How to Reduce Complications From Excess Skin Removal Surgery

Reducing Complications in Body Contouring for Post-Bariatric Patients

Most extreme weight loss patients struggle with excess skin after undergoing bariatric (weight loss) surgery, like gastric bypass (Roux-en-Y) or sleeve gastrectomy.

That’s where body contouring surgery comes in. Various skin removal cosmetic procedures, such as abdominoplasty, thigh lift, arm lift, and breast lift can help remove and tighten loose skin and reshape your body after bariatric surgery.

However, same as with any other surgery, these procedures carry a risk of post-op complications.

Dr Craig Rubinstein is a specialist plastic surgeon in Melbourne, Australia. Throughout the years, he’s gathered experience and in-depth knowledge of science-backed precautions that can prevent complications from skin reduction surgery after weight loss.

Continue reading to learn more about possible complications from post-bariatric skin removal surgery and what can be done before, during, and after the procedure to help avoid them.

What is Post-Bariatric Skin Reduction Surgery?

A post-weight loss skin removal surgery is a cosmetic procedure that gets rid of extra skin that usually results after extreme weight loss.

When you gain weight, your skin stretches to create more space for fat buildup. When the skin stretches out too much, it loses elasticity and can’t fully retract back into shape after you shed the extra weight.

That’s why you end up with flaps of skin that hang from your body after losing a lot of weight through diet, exercise, or bariatric surgery.

Skin reduction surgery removes the lax, overstretched skin, tightens the remaining skin, and reshapes the treated area after massive weight loss. Below are some of the most popular skin removal procedures after weight loss surgery:

• Abdominoplasty: This procedure removes excess abdominal skin and fat and tightens the underlying muscles.
• Arm lift (brachioplasty): An arm lift is a cosmetic procedure that removes excess skin and tissue from the arms.
• Thigh lift: A thigh lift eliminates extra skin from the thighs.
• Breast lift (mastopexy): A breast lift raises the breasts and removes excess breast skin.
• Lower body lift: This cosmetic procedure eliminates excess skin and fat from the stomach, thighs, and buttocks.

What are the Potential Complications of Post-Bariatric Skin Removal Surgery?

Patients can expect bruising, swelling, and minor pain during recovery after a breast lift, thigh lift, or abdominoplasty.

Nonetheless, like any other surgery, post-bariatric skin removal surgeries may cause complications, including the following:

1. Wound dehiscence (wound separation) : An incision may reopen during the healing period after skin removal surgery. This is known as wound separation or dehiscence. This complication may occur after any body contouring surgery but is most common after abdominoplasty, which requires large incisions.
2. Wound infection : An infection can occur when microbes enter a surgical wound, causing symptoms such as redness, pus discharge, and fever. Surgical site infection is one of the most common complications of skin removal surgery after weight loss.
3. Skin necrosis (tissue death) : When not enough blood and oxygen reach the skin around the incision, the tissue in that area can suffocate and die, turning blue to black. This post-op complication is more common in smokers since smoking reduces the blood flow to the wound.
4. Seroma : A seroma is a fluid buildup under the skin, commonly near incision sites after body contouring surgery. It may appear as a tender swelling or lump. You can develop a seroma right after skin reduction surgery or during the weeks after it.
5. Hematoma : Hematoma is a pocket of blood that collects under the skin. It may look like a raised, dark bruise. It usually takes 48 hours for a hematoma to develop after plastic surgery, but sometimes it can take up to ten days for the blood to pool.
6. Deep venous thrombosis (DVT) and pulmonary embolism (PE) : A blood clot can form during or after skin reduction surgery since the body remains still for a long time. If the clot forms within a deep vein in the calf or thigh, it’s called a deep venous thrombosis (DVT). When the clot breaks off, travels to the lungs, and blocks a blood vessel in the lungs, it’s known as a pulmonary embolism (PE).

What are the Risk Factors for Complications of Post-Bariatric Skin Reduction Surgery?

No matter how healthy, any patient may develop complications following skin removal surgery after extreme weight loss.

