Is weight loss your New Year’s resolution? What’s next when you lose the weight?

weight loss resolution next steps

Body contouring can help put the finishing touches on your 2020 weight loss goal and keep you motivated. Shedding excess weight, whether by diet and exercise or bariatric surgery, improves your health as well as your appearance.

However, major weight loss can result in excess skin and stubborn pockets of fat that no amount of dietary changes or exercise seem to touch. For this, body contouring procedures can help eliminate the excess skin and sculpt your curves, giving you your desired appearance, improving your motivation to keep the weight off and give you the self-confidence you deserve.

What body contouring procedures are available?

Whether to remove or tighten excess skin or help to repair stretched and lax muscles due to years of excessive weight, there are a variety of different surgical body contouring procedures available. These procedures include:

  • Tummy tuck – This procedure can remove excess abdominal skin as well as help to repair stretched and lax abdominal muscles.
  • Breast lifts and augmentation – Breast lifts can improve sagging tissue while augmentation can increase your bust line and breast appearance.
  • Thigh lifts – This procedure addresses sagging and excess skin on the inner thighs.
  • Upper arm lifts – An upper arm lift addresses excess, sagging skin and tissue in the arms.
  • Facelifts – As you lose weight, you may experience sagging in the mid-face, jowls and neck. Facelifts after weight loss can address these issues, giving you a younger, more defined look.
  • Lower body lifts – Lower body lifts address excess skin and sagging in the abdomen, buttocks, and inner and outer thighs.

How to decide if you are ready for body contouring surgery?

When you have lost a large amount of weight, you may be extremely eager to jump into body contouring surgery to help eliminate your excess skin and complete your weight loss journey. However, there are some important things to consider before you take that step.

  1. You need to be at or near your ideal body weight. If you are continuing to lose weight, now is not the time for body contouring. Additional weight loss after a surgical procedure can result in additional excess skin and the need for additional procedures.
  2. Your weight loss needs to be stable. You may have lost a double or even triple-digit number of pounds, but, as you know, weight loss can fluctuate and keeping weight off is often the hardest part of your weight loss journey. Before you are a good candidate for body contouring surgery, you need to be able to maintain your weight loss and show weight stabilization.
  3. You must be healthy enough for surgery. If you have lost weight naturally through diet and exercise, chances are you are already following a healthy diet and lifestyle. If you lost weight through bariatric surgery, you may need time to adjust to your new dietary restrictions and make sure you are meeting nutritional needs before surgery. If you are a smoker, you will be advised to stop smoking as this can impair healing and recovery.

What added benefits does body contouring provide?

Body contouring procedures address physical concerns such as the removal of excess skin and the repair of stretched muscles. But they do far more than that. After all the work you put in to lose the weight, the excess and hanging skin can create a different set of concerns. While you should be celebrating your success, this excess skin and tissue may leave you feeling self-conscious or even uncomfortable.

Many people who have lost significant amounts of weight report discomfort due to their excess skin. It can interfere with normal activity, including exercise necessary to maintain your new weight loss. Excess sagging skin is also prone to ulcers and infections. Body contouring procedures remove this skin, reducing the risk of infection and giving you the ability to get back to life.

What is your next step?

Once you meet the criteria for body contouring surgery, your next step is to consult with a board-certified plastic surgeon that specializes in body contouring procedures. Together, you and your plastic surgeon will determine which procedures will help you achieve your contouring goals and put a surgical plan in action.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Molecular Characterization of Lipoaspirates Used in Regenerative Head and Neck Surgery

Key Points

Question  What is the composition of lipoaspirates used for lipotransfer in the head and neck, and what is their potential for wound healing in vitro?

Findings  In this case series study of lipoaspirate samples obtained from 15 patients, adipose-derived mesenchymal stem cells were found in high purity and were able to multidifferentiate. The adipose-derived stem/stromal cells and their supernatants had proliferation- and immune-modulating properties in vitro.

Meaning  The findings suggest that lipoaspirates contain a concentration of adipose-derived stem/stromal cells that can be used for regenerative head and neck surgical procedures.

Importance  Adipose-derived mesenchymal stem cells (ASCs) have been used commonly in regenerative medicine and increasingly for head and neck surgical procedures. Lipoaspiration with centrifugation is purported to be a mild method for the extraction of ASCs used for autologous transplants to restore tissue defects or induce wound healing. The content of ASCs, their paracrine potential, and cellular potential in wound healing have not been explored for this method to our knowledge.

