After weight loss, the body changes twice: the role of plastic surgery in body contouring

Losing a significant amount of weight is a major achievement, but it does not always mark the end of the journey. After substantial weight loss, whether achieved through bariatric surgery or the new pharmacological treatments for obesity, many patients face a second challenge: living with the effects left behind by weight reduction, including excess skin, sagging tissues, and functional limitations.

This evolution is described by Professor Vincenzo Vindigni, Full Professor of Plastic Surgery at the University Hospital of Padua and a member of SICPRE (the Italian Society of Plastic, Reconstructive-Regenerative and Aesthetic Surgery), who has specialised for years in post-bariatric plastic surgery and body contouring after major weight loss.

«We have observed an exponential increase in these procedures», explains Vindigni. According to the specialist, this growth is linked both to the improved safety of bariatric procedures and to the widespread adoption of new obesity medications, which enable significant and more easily manageable weight loss.

When weight loss is not enough

Whether the weight loss results from surgery or medication, the impact on the body can be very similar. 

«From an objective and functional standpoint, these patients present the same problems, the same characteristics, and therefore the same types of body-related issues», notes Vindigni.

Excess skin can create not only aesthetic concerns but also practical difficulties in daily life, restricted movement, skin irritation, and hygiene problems. In addition, tissue quality is often compromised. 

«These tissues are poor in elastic fibers and have lost the ability to adapt to the body’s new volume».

Patients requiring special attention

Post-weight-loss surgery requires a highly personalised approach. These are not simple body-contouring procedures but operations involving patients considered to be at higher risk.

«We have seen that these patients have a higher complication rate than the general population», emphasises the professor.

For this reason, preoperative assessment becomes essential. Vindigni highlights the importance of carefully evaluating the patient’s overall health and planning surgery accordingly.

«It is necessary to conduct a thorough assessment of the patient’s physical condition and keep operating time within precise limits, ideally never exceeding three hours».

Postoperative recovery also plays a crucial role. Among the most important tools are advanced dressings and compression garments.

«Compression garments allow patients to get up as early as the following day with optimal comfort, helping to reduce swelling and support tissues during healing», adds Vindigni.

A journey that may involve the entire body

Post-bariatric plastic surgery is not limited to a single anatomical area. Depending on the patient’s needs, body contouring may involve several regions.

«We can operate on the arms, breasts, abdomen, lower limbs, and, in selected cases, even the neck».

At the University Hospital of Padua, treatment follows a structured pathway aimed at restoring both form and function.

«Together with the patient, we decide how to begin this recovery process, evaluating priorities and goals», the professor explains.

Increasingly advanced technologies to reduce surgical trauma

One factor contributing to the evolution of these procedures is the introduction of new technologies in the operating room.

The goal is twofold: to minimise tissue trauma and promote faster recovery.

«We always try to cause as little damage as possible to tissues, especially adipose tissue, which is particularly fragile in these patients».

To achieve this, surgeons use low-energy devices that allow less traumatic tissue dissection, barbed sutures that shorten operating times, and negative-pressure therapy systems that promote wound healing.

When intervention on fatty tissue is necessary, the Padua center employs a technique known as water-assisted liposuction.

«This is a gentle form of liposuction that preserves lymphatic structures through the use of substantial amounts of fluid».

An award-winning technique presented in Boston

The experience developed in Padua recently received important international recognition. At the annual meeting of The Aesthetic Society, held in Boston in May, Vindigni presented an innovative technique that received the “World Champion” award.

«It is the result of years of anatomical studies on perforator vessels and tissue behavior», comments Professor Vindigni.

The procedure makes it possible to use tissue that would normally be removed during a brachioplasty (arm lift) to reconstruct and fill the upper pole of the breast.

«We reuse tissue that would normally be discarded while preserving its blood supply».

The advantage is significant: two body areas can be corrected simultaneously without substantially increasing operating time.

«The technique allows us to solve two problems with a single operation: excess tissue in the arms and the lack of tissue in the breast», concludes the professor.

This approach reflects the direction in which modern plastic surgery is moving: less tissue waste, greater attention to function, and increasingly personalised results.