Nonetheless, some factors may increase your risk of having post-op complications, including:

• A high BMI : People who have a high BMI at the time of their skin reduction surgery are more likely to develop postoperative complications. Excess fat can block the blood and oxygen flow toward the incision site and slow wound healing.
• Smoking : Smoking reduces blood flow, delays healing, and can prolong recovery. The longer it takes for your wounds to heal, the higher your chances of getting a post-op infection.
• Unresolved health issues : People with unresolved medical conditions, such as diabetes, hypertension, heart disease, lung disease, anemia, or blood clotting problems, have a higher risk for complications from cosmetic surgery.
• Malnutrition : Nutrients, such as vitamins and proteins, are essential for wound healing and recovery. A nutrient deficiency increases the risk of wound separation, infection, and skin necrosis after excess skin reduction surgery.
• Certain medications : Steroids, blood-thinning meds, and other drugs can increase your risk of bleeding, slow wound healing, and delay recovery after cosmetic surgery.
• Type of surgical procedure : You have a higher risk of having blood clots, wound healing problems, and other complications if surgery lasts several hours or requires removing a considerable amount of excess tissue.
• Limited physical activity : Many people don’t move around much after skin removal surgery because of pain, discomfort, or inability to walk. Physical inactivity after cosmetic surgery increases your risk of developing a blood clot (DVT, PE) and other complications.
• Poor post-operative care : You are more likely to develop a post-op infection if you don’t keep your wounds dry, clean, and sterilised after plastic surgery. The risk of developing hematomas and seromas increases if you don’t wear your compression garments as recommended or if surgical drains become removed too early.

Having one or more of these factors doesn’t necessarily mean you will develop a complication from your skin removal procedure after weight loss surgery, but it does increase your risk.

How to Prevent Complications from Post-Bariatric Skin Removal Surgery?

Several things can be done by the patient and the surgical team before, during, and after post-bariatric skin reduction surgery to minimise the risk of complications and delayed recovery.

Before Plastic Surgery: PRE-operative Precautions

Below are the best ways to prepare for post-weight loss skin removal surgery and reduce post-op complications.

Blood tests

A pre-surgical health evaluation can help decrease the risk of bleeding, blood clots, wound infections, and other complications after post-weight loss skin reduction surgery.

Nutrient deficiencies are common in people who have had weight loss surgery. Post-bariatric patients often have:

• Low albumin and hemoglobin
• Vitamin A, C, and B complex deficiency
• Iron, zinc, and selenium deficiency

These nutrients play an essential role in wound healing and recovery.

Blood tests before skin removal surgery can help diagnose and treat these deficiencies and other underlying health conditions, such as a viral infection, blood clotting disorders, or anemia.

Taking multivitamin supplements and treating health concerns can improve wound healing and prevent complications after skin removal surgery in massive weight loss patients.

Stop smoking

Patients should quit smoking at least six weeks before a body-contouring procedure after sleeve gastrectomy or other bariatric surgery.

Smoking reduces blood flow, delays wound healing and recovery and damages health in general.

Quitting smoking will decrease your risk of wound healing problems and other complications after skin removal surgery.

Avoid alcohol consumption

Alcohol can thin your blood and cause you to bleed more during surgery.

Don’t drink alcohol in the days before your post-weight loss skin reduction procedure to prevent possible complications.

Inform your surgeon about any medications you’re on

Some OTC medications act as blood thinners and can increase bleeding and bruising after surgery. Those include herbal supplements (Gingko, ginseng, St. John’s Wort), vitamin E, Aspirin (ibuprofen, Aleve, Motrin), and anti-inflammatory drugs (Advil).

Ask your surgeon when and how you should stop taking these meds before post-weight loss body-contouring surgery to reduce the risk of complications.

Get close to your ideal weight

Having a high BMI at the time of your post-bariatric skin removal surgery increases your risk for complications.

After gastric sleeve or another bariatric surgery, weight loss patients must be at or close to their ideal weight before undergoing body-contouring surgery. This will help minimise the risk of postoperative complications.

Maintain good hygiene

Keep the surgical area clean and sterilised in the days preceding the surgery.

The night or morning before skin removal surgery, take a shower and wash your skin thoroughly with antibacterial soap. This will help decrease the risk of post-op wound infections.