Objective  To evaluate the characteristics of lipoaspirates used in reconstructive head and neck surgical procedures with respect to wound healing.

Design, Setting, and Participants  This case series study included 15 patients who received autologous fat injections in the head and neck during surgical procedures at a tertiary referral center. The study was performed from October 2017 to November 2018, and data were analyzed from October 2017 to February 2019.

Main Outcomes and Measures  Excessive material of lipoaspirates from subcutaneous abdominal fatty tissue was examined. Cellular composition was analyzed using immunohistochemistry (IHC) and flow cytometry, and functionality was assessed through adipose, osteous, and chondral differentiation in vitro. Supernatants were tested for paracrine ASC functions in fibroblast wound-healing assays. Enzyme-linked immunosorbent assay measurement of tumor necrosis factor (TNF), vascular endothelial growth factor (VEGF), stromal-derived factor 1α (SDF-1α), and transforming growth factor β3 (TGF-β3) was performed.

Results  Among the 15 study patients (8 [53.3%] male; mean [SD] age at the time of surgery, 63.0 [2.8] years), the stromal vascular fraction (mean [SE], 53.3% [4.2%]) represented the largest fraction within the native lipoaspirates. The cultivated cells were positive for CD73 (mean [SE], 99.90% [0.07%]), CD90 (99.40% [0.32%]), and CD105 (88.54% [2.74%]); negative for CD34 (2.70% [0.45%]) and CD45 (1.74% [0.28%]) in flow cytometry; and negative for CD14 (10.56 [2.81] per 300 IHC score) and HLA-DR (6.89 [2.97] per 300 IHC score) in IHC staining; they differentiated into osteoblasts, adipocytes, and chondrocytes. The cultivated cells showed high expression of CD44 (mean [SE], 99.78% [0.08%]) and CD273 (82.56% [5.83%]). The supernatants were negative for TNF (not detectable) and SDF-1α (not detectable) and were positive for VEGF (mean [SE], 526.74 [149.84] pg/mL for explant supernatants; 528.26 [131.79] pg/106 per day for cell culture supernatants) and TGF-β3 (mean [SE], 22.79 [3.49] pg/mL for explant supernatants; 7.97 [3.15] pg/106 per day for cell culture supernatants). Compared with control (25% or 50% mesenchymal stem cell medium), fibroblasts treated with ASC supernatant healed the scratch-induced wound faster (mean [SE]: control, 1.000 [0.160]; explant supernatant, 1.369 [0.070]; and passage 6 supernatant, 1.492 [0.094]).

Conclusions and Relevance  The cells fulfilled the international accepted criteria for mesenchymal stem cells. The lipoaspirates contained ASCs that had the potential to multidifferentiate with proliferative and immune-modulating properties. The cytokine profile of the isolated ASCs had wound healing–promoting features. Lipoaspirates may have a regenerative potential and an application in head and neck surgery.

Level of Evidence  NA.

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The Latest Technology & Inventions

Wolters Kluwer Health

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Extended Butterfly Graft for Functional and Cosmetic Correction of Saddle Nose Deformity

A middle-aged woman presented with saddle nose deformity after prior rhinoplasty. The patient related concerns of chronic nasal obstruction, which had worsened in the years since her procedure. She was also concerned about the appearance of her nose. She wished to have the deformity corrected and to have normal breathing restored.

Examination demonstrated severe nasal saddling with collapse of the cartilaginous dorsum and a deficient bony dorsum due to prior overresection. In addition, the upper lateral cartilages demonstrated an inverted-V deformity. Her nasal tip was overrotated, and the lower lateral cartilages (LLCs) were weakened, producing a pinched nasal deformity (Figure 1). Findings of the Cottle maneuver were positive. Marked internal nasal valve collapse was present, causing substantial functional deficit. Much of the septal cartilage had been resected.

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What kind of scar can you expect after a tummy tuck?

tummy tuck scarring

The tummy tuck (also known as abdominoplasty) is one of the most popular plastic surgery procedures performed in the United States. It is ideal for patients who have excess skin and tissue in the abdominal area. A tummy tuck also addresses the separated abdominal wall muscles (diastasis recti) that can occur after weight fluctuations and pregnancy.

If you are considering a tummy tuck, along with reviewing the benefits of the procedure and the expected recovery time with your surgeon, it will be important to understand the incision scar that will remain after surgery.

