You've worked so hard to lose the weight, now lose that extra skin


    Is excess skin left over from massive weight loss holding you down?

    You're not alone. About 45% of successful weight-loss patients have to face the scary, uncomfortable, and extreme health problems that can come from too much hanging skin.

    What is body contouring surgery?

    Body contouring is a term used to describe any of a number of individual or combined "lift" surgeries that a patient may undergo after extreme weight loss. The goal of body contouring surgery is to remove hanging fat or skin left over after massive weight loss and improve the shape of the remaining tissue. Although most people believe body contouring procedures are purely cosmetic, patients experiencing the pain and awful side effects that can come with massive weight loss know that all too often, the surgeries are medically necessary.


    Although we typically discuss the need for body contouring after some type of bariatric surgery, the operations actually apply to anyone who has lost a significant amount of weight for any reason. Why? When you lose weight, your skin lacks the elasticity to bounce back and conform to its original shape, leaving an excessive amount of overhang in patients who have lost a lot of weight. In fact, for every 100 pounds a patient loses, 10-15 pounds of hanging skin remains. This excess skin can create serious medical problems for patients, and the only solution is surgical removal of the excess skin folds.

    How many people need post-bariatric body contouring surgery?

    In 2015 there were 196,000 bariatric procedures performed and 50,165 body contouring procedures performed after massive weight loss.

    What kinds of procedures are included in post-bariatric body contouring surgery?

    Post weight-loss body contouring procedures can include breast lift surgery, lower body lifts, upper arm lifts, thigh lifts, and abdominoplasty (tummy tuck) surgery. Body contouring procedures are some of the most complicated and customized of all reconstructive surgeries. In fact, they are more customized and complex than nearly any other reconstructive procedure.


    Why? Because they affect your entire body, and if you start surgically altering the skin on one part of a body that has experienced a large amount of weight loss, it directly affects both the look and function of other body parts. It's easier to imagine with a short explanation. Imagine lifting and removing excess amount of skin and tissue from just your stomach. When you lift the stomach, how does that connect to your sides and your back? How do those connect to your breasts (in women) or your chest (in men)? Having skin that is too tight in one place and too loose in another can make certain problems even worse. This is why it's important to speak with a reconstructive surgeon who can really work with you from a "whole body" perspective to help you determine the least amount of surgery needed for the best visual and functional outcome.

    How big of a problem is excess skin?

    Nearly every successful weight loss patient is all too aware of how big of a problem excess skin really is. Not only is it unbelievably uncomfortable and often depressing, it is clinically very dangerous. From infection risk to muscle strain, hernias, and extensive functional impairments, excess skin is not to be taken lightly and in most cases should be removed when possible so that your remaining skin can be healthy and do what it was designed to do.


    Did you know that your skin is the largest single organ in your body? It makes up 16% of the average adults weight! Even more importantly, your skins job is to support your internal organs and protect your body. Soft connective tissue just under your skin is sort of a secondary protector as it cushions and/or makes up precious things like blood vessels. Your connective tissues are highly flexible (unlike bones), which is a great thing, but this means they are also easier to damage, especially during surgery. When you have too much skin or excessively damaged or infected skin and connective tissue, these organs simply can't do their job.


    During clinical procedures like bariatric surgery, your soft tissues can sometimes undergo irreversible deformations. This is what causes post-bariatric complications like ulcers. Although damage to your blood vessels from bariatric surgery can't be reversed entirely, removing excess skin can greatly reduce your risk of infection and injury. Further, removing excess skin can give you your life back. Patients feel alive again when they can walk and maintain a healthy lifestyle, enjoy the extra energy from their weight loss in new ways, go to work all day with ease, and have a wonderful and vibrant sex life.

    Body contouring procedures sound like traditional lift surgeries. Are they really that different?

    Traditional breast lift, body lift, arm lift and thighplasty surgeries are considered cosmetic surgeries. Body contouring procedures are considered reconstructive surgery, as they are performed with the intent to restore both form and function to a body. Not unlike reconstructing a face after trauma or a nose after Mohs surgery, a body that has undergone extensive weight loss has experienced some of the most life-changing trauma one can and will ever experience. Every part of the body changes with dramatic weight loss and necessary life function can be greatly altered. Although losing weight can add years to someone's life, having complications from the weight loss can put a stop to it in a heartbeat.


