Plastic Surgery After Significant Weight Loss: How to Regain Self-Confidence and Body Contours with the Help of Modern Surgery, Explains Nonna Tomiševa

We spoke with plastic surgeon NONNA TOMIŠEVA about the most in-demand cosmetic procedures and plastic surgeries following rapid weight loss.

As technologies in cosmetic and plastic surgery continue to advance, the specialists at the Latvian Microsurgery Center keep up with the latest trends, continually expanding the range of surgeries and procedures they offer. Among the most requested procedures for people who come to the center after significant weight loss are currently eyelid surgery (blepharoplasty), tummy tucks (abdominoplasty), and breast reduction and lift procedures for women. Men also opt for breast reduction.

What are the signs that indicate it might be worth considering plastic surgery after losing weight?

As soon as the subcutaneous fat layer begins to decrease, the first changes become visible on a person’s face. «Bulldog lines» form, the eyes begin to sink, making the face look tired and the expression sad, and wrinkles develop on the neck and décolletage. All of this is due to the force of gravity, as fat acts as padding that holds the tissues in place. Another area affected is the breasts, which lose their volume and shape. Breast discomfort also affects men; as they lose their subcutaneous fat layer, sagging pouches form in place of the mammary glands. The third area is the anterior abdominal wall, which sags and forms a belly. The upper arms and thighs also sag and lose their volume and shape. After weight loss, women develop sagging skin on their upper arms, which is particularly noticeable when they raise and stretch their arms out to the sides. If you want to wear off-the-shoulder dresses in the summer, this can be a problem. Someone who has lost weight rapidly often doesn’t look their best. As one patient once told me: “If I’d known that losing weight would require undergoing so many different plastic surgeries one after another, maybe I wouldn’t have lost weight so drastically.”

What kinds of life events lead people who have lost weight rapidly to come to you?

First, following a period of extreme stress. This could be the loss of a parent or a loved one, or some major tragedy that a woman experiences. Extreme anxiety is often accompanied by insomnia and a loss of appetite. The experience takes a toll not only on the nervous system but also on the quality of the skin and a woman’s appearance. There comes a moment when someone else—or she herself—has to say, «Stop! You can’t go on living like this; you need to pull yourself together.» You need to get your thoughts in order and regain your health, if it has been compromised so far. Only then can we, as plastic surgeons, help—by transforming what you’ve disliked about your appearance into something you love. Second, we also see people who have undergone bariatric surgery, which is a surgical method of stomach reduction used to treat obesity. Those who have undergone this procedure often develop excess skin on their abdomen, which is bothersome. This is often accompanied by diastasis—an increased gap between the abdominal muscles—because the abdomen appears saggy and stretched. Umbilical hernias—a tear in the abdominal wall around the navel—are also common, appearing as a bulge of varying size beneath the skin. The person may lose weight, but their abdomen continues to look like that of a pregnant woman because internal organs or deep tissues are being pushed out beneath the skin through the abdominal muscles. With the help of plastic surgery, not only is the body’s appearance improved in this case, but its functionality is also restored. The person regains the ability to exercise and run, which the umbilical hernia had previously prevented.

Third, eating disorders, such as anorexia nervosa and bulimia nervosa, can also lead to excessive weight loss. 

What types of plastic surgery do you currently offer for patients who have experienced significant changes in body weight?

When it comes to the face, these are plastic surgeries during which the muscular-aponeurotic layer is lifted and secured, tightening the skin of the face, cheeks, and neck, and removing excess skin. The result of the surgery is the restoration of youthful facial features. Reducing a double chin makes the face look more expressive. Tightening the skin on the neck makes a person feel younger. Correcting the jawline reduces «bulldog lines.» If bags and dark circles have appeared under the eyes and the eyelid skin has sagged, forming a sort of overhang above the lash line, we offer blepharoplasty, or eyelid surgery. It is one of the most popular procedures in Europe and is performed under local anesthesia. Sometimes patients say, “Everything seems fine, but those huge wrinkles…” In that case, we offer injections of botulinum toxin.

