Kishen Nara, MBBS, FACCSM(Surg)

Dear Jaspsadie,

Thank you for your question. This is relevant not just for yourself but also many others who seek an answer for this common presentation. First of all, well done for looking after yourself and losing some weight with a focus on healthy living.

Understandably, by this stage, we should have advanced with non-surgical techniques to alter the appearance of soft tissues after massive weight loss. Although a lot has improved in terms of techniques and research pertaining to radiofrequency, dermabrasion, lipofilling, platelet-rich plasma, and energy based devices, we still have a lot to learn and improve on. This is why cosmetic research is essential.

Without performing a thorough clinical assessment, it is impossible to provide a dedicated and accurate plan for you. However, upon basic visual inspection, it appears that you may have moderate skin excess with associated irregularities of the surface of the skin.

Of course, serial non-surgical procedures may assist temporarily in the mid-term especially with tightening the skin. Please realise that tightening the skin may not necessarily translate to the outcome you desire. This is a whole assessment on its own. The cumulative cost and unpredictable outcomes may be expected should you require further amendments following skin tightening.

Non-surgical options may have it's role for specific goals but this needs to be carefully assessed.

There is another option, which is surgery or brachiaplasty with or without simultaneous liposuction of the arms. Disclaimer: All surgical procedures have it's inherent potential risks and complications. It is imperative to seek a second opinion from a qualified medical professional prior to any surgical undertaking. Always consider your decision carefully after being fully informed about the procedure of your choice.

The benefits of surgical excision of the soft tissues of the arms may involve permanent removal of the redundant excess tissues that may present as "sagging" or "rippling" and the likely reduction of volume and diameter of around the arms. The downside of surgery of course are the potential risks of surgery such as scarring, numbness and contour irregularities especially around the scar line.

It is essential to have a comprehensive consultation with regards to your presentation from a trusted and experienced doctor or surgeon specific to aesthetic surgery.

To learn more about our quality consultation in Melbourne especially related to the component of liposuction you are welcome to click below. Learn about your options with confidence.

Dear Ace,

Thank you for your question. I am sure you want to have this fixed soon but please consider all your options carefully before deciding on what is the best option for you. First of all, well done on making the effort to look after yourself through health living! Let's understand what happens when a person has massive weight loss. The body goes through a lot of changes especially with regards to losing soft tissue elasticity. This translates into the tissues being unable to retract back favourably when there is moderate to large changes of volume. The soft tissues of the upper or lower abdomen in the body is sensitive to these drastic changes which result in excess skin. It is important to get examined by a doctor trained in aesthetic surgery to give you the best options available for any cosmetic procedure. If, on examination, you have moderate skin excess, there may be an option to consider surgical removal of excess skin. Of course, this leaves a permanent scar, but with the realisation of removing redundant skin. You need to also have the underlying structures beneath the skin assessed to ensure you do not have any herniation of the deeper soft tissues. There is certainly a lot more to the examination. Whilst it's tempting to think that energy based devices may assist the situation, sometimes there are advantages and disadvantages that need to be openly discussed to help you make an informed decision. Don't rush, get a second opinion from a qualified medical professional before proceeding. All cosmetic non-surgical or surgical procedures carry potential risks and complications. To learn more about skin excision procedures such as mini abdominoplasty coupled with liposuction feel free to click the link below. Thank you for your question and I hope it gives you some
insight into important factors to consider for your presentation.

Thank you for your question. Whilst it's easy to assume that dermal filler would lessen the appearance of the recognised and known nasolabial or marionette lines, it is first important to obtain a comprehensive clinical assessment from a medical practitioner trained in aesthetic medicine. The nasolabial lines are commonly referred to the area lateral and above the corners of the lips. The marionette lines usually refer to the indentation of skin area just below the corners of the lips or mouth. There may be multiple reasons why this may have occurred. The face has varies anatomical layers including the underlying bony structure, retaining ligaments, SMAS, subcutaneous tissues, and skin. Any of these structures or combination thereof may have a role with regards to the appearance as described. The assessment of this may be rather comprehensive. Yes, dermal filler may help to reduce the appearance of smile lines preferably with a low cross linkage properties. However, this may not necessarily be the only way to manage this area or let alone the best way to address smile lines. Is there an element of not being adequately hydrated? There's a myriad of reasons. Take time to obtain a proper assessment. Some patients are happy to leave the smile lines as they are and may decide against dermal filler. A comprehensive and balanced assessment for your smile lines is invaluable for your overall result not just on the surface but also within.

Thank you for your question. Please note that clinical questions warrant a comprehensive clinical assessment for the best diagnosis and exploration of your issues. This will never be replaced by any form of technology. I have seen several patients who have puffiness of lower eyelid region following "filler treatment" after more than 12 months as described by patients. There are a constellation of potential reasons for this. Some patients do have residual "filler" that can be further investigated with radiological investigations such as with specific magnetic resonance imaging tests conducted by specialist radiologists who are familiar with these issues. If this is the case, dissolving the residual "filler" may help although it has its inherent potential side effects, complications as well as limitations. Other causes need to be excluded such as underlying conditions or infection. The ageing process may potentially contribute to this. It is important to take time to make a plan of treatment before deciding on any treatment. Seek advice from your general practitioner and get a full medical check up. It would be good to speak with the initial treating doctor , who performed the facial treatment, to get their advice. If you could please upload better imaging that might be helpful. Hope this helps.

Thank you for your post. It is imperative to have an assessment performed by a clinician trained and skilled specific to cosmetic medicine and surgery. It is good to have a second opinion performed by a health care professional.
A general practitioner assessment is important. The reference of mid section may differ to our understanding of the "mid-face". That is why it is important to have a consultation and examination performed by a doctor that you trust. Fat graft to the face has its merits and risks. Some merits include increasing the volume in some fat compartments of the face that may have reduced at the time of your weight loss as well as benefits to the skin. Risks involve asymmetry, bruising, lumpiness or even accumulation of fatty cysts. The fat resorption varies from individual to individual and so do the risks of of any procedure performed by your surgeon. Remember, you have time to think of what treatment is right for you. Looking at your photos, you may consider regaining the lost weight to see if it makes a comfortable difference without any intervention.