    Although in theory a breast lift is a breast lift and a thighplasty is a thighplasty, the post weight-loss body contouring operations are intensely more complex. Reconstructive surgeons have to understand the anatomical, biochemical, physiological and pathological aspects of these extensive surgeries. So although reconstructive surgeons experienced in post-bariatric body contouring procedures are very well-suited for performing cosmetic-only lift procedures on patients, patients are ill-advised to see a traditional plastic or cosmetic surgeon for their body contouring procedure.

    How do I find a plastic and reconstructive surgeon best suited to my specific needs?

    You should perform extensive research on any doctor you are considering for any surgical procedure, no matter how big or small. Within the spectrum of plastic and reconstructive surgeons, this critical step is often even more important. Most "plastic surgeons" (as we are typically referred) specialize in a narrow subset of the field. It is impossible to be excellent at performing every single plastic, cosmetic and reconstructive surgery procedure because, quite frankly, there are so many of them.


    Thus, if you see a doctor who purports to do everything, you might take pause. For body contouring procedures specifically, you want a surgeon who spends a great deal of time discussing your case both clinically and aesthetically. If a plastic surgery office makes body contouring after weight loss sound like a simple procedure, you should be alarmed. Body contouring reconstructive surgery is highly complex and requires extensive knowledge and experience from both the surgeon and the rest of the team in the operating room. Both the surgery and the road to feeling normal again are long.

    What are the most common body contouring procedures?

    The most common reconstructive corrective procedures after significant weight loss are abdominoplasty (tummy tuck) surgery followed by breast lift. Other common surgery volumes are included in the chart below.

    Body Contouring Procedure ||| 2015 Volume ||| 2014 Volume ||| % Change 2014 to 2015

    Breast lift after massive weight loss ||| 12,325 ||| 12,048 ||| 2%

    Lower body lift after massive weight loss ||| 4,642 ||| 4,629 ||| 0%

    Thigh lift after massive weight loss ||| 4,702 ||| 4,885 ||| =4%

    Tummy tuck after massive weight loss ||| 21,696 ||| 17,261 ||| 26%

    Upper arm lift after massive weight loss ||| 6,800 ||| 6,112 ||| 11%

    See the full report from the American Society of Plastic Surgeons here.

  • Body Contouring Procedures: After Massive Weight Loss

    The following procedures are modified and combined for our post-bariatric body contouring patients to ensure optimal healing, function, and aesthetic outcomes.

    What do post-bariatric body contouring operations cost in San Antonio with Dr. Matt Bindewald?

    Note on pricing and average costs

    Under each individual procedure listed below, we quote the average national cost as state in the latest data available from the American Society of Plastic Surgeons (2014). Our patients typically find that their cost for reconstructive surgery with Dr. Matt Bindewald is less than the national average. So much so, in fact, that patients often travel for surgery under his expert care.


    How are your costs lower at our facility?

    Since Dr. Bindewald performs mostly reconstructive (vs cosmetic) procedures, he operates out of a full-service emergency and transplant hospital. He takes call with the hospital in order to help serve the community by taking care of trauma victims who require emergency reconstruction. This, combined with a lower COLA index in San Antonio, affords him the flexibility to extend these lower prices to our patients. Second, because Dr. Bindewald performs so many reconstructive surgeries, his staff has expert knowledge and experience working with insurance companies to get as much of your surgery covered by insurance as possible.


    How are outcomes better at our facility?

    Dr. Bindewald specializes in complex reconstructive operations and has extensive experience performing extremely long surgeries. His experience alone affords patients superior outcomes. Further, he operates out of one hospital. His team at this renowned transplant and emergency hospital is well-versed in Dr. Bindewald's procedures and surgical techniques, and they are trained in the highly advanced supportive and closure methodologies required of your post-bariatric body contouring operations. They also have extensive experience in trauma response and care in the event there are ever complexities during your operation.


    AVERAGE COST: $4,377

    Breast lift surgery for weight loss patients is typically combined with removal of excess skin from the upper back and arms

    After massive weight loss, profound breast atrophy is all too common; most women report that their breasts resemble pancakes. Sagging, loose skin combined with decreased tissue and fat leaves breasts uneven, uncomfortable, and hanging. A woman's nipples also often become distorted and ptotic (droop abnormally). Mastopexy to resolve these concerns in women after weight loss is very different from traditional breast lift surgery as the entire breast needs to be rebuilt and reshaped. During post-bariatric contouring surgery, we typically correct redundant skin along the back and upper arms at the same time, and then de-epithelialize certain flaps and place the woman's own excess tissue deep into the breast cavity to rebuild it while provide faster healing and a natural, full look.


