The surprising procedure everyone is asking for after weight loss [Dan Zegzula, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After. GLP-1s, it's been about two years since they really became widely available. I'm curious if you've seen a lot more people who've lost a lot of weight coming by to say, how can you help me?

Dr. Zegzula (00:15):
GLP-1s have been an amazing breakthrough, and we do see more patients who have been on GLP-1s coming in for body contouring surgery. And I was also surprised to see that some of these patients that are coming in have had prior bariatric surgeries, whether it be a gastric band, a gastric sleeve procedure, or even a gastric bypass, despite those surgeries still didn't hit their weight loss goal. And so they're adding a GLP-1 medication and they continue to lose weight after that to get to their goal. So these patients do come to see us and say, okay, I'm at my goal weight. What can we do to give me the body that I've been working towards? And that's very exciting. We love doing body contouring surgery at Portland Plastic Surgery Group. There are multiple different procedures for all of the different body areas that are affected by weight loss, such as the face, the breast, the abdomen, the thighs.

(01:18):
I don't think GLP-1 patients are all that different than any other weight loss patient, but it's bringing weight loss to patients that we're never able to succeed before. And so that broadens the patient base that we're seeing, and there's definitely a lot of interest to body contouring when patients finally achieve their weight loss goals. When I evaluate somebody's abdomen, I usually do it in a couple different positions. I'll have them stand and then I can see how the skin drapes, but I'll also have them lay down flat on the exam table. I'll have them challenge their core by doing a straight leg raise or half of a crunch and abdominal crunching, and I'd like to see how their muscles contract and you can see and feel their diastasis if it's there. And if you've never been pregnant, there's a much less tendency to have a stretched abdominal wall and almost never will you get rectus diastasis without a pregnancy.

(02:19):
You might have some fascial laxity, but you won't have a true diastasis because the diastasis really is caused by the pressure of that uterus pushing forward between your rectus abdominal muscles, separating those muscles, moving them laterally. And without that pregnancy effect, then the diastasis is usually not there. So body contouring in patients who've never been pregnant before is a little bit different. Sometimes we can completely skip doing fascial plication, that is tightening the muscles, because truly sometimes they don't need that. And if that's the case, their recovery is faster because they don't have muscle repair. The skin laxity is always there, so we do our tummy tucks, do the skin tightening, but if you don't have muscle separation, if you don't have rectus diastasis, sometimes you can avoid that fascial plication.

Eva Sheie (03:04):
Have you ever noticed a pattern in what people want to get done first? Is there something that emerges like as, this is the thing that drives me the most crazy, I must get this fixed?

Dr. Zegzula (03:13):
A lot of patients really hate their thighs. They really hate loose skin on their thighs, and that may be the one that drives them to get seen or drives them to the office. But the operation that probably gives them a bigger bang for the buck in terms of the way they wear their clothes is going to be their abdomen. Thighs are a little bit easier to hide even under longer shorts or in dresses. A torso is something that if you can't have the torso fit in your clothes, then nothing's going to look good. Discussion with patients in almost a negotiation as to where they want to start, what's their most important goal and how do we get there? Breasts and abdomen typically first followed by thighs later. Everybody gains weight in different ways, and when they lose weight, they have different deformities. And so there have been patients where we've started with the thighs, but more often we start with the abdomen and breasts just because it gets a bigger transformation with one operation.

Eva Sheie (04:07):
I imagine if you were saggy everywhere and you only did your thighs, that'd be an interesting look.

Dr. Zegzula (04:15):
Exactly. Yeah. It's just a little bit harder because sometimes the scars that are involved in a thigh lift are based somewhat on the scars of the lower abdomen and where the thigh lift scars are placed as they go up into the groin. So I think for a staging ways and planning purposes, I think doing the abdomen first is more logical and it does result in a bigger transformation as the first step.

Eva Sheie (04:40):
What's thigh lift recovery like?

Dr. Zegzula (04:43):
Thigh lift recovery takes about four to six weeks to fully recover, and by that I mean you're back to doing all your exercises that you were wanting to do before. The incisions are relatively long depending on how much skin you have. There isn't any muscle repair involved, so for that reason, you heal more quickly. There's less pain down the line, but you have to let those incisions heal. The nature of a thigh lift is that the incisions are many times hidden in the groin, and the groin is a darker place and a damper place, and so you have to be a little bit more careful with local wound care. You have to get through that early first two to three weeks of wound healing to get the incisions fully healed before you can start exercising. It takes a little while and it's one of the operations where there may be a little bit more risk of delayed wound healing, but the transformation can be pretty remarkable.

Eva Sheie (05:40):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.