lift removes the skin that “flaps” on the inner arms, most often combined with liposuction. When the folds extend to the chest and back, an upper body lift combines an arm lift, a lift of the sides of the chest and of the back and, depending on the case, correction of the breasts. All about the arm lift

The thighs

A thigh lift removes loose skin from the inner thighs. It may or may not be combined with liposuction of the thighs. All about the thigh lift

The breasts

In women, the breasts are often deflated and sagging: a breast lift removes the excess skin and raises the gland, combined if necessary with implants or lipofilling to restore volume. In men, the chest may retain excess skin and glandular tissue, treated as gynaecomastia. All about the breast lift · All about gynaecomastia

The face and neck

Major weight loss can also loosen the skin of the face and neck. A face and neck lift tightens these tissues.

In what order are the procedures carried out?

There are usually many areas to treat. They are corrected in several operative stages, 3 to 6 months apart. The abdomen is generally treated first, as the abdominal apron is often the main problem. The upper body lift is most often carried out some time after the lower body lift, as a separate procedure. Some procedures can be combined in the same operation, for example an abdominoplasty and a breast lift, or an arm lift and a breast lift. The order is decided with you at the consultation, according to your priorities and the examination.

Dr Médard de Chardon’s experience in surgery after weight loss

Dr Médard de Chardon has practised in Cannes since 2011 and has performed more than 300 body lifts. He carries out the full range of procedures in surgery after weight loss: abdominoplasty, lower and upper body lift, arm lift, thigh lift and breast lift. He does not perform bariatric surgery itself, which is the field of the digestive (gastrointestinal) surgeon.

Sleeve, bypass, band: what difference does it make for plastic surgery?

A sleeve gastrectomy removes a large part of the stomach. A gastric bypass also bypasses part of the intestine, which reduces the absorption of food. The gastric band, less often fitted today, narrows the entrance to the stomach. After a bypass, deficiencies in protein, iron and vitamins are more common. Dr Médard de Chardon checks for them with tests he prescribes at the consultation; they are corrected before the procedure, as they can delay healing. The choice of bariatric technique and its follow-up are the responsibility of the digestive surgeon and the team who operated on you.

How to prepare

• a recent nutritional and blood assessment (protein, iron, vitamins), prescribed at the consultation;
• a weight that has been stable for at least 6 months;
• stopping smoking completely at least one month before and one month after the procedure;
• stopping aspirin, anti-inflammatory drugs and herbal supplements, which increase bleeding;
• the operative report from your bariatric surgery and the letters from your follow-up, to bring to the consultation.

What does the care pathway involve?

1. ConsultationAt the practice, 101 rue d’Antibes, Cannes (€100): examination of the areas, choice of procedures and their order, photographs, written quote.
2. Request for prior approvalTo the Assurance Maladie, if the criteria for cover are met. You will be called in by the Assurance Maladie medical adviser within 15 days of their receiving the letter.
3. Cooling-off period15 days after the quote is given to you.
4. Anaesthetic consultationWith an anaesthetist (anaesthesia and intensive care specialist).
5. ProcedureAt the Clinique Oxford in Cannes, under general anaesthesia; duration and length of stay depend on the procedure (from 1 to 3 nights for a lower body lift).
6. Follow-upAt the practice for 12 months.

What are the risks?

Like all surgery, these procedures carry risks, explained in detail at the consultation: delayed healing, made more likely by smoking and deficiencies; widened or thickened scars; haematoma; collection of lymph fluid (seroma); infection; temporary changes in sensation; phlebitis, prevented by preventive anticoagulant treatment; asymmetry. After major weight loss, skin quality and nutritional status make these risks a little more frequent. Choosing a qualified, experienced and reputable surgeon reduces these risks, and in some cases eliminates them.

Is it covered, and how much does it cost?

The Assurance Maladie may cover part of an abdominoplasty when the abdominal apron covers at least part of the pubic area, after prior approval. Body lifts, arm lifts and thigh lifts may be covered after a request for prior approval if the criteria are met. True gynaecomastia is covered without a request for prior approval. A cosmetic breast lift is not reimbursed. As Dr Médard de Chardon practises in Sector 2 (fees above the national health insurance rate), additional fees remain payable by you or by your mutuelle (top-up health insurance), depending on your policy.

Prices range from €2,500 to €15,000 depending on the procedure (see the table above), on a written quote after the consultation (€100). The quote includes the surgeon’s and anaesthetist’s fees and the clinic charges.

Frequently asked questions