Flankoplasty, combined with other procedures, is indicated for patients who are moderately obese with loose skin or who have lost massive amounts of weight. In patients who have undergone bariatric surgery, weight should remain stable for at least 1 year. Patients with massive weight loss frequently have large amounts of excess skin, leading to chronic hygiene problems, especially suppurative intertrigo. Excisional surgery often is the only way to correct these problems.

Finally, and often most importantly, a highly motivated patient is required. This surgery is not for an uncertain patient because of the extensive surgery and scarring involved. Large amounts of skin and subcutaneous fat are excised, leaving long, occasionally wide, and permanent scars. Understand the patient's motivation, aesthetic goals, and future commitment to not gaining weight. The patient must have realistic ideas of what can be accomplished, the location of scars, and the amount of postoperative care that is required.

SKIN REMOVAL ON BUTTOCKS AND LEGS (THIGH AND BUTTOCK PLASTY)

Contraindications

Contraindications to this surgery include unrealistic patient expectations, inability to deal with major unpredictable scarring, peripheral vascular disease (arterial, venous), and lymphatic disease. Note any previous surgery that may impact on the venous or lymphatic drainage of the lower extremity. This includes pelvic exenteration and gynecologic procedures leading to inguinal lymph node dissections. Patients who have had varicose vein stripping or saphenous vein harvest probably are not good candidates. Patients who smoke excessively also are not good candidates.

Major resectional surgeries are contraindicated in patients who are massively obese, especially those with comorbid factors (eg, cardiovascular disease, diabetes mellitus, cancer, decreased pulmonary function). They also are contraindicated in patients with massive weight loss and multiple metabolic derangements from previous surgery.

As for all major procedures, a complete history and physical examination is important.

This surgery  is required in virtually all patients with massive weight loss. There have been a lot of different techniques, the fundamental principle of total body contouring is the excision of as much redundant tissue as possible with minimal undermining and moderate tension (Regnault and Daniel). As for all surgical procedures there are some complication like hematoma, infection, wound dehiscene, widened scars. While these complications are rare, they can be sometimes quite troublesome. Your plastic surgeon will address how can be avoided it.

SKIN REMOVAL ON ARMS (BRACHIOPLASTY)

Loose upper arm skin is most often related to weight loss. If you were ever overweight, you more than likely developed heavy upper arms. To accommodate the increased volume of the upper arms, your skin stretched. After weight loss, the skin often fails to tighten, and so it sags. The only way to improve this problem is through an arm lift, also called brachioplasty.

Liposuction is an ideal procedure for arms but the main contraindication to liposuction alone of the upper arms is minimal fat excess and moderate skin excess. Such patients are usually older and have lost a moderate amount of weight. In this patient population, some form of brachioplasty is required.

Scars are the greatest drawback of this operation. They will extend from the armpit to the elbow, along the inside of the arm. This operation exchanges one cosmetic problem (loose skin) for another (scars). In general, those with very loose saggy skin are most likely to find this exchange worthwhile.

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