However there are differences between these two conditions.

People with large amount of fat don’t have usually sagging skin and , if overall health is good , can be submitted to a full body contouring without cutting skin and remodeling their body in a scarless way.

So using modern devices like power assisted liposuction and Vaser , we can remove large quantity of fat with less bleeding and quicker recovery time. We can manage to do liposuction in the abdomem , back and arms , with fat injected to the buttocks and breasts as well to reshape both VASER is used to facilitate such procedure but attention must be paid to avoid excessive timing with the VASER to avoid loss of viable fat or even burns , which unfortunately are becoming common , due to both the patients excessive demands for thinking the skin as much as possible and the doctors wiliness to follow patients demands.

And today we can apply for the same liposuction an extra time with the new J Plasma , which through cold helium , a more precise tightening is done with the skin and tissues. So even after major liposuction , Daley is necessary to remove skin in today’s technical environment a through liposuction will give patients a very sharp and curved waistline allied with fat injected in the hips , a more curvilinear shape that reacts harmony and proportions as well.

Sagging skin is a major hurdle that we today face with patients undergoing gastric sleeve or by pass , with a very steep weight loss leading to a thinning of the skin and dermis , and a less reliable skin to retract , with major skin sagging present after 1-2 years of massive weight loss, with multiple folding skin rolls around their bodies , making very difficult to avoid long and unpleasant scars. However , we have managed to correct patients with such conditions , because we discovered that a very agressive  liposuction under the skin, by aggressively removing sagging tissues between muscles and skin , can and actually leads to retraction of the emptied skin around the torso. So areas of the back and waistline , that before were removed surgically with ugly scars , today are treated only by extensive long but effective liposuction only treatment.

Folding rolls skin in the back and waistline can be treated with 80-90% success rates. No need in a vast majority of the cases for a lengthy scars anymore. The liposuction with power assisted device and VASER , as well J Plasma helps to bring this outcome. However, on the anterior Abdomem , under the belly button, skin sagging unfortunately, has to be managed surgically and usually we have to do a classic abdominoplasty or tummy tuck , but that is always associated with a major liposuction on the back and waistline to avoid long stretched scars that before went to the back

Today we avoid such full body scars.

Anatomical challenges in patients with massive weight loss. Once fat was considered our worst enemy m even in our diets , today is becoming more and more our best friend and it is true for the body contouring surgery. And it is badly needed.

Patients after massive weight loss experience a very significant shrinking of the buttock areas, mainly at the lower half , with some patients having not only sagging around , but hardened skin attached to the fascia underneath the skin at the bottom of the buttock, given the buttock retracted and saggy shape , like a half saw cut of the lower half of the buttock. In these circumstances , some times we can manage to expand intraioerstively the ata he’d skin and fill the whole buttock in a more proportional way and  recover the whole spherical shape of the buttock. But frequently we can’t expand in proper way so we prepare our patients with multiple Pre op treatments to get the skin to expand and fill properly.

After we have the buttock ready for fat injection , then we proceed with the surgery. Excellent results are obtained in patients that were usually submitted to buttock lifting with long and visible scars without today cutting.  It there are other problems Keith post massive weight loss patients related to the quality of fat that we can harvest. Usually , after major weight loss , patients lack fat in amounts that can help rebuild the buttock area properly and most importantly , there is a loss of quality fat after weight loss that few medical experts are aware off. Simply put, áreas that we usually harvest fat from in patients after weight loss , are mainly non fat areas and are actually made of sagging tissues and components of scaffolds that supports the skin made of bad collagen and structures empty of fats that we end up removing and re injecting into the buttocks of patients. Patients have to be aware that the small amounts of fat among those sagging tissues that we have harvested , has to be taken care and very carefully treated , so the fat that was injected don’t disappear. Because of that patients have to avoid sitting for at least 3-4 weeks , if they were treated to correct post massive weight loss due to the fat poor quality

Because of all this , we usually recommend surgery associated , with buttock Intra muscular implants plus fat to fix the buttocks in post massive weight loss patients. Fat in those cases are used to give contouring of the buttocks for a more round shape and the implants used to give proper projection of the buttock.