Body contouring after major weight loss in Thessaloniki and Athens, Greece

Body contouring after massive weight loss is a plan of operations rather than a single procedure. In stages, we remove the skin left loose after losing a lot of weight and lift the abdomen, buttocks, thighs, upper arms, chest and back, so that your body follows your new shape.

After major weight loss the skin loses its elasticity and does not shrink back enough. The laxity usually involves the whole trunk and the limbs, and it forms folds that make movement and hygiene harder. Some of the operations are similar to cosmetic procedures, while others, such as the body lift, are designed specifically for patients after major weight loss.

This page gives the overall picture of the plan and also covers loose skin after liposuction for lipoedema. For each individual operation, see the tummy tuck (abdominoplasty) page.

You are a good candidate when your weight has been stable for 6 to 12 months, your health and nutrition are good, and you do not smoke. After bariatric surgery we usually wait 12 to 18 months. I confirm whether surgery is right for you when I examine you.

The wait is needed so that your body can recover, your weight can settle and your skin can shrink back as far as it is able to.

Who is typically suitable?

• People who have lost a lot of weight through diet and exercise, bariatric surgery or weight-loss medication, and have loose skin in several areas.
• A stable weight for at least 6 to 12 months, ideally close to a normal weight.
• People with skin folds that cause irritation, sweating, or difficulty moving and exercising.
• Good general health, adequate nutrition and normal blood tests, particularly iron and albumin.
• People who understand that the plan is carried out in stages and leaves long scars.
• Women with lipoedema who have completed liposuction, whose weight and result are stable, and who still have loose skin on the thighs, arms or knees. This is more common in stage 3 lipoedema, in older patients and in those with lax collagen.

When do I advise against it?

• When your weight is still falling or going up and down.
• Less than 12 to 18 months after bariatric surgery, so that your weight has time to stabilise.
• When anaemia, low albumin or another nutritional deficiency has not yet been corrected.
• In smokers who will not stop smoking for at least 4 weeks before and after surgery.
• When your BMI remains above about 32 or you have serious health problems that are not under control.
• When you are planning a pregnancy in the near future.
• In lipoedema that has not first been treated with liposuction: removing skin on its own often leads to disproportion and wide scars. In lipo-lymphoedema I take a more conservative approach.

At the consultation I examine your whole body, review your weight loss, its stability and your medical history, and we agree the order of the stages. Before each stage you have blood tests, any deficiencies are corrected, and you stop smoking. The date of each stage is set only once this is complete.

What happens at the consultation?

At the consultation I examine your whole body, not only the area that bothers you most: the abdomen, flanks, buttocks, thighs, upper arms, chest and back. We discuss your weight loss, how stable it has been and your medical history, and together we decide the order of the stages. You receive a written plan.

Which tests and instructions apply before surgery?

After major weight loss I also check for anaemia, iron, ferritin, albumin, vitamin B12, folic acid and vitamin D. Deficiencies are common and affect healing, so they are corrected before surgery with your doctor or dietitian. You need enough protein (usually 70 to 100 g a day). For the larger stages I check your haematocrit.

Smoking greatly increases healing complications. Stop for at least 4 weeks before and 4 weeks after surgery; I do not operate on heavy smokers unless they stop. If you take anticoagulants or antiplatelet medicines, tell me; they are only stopped in agreement with the doctor who prescribes them. The date of each stage is set once your tests are complete and any deficiencies have been corrected.

The surgery is done in 2 to 3 stages under general anaesthesia. We almost always start with the trunk and correct the upper arms, chest, back and thighs at a later stage. We do not combine every area in one session, so that your body is not put under excessive strain.

Each stage usually takes 3 to 6 hours, depending on the areas treated. We leave 3 to 6 months between stages so that your body can recover and the scars can mature.

In what order are the stages done?

• First stage, the trunk: a lower body lift or a fleur-de-lis abdominoplasty, for the abdomen, flanks, buttocks and outer thighs. When needed, an inner thigh lift is added, although this can also be done at a later stage.
• Second stage, the upper body: an arm lift (brachioplasty), a breast lift or restoration of breast volume, and correction of the back rolls.
• Third stage, where needed: a face and neck lift, liposuction or smaller refinements.

The order is adapted to what bothers you most. If, for example, your upper arms cause you the most difficulty, we can start there.

Lower body lift (belt lipectomy)

This is the classic operation after major weight loss. Through a circumferential incision, or a T-shaped incision, at the level of the buttocks and lower abdomen, the loose skin of the buttocks, outer thighs and hips is removed. The skin is lifted upwards and anchored to strong fascial layers, so that the result holds and the scar does not move.

Fleur-de-lis abdominoplasty

This is a variation of the tummy tuck for patients whose skin is loose vertically as well as horizontally. A vertical incision in the midline is added to the low horizontal incision on the abdomen, which narrows the waist and corrects the flanks. It leaves an additional vertical scar, but gives a better contour when the excess is large.

Upper body lift, back and breasts

With an additional excision at the level of the armpit and back, we correct pronounced back rolls. In women with marked loss of breast volume, we can use the excess skin and fat from the sides of the back to restore breast volume, with or without an implant. See the breast lift page for more on that operation.

Upper arms and thighs

The upper arms are corrected with an arm lift (brachioplasty) and the inner thighs with a thigh lift. When the excess is large, the incisions extend to the elbow or towards the knee.

Loose skin after liposuction for lipoedema

Liposuction done correctly rarely leaves loose skin in lipoedema; what looks like laxity is often the weight of the lipoedema tissue. When it is needed, an arm lift or thigh lift follows at a later stage; I explain this in detail on the page on loose skin in lipoedema.