When it comes to the body, abdominoplasty—or cosmetic surgery of the anterior abdominal wall—is in high demand. This procedure involves removing excess skin and stretched muscle tissue, as well as reducing the fat layer through liposuction. It also removes scars that were previously located below the navel, such as those from a cesarean section or appendectomy. One of the benefits of this procedure is the tightening of the anterior abdominal wall. For those who have previously had diastasis recti, the surgery helps make the abdomen flat, supple, toned, and attractive. After losing weight, women also opt for upper arm skin tightening, or brachioplasty, which removes sagging “bat wings.” The skin regains its elasticity, allowing women to feel confident when wearing sleeveless clothing. A similar procedure is also performed on the legs—cruroplasty removes and tightens excess skin from the thighs.

One of the most popular breast surgeries is the restoration of breast volume and shape, with or without the use of implants. Breast reduction and restoration of shape, lifting of breast tissue, and creation of a new breast shape using the patient’s own tissue. For women whose breasts have sagged down to their navels, the surgery restores firmness. «They’ve never been this beautiful, not even when I was young,» one patient once told me. The result not only makes a woman feel more attractive but also relieves her of back, neck, and shoulder pain, which is often caused by overly large breasts. Not only aesthetics but also the body’s functionality is improved. Women who undergo breast reduction and lift surgery always feel happy. Finally, they are free from pain; they no longer need to use talcum powder to protect the skin under their breasts from irritation, nor do they have to avoid dark-colored clothing, on which talcum powder used to leave white marks. Men with gynecomastia also opt for breast reduction surgery. During the procedure, breast tissue is removed and excess skin is excised, if necessary.

Are there any people who should not undergo plastic surgery after losing weight?

Anyone can do this, even if the year on their passport starts with a seven or an eight. One of my patients was 82 years old. Her grandsons had given their grandmother eyelid surgery as a gift. She came in for the surgery with a twinkle in her eye. The only thing a person must not do is to conceal any chronic illnesses when coming in for a consultation. If you have any, they must be managed—which means that if a doctor has prescribed medication, you must take it. By hiding them, a person risks complications during plastic surgery. Untreated skin conditions can also cause problems during recovery.

How much time should be set aside for the surgery and the recovery period afterward?

Eyelid surgery takes between 45 minutes and an hour. It is performed under local anesthesia, so the patient can go home after just a few hours. Recovery depends on whether the procedure is performed on the upper or lower eyelids. For the upper eyelids, significant signs of the procedure—such as swelling, redness, and bruising—are often no longer visible just two weeks after surgery. For the lower eyelids, these symptoms subside a little later. Tummy tuck surgery, like breast reduction and lift, takes two to four hours. Discomfort in the breast area subsides after two to four days, but full recovery takes about a month. Recovery for the abdomen takes up to two or three months. For almost all procedures, the full results are visible after six months to a year. At the same time, you can return to work as early as one week after the procedure. If the treated area is covered by clothing, those around you may not even notice the changes. More and more often, people are choosing to combine multiple procedures—such as eyelid and breast surgery, or arm and leg surgery, or abdominal and breast surgery. It’s much easier to have several procedures done at once than to undergo yet another surgery later on.

How many times in a person's lifetime can such surgeries be performed, and can they be repeated?

Both breast lifts and tummy tucks can be performed more than once. There are cases where people have had their breast shape improved as many as three times. Upper eyelid surgery can be performed twice, but lower eyelid surgery only once.

Can plastic surgery give a person youth and beauty?

As cliché as it may sound, all we plastic surgeons can do is reposition and reshape the tissues a little—so that a person looks good. If, when you come to us, there’s no sparkle in your eyes, a plastic surgeon can’t just stitch everything up so that it suddenly appears. Plastic surgery isn’t a winning lottery ticket to a new and much happier life. If you lack inner charisma, a plastic surgeon can’t give it to you. First and foremost, you have to love yourself. Plastic surgery can’t give you back your youth, but it can reduce the traces that emotional experiences have left on a person’s appearance.

The magazine ‘Ieva’s Beauty’