Types of tummy tuck incisions

Incisions for a tummy tuck most commonly extend from hip bone to hip bone as well as a small incision around the belly button. This allows your surgeon to remove all the tissue below and just above the belly button. Any stretch marks in that area will be removed as well. The belly button is brought out through a new opening but stays in its original place on the abdominal wall. If liposuction is part of your procedure, these additional incisions are very small and generally made in an area of tissue to be removed.

The mini tummy tuck is best for those who have minimal excess skin or roundness that is limited to the area just below the belly button. This can be done with a shorter incision – often the same length or a bit longer than a typical C-section scar. The incision and recovery for a mini tummy tuck are often less than that of a more traditional abdominoplasty.

For patients with a lot of excess skin due to multiple pregnancies or a large amount of weight loss, an extended incision may be recommended. Patients who have successfully lost weight with gastric bypass or diet and exercise in excess of 100lbs can have laxity and excess tissue that extends both horizontally and vertically. The procedure is sometimes referred to as a fleur-de-lis tummy tuck. In addition to the standard tummy tuck incision, it includes a vertical incision from the lower breastbone to the pubic bone. The final scar will resemble a large upside-down T.

Caring for your incision to minimize scarring

No matter what incision you plan to have for your tummy tuck it is important to review your plastic surgeon’s aftercare program so that your incision heals with the best scar possible. Most surgeons use surgical glue and steri strips or paper tape at the time of surgery. They may transition you to a scar cream after two weeks and some will incorporate laser therapy to optimize scar remodeling following surgery.

It will be important to keep your incision out of the direct sun and use sunscreen for the first several months after surgery to help your scar heal to its best potential. It will take a full year for the scar to completely fade.

Next steps on your tummy tuck journey

Tummy tuck surgery should be tailored to your individual body type and may include additional procedures such as liposuction to achieve the best results. It is important to seek a consultation with a board-certified plastic surgeon to determine whether you are a candidate for a tummy tuck procedure and discuss the surgical plan that best meets your needs and expectations.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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New Technology & Inventions

Wolters Kluwer Health

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Review of Facial Trauma Surgery: From Primary Repair to Reconstruction

There are no better authors to write about the advances in any field than those who are actively shaping it. The editors of this text combine nearly 8 decades of clinical experience to provide the most current and comprehensive approach to evaluating and managing facial trauma. True to its subtitle, this book covers everything from the first encounter with the patient with facial trauma in the emergency department all the way through final reconstruction.

The authors include increasingly relevant topics in the field, such as intraoperative imaging, virtual surgical planning, and vascularized composite allotransplantation, that previously may have been considered tangential but are now integral to modern facial trauma surgery. In our increasingly digital world, the book appropriately includes an easy-to-use electronic book, which includes a collection of high-quality videos that walk the viewer through many of the evaluation methods, clinical examination findings, and surgical techniques that are described in the text.

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How to decide if you need a breast lift, breast implants or both

how to decide if you need a breast lift, breast implants or both

If you have considered having cosmetic breast surgery, there is a good chance that you have also wondered if you need breast implants and/or a breast lift.

A woman’s body goes through many changes throughout her lifetime, especially during pregnancy and breastfeeding. Breasts can lose their youthful perkiness and even start to sag on the chest. These changes are not only reserved for women with large, heavy breasts; small chested women can also experience deflated breasts or a downward droop.

So, how can you determine if the way back to a youthful-looking chest will be through breast augmentation, breast lift or both? Various factors will come into play when making this decision. The three most important points include nipple position, your desire for more breast volume and the overall breast size you would like to achieve. It is a combination of these patient-specific goals that should steer you in the right direction.

What you need to consider

Nipple position

If you look in the mirror and notice that your nipples point downward or sit below your breast crease, you may be a good candidate for a breast lift. Sagging tissue or the loss of volume can cause the nipple/areola to change position, stretch or become larger. When the breasts lose volume and become heavier in the lower pole, your nipple will sag, as well. While raising breast tissue, a breast lift will also reposition the nipple/areola to a more proportionate position. During the mastopexy, your surgeon can also reshape your nipple/areola, as well.

Volume

Breast volume refers to how round or full your breasts appear. Weight loss can leave the breasts looking flat or too small. Additionally, age or pregnancy and breastfeeding can cause the breasts to become larger and then deflate. In this situation, a breast implant can be used to restore volume to the chest, improving the shape of your breasts. A breast lift may also be needed to address any lax tissue.