Incisions and stitches

After major weight loss the scars are inevitably long, because a large amount of skin is removed. I plan them so that they are hidden as far as possible below the underwear or swimsuit line, on the inner side of the arms and thighs, and in the fold under the breasts. The stitches are mostly internal and dissolvable. Drains are often placed for a few days.

Combining procedures

In the same stage we combine areas that lie close together, such as the abdomen, buttocks and thighs, or the upper arms and chest, provided the total operating time remains safe. Liposuction is often added to smooth the contour. See also the liposuction page.

Hospital stay

After a body lift you stay in the hospital for 2 to 3 nights, and in some cases up to 4. After the smaller stages the stay is usually shorter. We fit a special compression garment before you leave, and you receive measures to prevent blood clots.

After a body lift you stay in hospital for 2 to 3 nights, wear a special compression garment and avoid sitting for 2 to 3 weeks. Most people return to work after week 3 and to exercise after week 6. The final result of each stage takes shape over about 6 months.

When	How you feel	What you can do
Days 1–3	Pain controlled with painkillers, a feeling of tightness, swelling	Stay in hospital; walk from the first day with your trunk slightly bent; compression garment
Week 1	Tightness and bruising, which start to settle	Light activity at home; no sitting for long periods; drains removed when the fluid decreases
Weeks 2–3	Less pain; your body is still swollen	Avoid sitting until 2–3 weeks; stitches removed where needed
After week 3	You feel more comfortable in daily life	Back to work; keep wearing the compression garment
After week 6	Swelling has gone down considerably	Gradual return to exercise and sport
Months 3–6	Scars mature and the shape settles	Normal activity; planning the next stage
Month 6	Final result of that stage	Review and decision on the next steps

For the smaller stages, such as an arm lift or a breast lift, recovery is usually quicker; you will find their timings on the pages for those operations.

After lipoedema. Recovery after a thigh lift or arm lift takes about 10 days for the arms and 10 to 15 days for the thighs. You wear a compression garment for 4 to 6 weeks (a bolero with sleeves for the arms), with lymphatic drainage where needed, and afterwards you continue compression for lipoedema as I advise.

After a body lift you stay in hospital for 2 to 3 nights, sometimes up to 4, and fewer after the smaller stages. Plan to remain in Greece for 10 to 15 days in total, until your first check-up is done and you are cleared to fly.

Drains usually come out during the first week, once the fluid has decreased, and most stitches are internal and dissolvable; any external stitches come out at 5 to 7 days, at the practice. Because you should avoid sitting for long periods for the first 2 to 3 weeks, the flight home needs careful planning: you can usually fly from day 10, with flights of 3 hours at most in the first weeks.

Before you leave, you are fitted with your compression garment and given measures to prevent blood clots: early walking, compression stockings and, depending on your risk, blood-thinning protection. After you return home, follow-up continues by video call at 10 days, 1 month, 6 months and 1 year, and you come back to Greece for each later stage, 3 to 6 months apart.

At home, arrange help for the first weeks, a chair or bed setup that lets you avoid long periods of sitting, and time off work: most people return after week 3, and to exercise after week 6. Nursing care at home for dressing changes can be arranged if you need it.

The laxity in the middle and lower body is removed straight away, and the final result of each stage settles at about 6 months. The result lasts for years as long as your weight stays stable. The scars are long, but they are planned to sit hidden under underwear or swimwear.

In the first months the scars move slightly downwards, but only a little, because the skin is anchored to deeper, stable structures. After body contouring most patients report a large improvement in quality of life, both in appearance and in function: walking, running, swimming and skin hygiene become easier, and their mood improves considerably. Your skin continues to age with time, and a new large change in weight or a pregnancy can affect the result.

These are major operations, and healing complications are more common than after the equivalent cosmetic procedures. Most are minor, such as small wound openings or a fluid collection, and are treated without further surgery. The risk falls with a stable weight, good nutrition, stopping smoking and staged operations.

Complication	How common	Prevention and treatment
Small wound openings	Not uncommon	Good nutrition, no smoking; they usually close with wound care
Fluid collection (seroma)	Not uncommon	Drains, compression garment; if it occurs, it is drained with a needle at the practice
Infection	Rare	Antibiotics and wound care
Haematoma	Rare	Review of medicines that affect clotting; if it occurs, it is drained
Anaemia or need for a blood transfusion	Not uncommon after a body lift	Correcting iron and haematocrit before surgery; staged operations
Deep vein thrombosis or pulmonary embolism	Rare, but serious	Anticoagulant prophylaxis, stockings and early mobilisation
Wide or stretched scars	Varies from person to person	Anchoring to deep fascial layers, scar care; correction with a minor procedure
Asymmetry or residual laxity	Not uncommon	Slight overcorrection; correction at a later stage
Change in skin sensation	Common, temporary	Usually returns within months
Swelling of the lower legs or hands (in lipoedema)	Common, temporary; rarely persists	Technique that protects the lymphatic vessels, surgery at a later stage, compression, lymphatic drainage

Smoking. Stop for at least 4 weeks before and 4 weeks after each stage. In large skin excisions smoking considerably increases wound openings and skin necrosis, which is why I do not operate on heavy smokers unless they stop.

Blood thinners. Tell me if you take anticoagulants or antiplatelet medicines. They are always stopped in agreement with the doctor who prescribes them.

We do not publish prices. The cost depends on the number of stages, the areas treated at each stage, the length of the operation and the nights in hospital. Because every plan is different, you receive a quote for each stage separately after your consultation.

• The number of stages and the areas treated at each stage.
• The technique: body lift, fleur-de-lis abdominoplasty, upper body lift.
• The length of the operation and the anaesthesia.
• The nights in hospital.
• Combining with liposuction or a breast implant.
• Compression garments and follow-up visits.

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