Probiotics

During excess skin removal surgery, your gut bacteria might become disrupted, which can trigger postoperative wound infections.

Studies show that taking probiotics (a mixture of good bacteria and yeast) before surgery can decrease the risk of complications such as infections following skin reduction procedures after bariatric surgery.

Antibiotics

Your surgeon may prescribe an antibiotic treatment before post-weight loss skin removal surgery to help prevent postoperative infections.

Don’t take antibiotics before surgery unless your surgeon instructs you to do so.

During Plastic Surgery: PERI-operative Precautions

Your surgical team can take several precautions during post-bariatric skin removal surgery to prevent possible complications.

Using disinfected surgical equipment

During body-contouring surgery, your medical team should only use surgical instruments and other reusable devices that have been effectively cleaned and sterilised. This will significantly decrease the risk of postoperative complications, such as wound infections.

Perioperative nutritional support

After gastric bypass or sleeve gastrectomy, weight loss patients often have deficiencies in nutrients required for proper wound healing and recovery. Giving post-bariatric patients nutritional supplementation during skin removal surgery decreases wound healing complications.

Using PlasmaBlade for incisions

The PlasmaBlade is a device that uses radiofrequency (RF) energy to make precise incisions. Using PlasmaBlade for incisions can help increase surgical precision, decrease tissue damage, and reduce the risk of bleeding, seroma formation, infections, and other postoperative complications.

Wound closure techniques

Surgical wound closure techniques have evolved significantly and are vital for proper wound healing and preventing post-surgical complications.

Below are some of the most advanced wound closure methods that can help prevent complications after skin removal surgery in weight loss patients:

• Evicel Solutions Glue is a medicine used as a sealant (glue) to close up incisions during surgery. It minimises bleeding and helps the wounds heal faster.
• Prineo dressing is a unique wound dressing that seals the incision tightly and protects it from external bacteria that can cause wound infections.
• Vacuum-assisted wound closure (VAC ), also known as negative pressure wound therapy (NPWT), applies negative pressure to the open wound to remove fluids from it and bring its edges tightly together. This will stimulate the growth of new tissue, help the wounds heal faster, and decrease the chances of surgical site infections from skin reduction procedures after bariatric surgery.
• Special suturing techniques like the quilting technique can lower the risk of seroma formation, wound dehiscence, and other complications following excess skin removal surgery.

Surgical drains

During a post-weight loss abdominoplasty, thigh lift, or lower body lift, your surgical team may suture drains near your incisions to prevent fluid accumulation under the skin.

Surgical drains are tubes that remove blood and pus from a wound and prevent fluid buildup under the skin. In most cases, they’re enough to prevent post-surgical seroma formation.

A warm surgical environment

If the patient is exposed to low temperatures (<36°) for a long time during surgery, their risk of post-op bleeding and hematoma formation increases.

Keeping the operating room at a moderate temperature of 37° can improve the patient’s outcomes and prevent certain complications after skin removal surgery.

Precise fluid administration

The risk of postoperative hematomas, seromas, and wound healing problems may increase if patients receive higher fluid volumes during surgery.

Precise fluid administration during excess skin removal surgery can help avoid post-op complications in post-bariatric patients.

After Plastic Surgery: POST-operative Precautions

After your cosmetic procedure, you must take proper care of your body and wounds to ensure a speedy and uncomplicated recovery.

Below are the best tips to prevent complications after post-bariatric excess skin removal surgery.

Don’t strain

Avoid heavy lifting and strenuous activity during your recovery from post-weight loss body-contouring surgery.

Heavy physical activity during the initial healing period can strain the wounds and delay your recovery. This would increase your risk of wound breakdown, seroma formation, infection, and other post-op complications.

Get enough rest to give your incisions sufficient time to heal and recover properly.

Perform light physical activities

Although you shouldn’t strain yourself, light movement, such as walking, is encouraged immediately after plastic surgery.

Walking will improve your blood flow and help prevent the formation of blood clots (DVT or PE). Be careful not to push yourself too hard to avoid ripping your stitches.