Breast size

As the most common cosmetic plastic surgery procedure performed every year, there are many reasons women are unhappy with their breast size. You may have always wanted larger breasts or want to correct asymmetrical breasts. During your consultation, your plastic surgeon will explain all of your implant options. You will also have a chance to try on implant sizes, giving you a better idea about how you will look after the procedure.

Combining breast augmentation with a breast lift

A breast lift and breast augmentation can be performed alone or combined into one procedure. Combing procedures can save you both money and time spent in recovery. However, choosing to have a breast lift years after your breast augmentation will not normally be a problem.

Everything begins with a breast augmentation consultation

Start your journey with a consultation with a board-certified plastic surgeon, with years of experience. He or she will be a vital part of your team, walking you through this life-changing cosmetic procedure. When choosing a board-certified plastic surgeon, ask to look through their before and after photographs. These will give you a good idea of their style and skill level. The more pictures they have to offer can often be an indicator of their satisfied patients and their level of experience.

Your consultation should consist of an extensive, patient-centered evaluation where your surgeon will answer your initial questions, learn about your medical history and find out what your desired results will be. Next, the surgeon will evaluate breast shape, nipple position and breast size. Together, you will determine the right procedure(s) to achieve your desired results.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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In, Out, And On Your Way

Wolters Kluwer Health

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Changes in Opioid Prescribing Habits for Patients Undergoing Rhinoplasty and Septoplasty

Key Points

Question  Has there been a decrease in the amount of opioids prescribed to patients following rhinoplasty and/or septoplasty since the Vermont opioid prescribing legislation took effect on July 1, 2017, and if so, are patients experiencing more postoperative pain?

Findings  In this case-control study of 80 adults, the mean number of opioid pills prescribed to patients after the Vermont opioid prescribing legislation decreased from 17.5 to 9.7, which was associated with a statistically significant decrease in the mean morphine milligram equivalents that were prescribed (130.9 to 73.2). There was no statistically significant difference in the number of postoperative telephone calls for pain, second prescriptions, or increased complaints of pain at the postoperative visit.

Meaning  Since there was no increase in patients’ complaints about postoperative pain or a need for a second prescription after surgery, the decreased amount of opioids prescribed seems sufficient for pain control.

Importance  Opioid prescriptions have increased substantially over the last 2 decades, contributing to the opioid epidemic. Physician practices and legislative changes play a key role in decreasing prescription opioid use.

Objective  To evaluate changes in opioid prescribing habits for patients undergoing rhinoplasty and/or septoplasty before and after the adoption of new opioid legislation.

Design, Setting, and Participants  This single-institution case-control study examined opioid prescribing habits for 80 patients who were undergoing rhinoplasty and septoplasty with or without turbinate reduction at the University of Vermont between March 2016 and May 2018. Patients were excluded if they underwent concomitant endoscopic sinus surgery or were younger than 14 years. Patients were divided by surgery date before or after legislative changes on July 1, 2017.

Exposures  Rhinoplasty and septoplasty with or without turbinate reduction.

Main Outcomes and Measures  Patient demographics and opioid prescriptions were recorded. Patients were evaluated if they reported pain during follow-up, called the office, or received a second prescription. The Vermont Prescription Monitoring System was queried to determine if opioid prescriptions were filled within 30 days of the procedure. The 2 groups were compared to test the hypothesis that opioid prescriptions had decreased after legislative changes.

Results  Of a total of 80 participants, the mean (SD) age in the before (15 women [37.5%]) and after (16 women [40.0%]) groups were 41.4 years and 40.6 years, respectively. There was a statistically significant decrease in the number of pills prescribed to the after group (17.5 to 9.7; P < .001) as well as a decrease in the morphine milligram equivalents that were prescribed (130.9 to 73.2; P < .001). There was no statistical difference in the number of postoperative telephone calls for pain, second prescriptions, or increased complaints of pain at the postoperative visit.

Conclusions and Relevance  Recent laws in Vermont regarding opioid prescribing were implemented in 2017 to curb the ongoing opioid epidemic. Our observations of patients undergoing septoplasties and rhinoplasties found a significant reduction in opioid prescriptions. This was not associated with an increase in patient complaints about postoperative pain or the need for a second prescription after surgery. This shows that we may safely be able to decrease the number of narcotic medications that we prescribe.

Level of Evidence  3.

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