Dr. Hakan Gündoğan

Post Bariatric Surgey


Body contouring after major weight loss reduces the excess skin and fat that is left behind from the expansion of skin, loss of fat and lack of tissue elasticity that often occurs after a major weight loss. 

This sagging skin commonly develops around the face, neck, upper arms, breast, abdomen, buttocks, and thighs and can make your body contour appear irregular and misshapen. If you have undergone dramatic weight loss either through diet and exercise or bariatric surgery, and you are at your optimum weight loss goal, you may be a good candidate for this surgery and may wish to consider undergoing this procedure.

The success of body contouring, whether it is done to reduce, enlarge or lift, is influenced by your age and by the size, shape and skin tone of the area to be treated. Some contouring procedures leave only small, inconspicuous scars. More noticeable scars may result when surgical removal of fat and skin is necessary to achieve your desired result. Most patients find these scars acceptable and enjoy greater self-confidence when wearing a bathing suit or form-fitting clothes.

It is not uncommon, depending on individual patient factors, the extent of surgery needed and surgeon preference, for massive weight loss patients to have multiple operations performed in stages. In such cases, the waiting period between surgeries ranges from weeks to several months or longer.

Face and Neck Lift

After dramatic weight loss, the face skin can become flaccid, resulting in the cheek pads dropping, and jowls forming, resulting in the loss of a defined jaw line. In addition, the neck is loose and sagging.

A face and neck lift raises the cheek pads, corrects the jowls, and removes the loose and sagging skin. The incisions are inconspicuous. They are placed in front of and behind the ears, and extend into the hair above and behind the ear.

Post-bariatric surgery patients may be nutritionally deficient, and this can have consequences for surgery and recovery. Patients may be referred for nutritional counseling and advised to wait a year or longer following their weight loss before undergoing plastic surgery. It is also important for the patient’s weight to stabilize before body contouring begins.

Patients may be surprised to learn the extent of plastic surgery that is required to bring their body back to a more normal and aesthetic appearance. Many of these patients will need a total body lift. While surgeons may define this term somewhat differently, treatment most likely would include a tummy tuck, circumferential lower body lift, thigh and buttock lifts, removal of back rolls, breast lift and upper arm lift as well as face and neck procedures to get rid of loose, hanging skin in these areas.

Remember no two patients will have exactly the same results. You should realize that to re-contour and shape your body after dramatic weight loss, you will have visible scars, and uneven contours can develop. While the results of body contouring are visible immediately, if you have poor skin elasticity or gain weight, you will have some relapse of the sagging skin.

Through recent advances in all types of body contouring surgery, it is now possible for many patients to have a more proportionate body, better body image, and more self-confidence. The best way to get answers to your specific questions to see if you are a good candidate for this type of surgery is through a personal consultation with Dr. Hakan Gundogan.

Arm Lift (Brachioplasty)

An arm lift, or otherwise known as brachioplasty, can remove the excess skin and fat deposits, leaving the upper arms with a more pleasing and youthful contour. As a person ages, upper arm skin can become loose and flabby. Dr. Hakan Gundogan will consult with patients about undergoing surgery for an arm lift if they wish to tighten this skin to look and feel more youthful. The incision extends from the elbow to the underarm, and sometimes on to the side of the chest. In some instances, your plastic surgeon may recommend that liposuction be used alone or in conjunction with an arm lift to remove excess fat in the upper arms.

Upper arm excess in a massive weight loss patient usually crosses the armpit and involves loose skin that extends onto the chest region. Brachioplasty, or upper arm reduction surgery, usually involves reducing the skin through a scar that runs on the inner part of the upper arm, often crossing onto the armpit.

Am I good Candidate for Upper Arm Lift

Arm Lift surgery can be performed on a large variety of patients including normal weight patients who simply need a little tightening. However the majority of patients are massive weight loss patients that have stabilized their weight loss and do not have out of control medical problems. They present with excess skin and fat in their upper arms. Many of these patients complain that their arms feel and look like “bat wings”. Occasionally some older women have a lot of extra skin that is bothersome and would also be reasonable candidates.

Arm Lift Benefits/Advantages/Options

* Reduction in upper arm excess

* Better self image/confidence

* Being able to wear short sleeve clothing without being self conscious

Arm Lift Standard Procedure Techniques

For patients who have minimal upper arm fat excess, with no skin excess, liposuction alone can be effective. For patients that have some extra skin that is minimal in nature and is located near the armpit, an improvement can be attained through a scar limited to the arm pit. For patients who present with a lot of upper arm excess, as in the case of most massive weight loss patients, tissue must be removed through a scar that runs from the elbow, through the arm pit, and onto the side of the chest.


If you are a smoker, it is recommended that you stop smoking well in advance of the surgery. Smoking can affect your ability to heal. Certain medications that increase the risk of bleeding such as Aspirin, non-steroidal anti-inflammatory medications, and some vitamins/homeopathic regimens should be discontinued prior to arm lift surgery.

Arm Lift Recovery Process

* Dr. Hakan Gundogan prefer neither to wrap the arms nor use compression garments

* Dr. Hakan Gundogan prefer that the arms are elevated for a few days, above the heart

* Slow return of normal function of the arms and hands over a couple of weeks

You should avoid Aspirin and non-steroidal anti-inflammatory medications for the first few days after your arm lift surgery. Smoking and exposure to second-hand smoke may impair the healing process and should be avoided. 


Will Arm Lift surgery be painful? 

Postoperative pain is subjective and will vary considerably from person to person. The average patient undergoing an upper arm reduction procedure will usually require a few days of oral pain medication to treat discomfort. Over a 7 to 10 day period most people resolve the majority of their acute postoperative pain. 