Avoid smoking

Stay away from smoking, vaping, and second-hand smoke during your body-contouring surgery recovery. That will allow your wounds to heal better and prevent wound separation, skin necrosis, and other complications from your surgery.

Wear your compression garments

A compression garment supports your wounds, reduces swelling, and protects the skin around your incisions. It can prevent seroma formation and help your wounds heal more quickly.

Stick to your surgeon’s instructions on how long you should wear your compression garments following an abdominoplasty, thigh lift, or breast lift to avoid post-surgical complications.

Maintain good hygiene

Dr Rubinstein will provide detailed post-operative wound care instructions to help you prevent wound infections and ensure a speedy recovery.

Keep your wounds dry and clean, and follow your surgeon’s post-op instructions for a smooth and uncomplicated recovery.

Give your body enough nutrients

Supply your body with nutritious, healthy meals after excess skin removal surgery.

Proteins, vitamins, and other nutrients can speed up your wound-healing process and reduce post-surgical complications.

Inform your surgeon of concerning symptoms

Contact your surgeon immediately if you develop a fever, worsening pain, excessive bleeding, or other warning symptoms after skin reduction surgery.

If caught early on, your surgeon could easily manage your post-surgical complications and prevent them from worsening.

You can’t completely prevent complications after surgery. Nevertheless, Dr Rubinstein takes all the necessary precautions and measurements to make your body-contouring surgery as safe and successful as possible.

How Do You Manage Complications From Post-Bariatric Skin Reduction Surgery?

Postoperative complications can happen even with the top plastic surgeon and the most advanced surgical techniques.

Dr Rubinstein can perform several interventions to manage complications after your skin removal surgery in case they do occur.

Antibiotic therapy

Our surgeon will prescribe an antibiotic treatment to clear the bacteria if you develop a wound infection after post-bariatric body-contouring surgery.

You’ll receive oral (pills) antibiotics in case of a mild infection. More severe cases may require hospital admission and intravenous (IV) antibiotics treatment.

Fluid aspiration

If you develop a seroma or a hematoma after skin removal surgery, the plastic surgeon will insert a small plastic tube into your surgical incision and drain the accumulated fluid.

Your surgeon can also treat a post-op wound breakdown by draining the blood, fluid, or pus collecting under the wound and causing it to reopen.

Moreover, fluid aspiration can help treat a wound infection when combined with antibiotic therapy. Your surgeon will reopen the wound and aspirate the pus to clear the infection.

Wound debridement

Wound debridement involves removing dead or infected cells from the wound using a special wound bandage, scissors, or a scalpel.

It can treat wound separation and infections after plastic surgery and accelerate wound healing.

VAC dressing treatment

Coco Ruby plastic surgeons can use vacuum-assisted wound closure (VAC) to remove fluid and infection from a separated wound and bring the edges of the incision tightly together.

That makes it easier for the wound to repair and heal after body-contouring surgery.

Managing your risk factors

Your surgeon may be able to treat your post-surgical complications by managing the risk factors that could have caused them.

For example, controlling blood glucose levels in diabetic patients can help quicken wound healing and prevent additional complications.

Re-closure of wounds

In very rare circumstances, your specialist plastic surgeon can reclose an open wound using staples or new stitches. If your wound separation is deep, you may need another surgery to close your incision adequately.

All surgeries come with a risk of complications. However, our experienced surgeons use their knowledge, skills, and experience to take all necessary precautions and reduce the risk of complications from excess skin removal procedures after bariatric surgery.

Medical Sources:

• Reducing complications in post-bariatric plastic surgery: our experience and literature review – PMC
• Complications of Lower Body Lift Surgery in Post-Bariatric Patients – PMC
• https://parjournal.net/article/view/2754
• Safety of Outpatient Circumferential Body Lift: Evidence from…: Plastic and Reconstructive Surgery
• Minimizing complications in abdominoplasty: An approach based on the root cause analysis and focused preventive steps – PMC
• PULMONARY EMBOLISM AFTER ABDOMINOPLASTY – ARE WE REALLY ABLE TO AVOID ALL COMPLICATIONS? CASE REPORTS AND LITERATURE REVIEW
• Gut microbiome, surgical complications, and probiotics – PMC