Post-Bariatric Plastic Surgery

Dr. Kenkel sees many post-bariatric surgery and other weight loss patients at his Dallas practice who have overcome obesity but need plastic surgery to complete their body transformation. Bulky, sagging skin commonly stays behind after significant weight loss, distorting the contours of the newly slimmer body. This can cause discomfort and discouragement, making it very difficult to fully enjoy the hard-earned weight loss.

If you have reached your weight loss goal and want a physique that matches your hard work, please request a consultation or call the practice at (214) 645-3112 to schedule an appointment.

How will surgery after weight loss help?

Significant weight loss often leaves behind skin and tissue that has lost its elasticity. This can give a slimmer body an irregular look that belies the hard work that went into the weight loss. Body contouring surgery can reshape the skin and tissue to fit the body's new form.

That said, post-bariatric plastic surgery has certain indicators that will ensure a successful result:

  • Your weight loss has stabilized.
  • You do not have any medical conditions that could impair healing.
  • You are a non-smoker.

Dr. Kenkel also stresses that the work you have already done takes a lifetime to maintain. It's important to think about your expectations for surgery and reaffirm your commitment to a healthy lifestyle before deciding to undergo the procedure.

What should I expect from my consultation?

The consultation is your chance to get to know Dr. Kenkel, express your concerns, ask your questions, and confirm your eligibility for the procedure. Dr. Kenkel will be focused on 2 things: listening to you and examining your body.

Once you've gotten acquainted, Dr. Kenkel will explain the surgical techniques that will be best for you. This depends on a number of factors, including the quality of your skin tone and your current body contours.

We will take photos of your body to save in your file after your meeting with Dr. Kenkel. You will then work with our patient coordinator to talk about the cost of your procedure and possible surgery dates. You have the option to schedule a computer imaging appointment, which can model your proposed surgical outcome for you.

What happens during my procedure?

With your safety in mind, we often divide your surgery into 2 or 3 stages. You will be under a general anesthetic for each procedure, which takes about 4 to 6 hours. Staging has flexibility and can be tailored to the patient's desires.

Stage 1: Lower Body & Arms

In the first stage, Dr. Kenkel performs a lower body lift in conjunction with brachioplasty (an arm lift). With the lower body lift, he corrects sagging skin and tissue in the abdomen, buttocks, groin, and outer thighs. To accomplish this, Dr. Kenkel makes an incision all the way around the lower torso. This may seem drastic, but it yields an improved waist, buttocks, and thighs.

For results in the abdomen, the skin is lifted up from the abdominal wall so that Dr. Kenkel can tighten the underlying muscles, lay the skin over top, and hold it in place with sutures. The navel remains attached to the abdominal wall but changes position. During this portion of the procedure, which is similar to a tummy tuck, Dr. Kenkel may insert drains under the incision. These remain for up to 10 days in order to remove fluids produced by the body during the healing process.

The arm lift involves removal of the skin and fat from the upper arm, using an incision from the armpit or chest down to the elbow (and sometimes below). If there is excess fat present, as well, Dr. Kenkel may decide to do liposuction in this area and excise the skin a few months later. This is the region that produces the most prominent scarring, both because of the location and the way the scar heals.

Stages 2 and 3: Inner Thighs, Breasts, Back, and Chest Wall

The second stage of surgery begins with an inner thigh lift. Dr. Kenkel makes 2 incisions: one in the groin and one along the inner thigh. Note that in leg surgery, prolonged swelling (up to 6 months) is common.

When treating breasts, Dr. Kenkel most often uses a J or L-shaped incision, encircling the areola before extending downward to follow the breasts' natural curvature to the lateral chest. The skin is then adjusted to reshape their contour. Many patients require breast augmentation at the same time to achieve their desired results.

With excess skin and tissue on the back, Dr. Kenkel can either use incisions along the bra line, which may extend to the back, or use incisions within the armpit and chest that extend to the breast crease. There are many ways to globally improve contour. Another alternative would be to perform an abdominoplasty with an Upper Body Lift (brachioplasty, lateral chest excision, and breast surgery). After a minimum of 3 months recovery, a thighplasty is performed with a flank excision.

What happens on the day of surgery?

Dr. Kenkel performs the surgery at the Medallion Guest Suites. You will stay 1 to 2 days to begin your recovery and can go home afterward. Please arrange for someone stay with you and to drive you home and assist you in those first few days, because your activity will be limited.

We have created an informative document that details how you can prepare for your surgery. For example, there are some recommended dietary changes, and it's important to stop smoking at least 4 weeks before surgery. Aspirin and certain anti-inflammatory drugs should also be avoided in the weeks leading to your procedure, as they thin the blood and can cause increased bleeding.

What will my recovery be like?

Some pain and discomfort are natural following surgery. Initially, intravenous narcotics provide pain control during your first 24 hours in the hospital. A long-acting pain reliever called EXPAREL® will be used to help you recover during the first few days. You will leave the hospital with prescriptions for both pain medication and antibiotics.

Once you're home, a gradual return to activity is essential. Avoid bending, straining, or lifting for up to a few weeks. Because skin has been removed, you will be walking stooped over for the first 10 days or so, until your remaining skin stretches a little. A compression garment must be worn both day and night for the first 2 weeks, and when you sleep for 2 more weeks after that.

If drains are present, they will be removed in accordance with their output. Dr. Kenkel will ask you to log how much fluid is draining and use that to judge when it's best to remove them. Before you leave the hospital, you will also learn how to care for the drain sites.

The incisions have glue and tape on them so there is no wound care. These will be removed by Dr. Kenkel in the office between 2-3 weeks.

What should I know about the results?

Like all body contouring procedures, surgery after weight loss requires that incisions be made to remove skin and fat. This results in a scar at each incision site. Dr. Kenkel works to make your scar placement as discreet as possible, but it's important to understand that a scar will always be present. Scars can be concealed in some areas and are more visible in others. The scar will take approximately 1 year to mature and fade to a pale hue.

Your results from surgery are just the beginning. A healthy lifestyle is essential to making those results last. Dr. Kenkel provides you with information about proper nutrition and exercise, but ultimately, the longevity of your results is in your hands.

How many visits will I have following surgery?

Typically, Dr. Kenkel will see you the day after your surgery, 3 to 4 days later, and again in 7 to 10 days to remove your sutures. Depending on how you are progressing, drains (when applicable) will be removed between 1 to 3 weeks after surgery, as well. Think of each of these visits as time for Dr. Kenkel to make sure you are on track, and for you to ask any questions or address any concerns that may come up.

Once these initial visits are complete, Dr. Kenkel sets a schedule of appointments at decreasing frequency. Generally, you will settle on something like 3 weeks, 6 weeks, 3 months, 6 months, and 1 year after surgery for follow-up visits. That said, please always feel free to contact Dr. Kenkel at any point during your recovery.

How much does post-bariatric plastic surgery cost?

It's difficult to give a uniform quote because the extent of surgery will vary from patient to patient. During your initial consultation, you will receive a written quote that includes the details of your surgery, the surgeon's fee, hospital and anesthesia fees, and more.

Insurance companies are unlikely to cover the procedure, as they generally consider it cosmetic. We accept cash, check, money order, or credit cards. If you decide that surgery is right for you, we ask for a $500 deposit to reserve a specific time and date for your procedure.

Further Reading

  • Dr. Kenkel helped develop several new body contouring procedures to help patients attain a new, slender body shape after massive weight loss.
  • Dr. Kenkel explains his approach to post-bariatric plastic surgery in detail for the Dallas Medical Journal.