    The upper body lift is performed as either part of a one-stage total body lift for as the 2nd surgery in a two-stage body lift

    Although sometimes performed in conjunction with the lower body contouring surgeries (one-stage body lift), the upper body procedures are performed after the lower body and abdomen procedures to ensure optimal outcomes. During this surgery, we remove the excess skin from the upper portion of the abdomen, lifting the upper stomach up to align the belly button. We then proceed to the midtorso in the back, removing excess back folds and lifting the remaining skin for a tight aesthetic. We typically hide the scar under the patient's bra line. This gives us the best projection of augmented and lifted breasts, combined with the ability to balance the upper body with the reshaped hips and lower body.



    An arm lift reshapes the arm from the armpit to the elbow

    Although some post weight-loss patients seek only an upper arm lift, this procedure is typically done in conjunction with any other required or desired procedures in the upper body. Combining procedures allows us minimize costs and pre-plan for optimal aesthetic outcomes and minimal scarring. We sometimes use liposuction during this procedure to enhance results if there is some remaining stubborn fat in the area, and then we remove any skin that droops or hangs below the arm. Incision placement depends on other skin folds that may need to be removed at the same time.



    Thighplasty requires intense balancing of the biomechanics of skin tension with precise incisional technique and order of operations

    Thigh lift surgery differs considerably between patients, but even more so between males and females. For men, we typically operate along the anterior and medial thigh and not the lateral thigh. Women tend to develop more of a saddlebag appearance with atrophy in the buttocks. Their upper posterior thigh typically requires less surgical intervention than male patients, while medial and anterior thighs require more intervention.



    Abdominoplasty is the most common post-bariatric body contouring operation

    Tummy tuck surgery after massive weight loss is one of the most common operations because we are able to not only remove and lift excess skin from the area, but also repair weakened abdominal muscles. Depending on the extent and location of excess skin, abdominoplasty after massive weight loss is often performed in conjunction with a panniculectomy (to remove the apron of skin that covers the pubic area), as well as a lower body lift or thighplasty. During tummy tuck surgery, we re-align the belly button and also lift and remove excess all the way down to the mons pubis (pubic mound). Removing excess from the mons pubis when it exists ensures greater patient safety long term and is very important for post-bariatric patients.



    Extensive experience in post-bariatric corrective surgery is essential to minimize the risk of ulcer-causing vessel damage

    Lower body lift surgery after significant weight loss typically concentrates on reshaping of the buttocks, hips, and inner and outer thighs while removing excess overhang of skin. We typically resect the skin in a place just beneath the dermal layer in order to preserve as much blood and connective tissue as possible. This is incredibly important in post-bariatric patients who have already suffered from skin ulcers caused by damage to blood vessels during bariatric surgery, and a critical reason to only seek experienced reconstructive surgeons for your post-bariatric corrective surgery. We then perform liposuction under the resected area and re-align the remaining tissue to enhance buttock projection and streamline the contour of the entire lower body.

  • Contact Us Today

    Are you considering some type of post-bariatric or post weight-loss body contouring surgery? Dr. Matt Bindewald has extensive experience with complex reconstructive surgery procedures, and is known for his attention to detail when planning the techniques and tools he will use during surgery to achieve the best functional and aesthetic outcome for each patient given their unique situation.


    Dr. Bindewald's exacting techniques and artistry, combined with our transparency in pricing, has resulted in patients who are overwhelmingly pleased with their final outcome as well as their pocketbook.


    We accept and welcome patient questions both online and in person; Dr. Bindewald responds to all patient inquiries directly. Our HIPAA-compliant website and email ensures your utmost discretion and privacy when sending communication to our surgical team.


    Contact us online or schedule an appointment in our San Antonio office today. You can reach us at the phone number or email address listed below, through this web form, or schedule your own appointment via our online request form, which can be accessed here.

    7950 Floyd Curl Drive, Ste. 1009
    San Antonio, TX 78229
    Mon-Thurs, 8am-5pm
    Fri, 8am-12pm