Will there be scarring with Arm Lift surgery?

Upper arm reduction involves the removal of skin and necessitates the creation of a scar that starts near the elbow, traverses to the armpit, and often crosses onto the chest wall. Any scar goes through a maturation process, which takes a year to complete. Most scars are conspicuous, at least initially. According to patient’s needs Dr. Hakan Gundogan prefers to place the upper arm reduction scar eıther on the inner arm aspect so that it is not visible when the patient’s arm is by their side or a bit more towards the back of the arm so that it is not visible from the front, especially when the patient is observed from the front while moving the arm.

What type of anesthesia will be used for Arm Lift surgery?

Most arm lifts are performed under a general anesthetic, although some surgeons will utilize a local anesthetic, with sedation.

Breast Lift

A breast lift will raise and firm sagging, flat breasts. Some patients also may require breast implants to improve the shape and size. Incisions are placed around the nipple, from the nipple to the crease under the breast, and horizontally along the breast crease.

Medial Thigh Lift

The medial thigh lift will lift and tighten the sagging skin of the inner thigh. Incisions are usually placed in the groin.


A panniculectomy is performed to remove the hanging pannus, or apron of skin, from the lower abdomen below the belly button. The excess skin and fat above the belly button are not removed. A panniculectomy is often performed on patients who are still significantly overweight but have skin irritation from their hanging skin. After surgery, these patients have less skin problems but have little improvement in the contour of their bellies. 

Lower Body Lift

In one procedure, the sagging skin of the abdomen, outer thighs, buttocks, hips, and waist is corrected. Incisions extend completely around the body to remove a "belt" of excess skin and fat. Another common name for this procedure is a "belt lipectomy."

When people gain a lot of weight they usually deposit their fat around their entire lower trunk, which involves the front, sides and back starting from just below the ribs to the pelvic region. When they lose the weight they end up with a lot of excess fat and skin that is most obvious in the front, often looking like an apron that will hang to varying degrees. However the hanging excess does not stop in the front, and most often it will continue on to the sides and the back involving the outer thighs, lower back, and buttocks regions. This type of problem is called circumferential excess.

To treat circumferential excess of the lower trunk in the massive weight loss patient, a lower body lift/belt lipectomy is most often employed. In this procedure, a wedge of tissue that goes around the lower aspect of the lower trunk is removed to treat the entire region so that the greatest amount of improvement can be attained. Although a tummy tuck/abdominoplasty, a procedure where only the front of the belly area is reduced, can be used in some massive weight loss patients, the results are often less than ideal because the sides and back are not adequately addressed.

Am I good candidate for lower body lift?

Lower Body Lift is indicated in patients who were obese and have lost a significant amount of weight leading to circumferential lower truncal excess. To operate on a patient they should:

* be medically stable

* be psychiatrically stable

* have stabilized their weight loss (neither losing nor gaining weight)

Although this type of procedure is most often utilized in massive weight loss patients, there are three other groups that may benefit from this type of surgery:

* Women who were never obese but are 30 to 40 pounds over weight and are not able to lose the weight

* Normal weight patients who desire outstanding body contour

* Patients who underwent liposuction with excess skin in the area of the lower trunk and/or thighs

Lower Body Lift Standard Procedure Techniques

Lower Body Lift surgery involves removing a circumferential wedge of tissue. In the front the procedure involves removing the hanging apron of skin and fat and tightening up the underlying muscle wall, which is very similar to what is accomplished in a tummy tuck. To remove the excess tissues located in the back and sides the patient has to be turned in the operating room to allow for exposure of these areas. Liposuction of the thighs is often performed at the same time. The final scar has a similar shape to a “thong bikini” for most surgeons.

* Elimination of the hanging apron

* Flattening of the belly

* Pulling up the droopy pubic region

* Creation of a waist

* Lifting the thighs

* Lifting and defining the buttocks

Lower Body Lift Recovery Process

* This procedure may take 3 to 4 weeks to recover from

* Dr. Hakan Gundogan prefer to use compression garments only on abdominal area.

* Most patients may be instructed to walk bent at the waist for a week

* Usually patients will have drains, plastic tubes that drain blood and body fluids, from the areas that were operated on. They will stay in place for a variable amount of time, from a few days to weeks

* The final results may not be apparent until all swelling has resolved which may take up to a year for this type of procedure

Is lower body lift surgery painful? 

The amount of pain that any particular patient will have after surgery is dependent on their pain tolerance, the type of procedure performed, and the methods used by Dr. Hakan Gundogan to control pain. Postoperative pain is subjective and will vary considerably from person to person. The average patient undergoing a lower body lift procedure will usually require a few days of pain medication to treat the feeling of discomfort. Over a 7 to 10 day period most people resolve the majority of their acute postoperative pain. Although some pain may persist after this period of time, it is usually not severe enough to require significant doses of pain medication. 

Will there be scarring from a lower body lift?

The scar created by a Lower Body Lift goes around the entire trunk in the shape of a “thong bikini”. Scarring quality is variable and mostly dependent on the patient’s genetic makeup. It is usually covered by the patient’s underwear, although not in all cases.

What are some typical short-term side effects of lower body lift?

Immediately after surgery some patients will have a feeling of tightness in the abdomen, sides and back. There will be swelling and obviously pain as discussed above. Most patients have to walk slightly bent at the waist for at least one week, if not longer. Because this is an extensive operation, most patients will need a few weeks to regain their strength and activity level.

What type of anesthesia will be used for lower body lift?

All body lift procedures are performed under general anesthesia in a hospital.