Although one may think of the skin as a mere covering of the body, like an overcoat, it is in fact an active participant in the body’s biochemical and physiologic functions, and not an inert 20 square feet of covering, no matter how attractive it is to look at.
But like an overcoat, it does keep out the undesirable effects of weather with its waterproof surface, the plethora of blood vessels to keep us warm, and sweat glands to cool us off, and the nerve endings warn us of danger and can discriminate the types of danger: heat, cold, sharp, blunt etc. As an active organ the skin is the site of transformation of the precursor into Vitamin D under the effects of sunlight.
The skin has layers, the outermost, epidermis, is an epithelium and continuous in many parts of the body with the mucous membranes. The layers beneath are called dermis and hypodermis.
The epidermis is stratified squamous epithelium which has an outer layer of stratum corneum or “horny layer” of material that peels away; beneath this is the layer of actively dividing cells, the stratum granulosum, and the stratum Malpighii.
The sweat glands and hairs penetrate the epidermis, but their “roots” are in the layer of dermis beneath it; here run the blood vessels and the cutaneous nerves.
The dermis is composed of fibro-fatty tissue, varying in the quantity of each component, but basically having a fairly dense collagen mat with varying quantities of elastin and fat.
Color is given to the skin by the dark brown melanin and melanoid, and by the yellow keratin, there is a congenital condition of albinism in which the skin lacks pigmentation, and other conditions in which patches of skin are not pigmented.
There are at least five different pigments that determine the color of the skin. These pigments are present at different levels and places.
Most persons are horrified when they see a scanning electron microscope picture of their skin and find it is swarming with mites and bacteria.
As skin ages, it becomes thinner and more easily damaged. Intensifying this effect is the decreasing ability of skin to heal itself as a person ages.
The thinning of bone with age is widely recognised because it tends to lead to fractures of the hip. What is less widely recognised is that thinning of the bone is merely a localised manifestation of thinning of all collagenous structures in the body, and the skin thins with age just as much as does bone. It also loses its elastin component and falls more readily into folds and creases. Skin of the very old persons tears easily, or can easily be pulled away from its underlying supporting tissues.
The same changes occur with “premature aging” of the skin associated with abuse of ultra-violet light (natural or artificial) or with cortisone which inhibits collagen formation.
This 33 year old woman embarked upon a diet and exercise program that resulted in a 100 pounds weight loss over a 10 month period. Significant changes in her body's appearance occured, but because there is a limit to how much an individual's skin can shrink down to a smaller contour, some issues remained.
These types of issues are ideally adressed by performing an abdominoplasty along with tailored liposuction.
This 49 year old woman reached her plateau weight after losing 100 pounds following bariatric surgery. She is an excellent example of an individual whose breast tissue had been largely replaced with fat and as such, after massive weight loss, there was not enough breast tissue remaining to rearrange into a new breast shape that appeared typical of what one might expect after a breast lift or mastopexy.
From an aesthetic standpoint, this woman informed me that she would be satisfied with any improvement in her breast shape. Her primary goal, however, was to remove the extra skin that otherwise laid across her abdomen unless she wore an underwire bra. Her skin had lost a great deal of its elasticity and was unlikely to tolerate insertion of an implant to replace lost volume without sagging or becoming ptotic in a relatively short period of time. The use of commercially available skin substitutes, which would have allowed use of an implant, was not an option for her.
Her post surgical photographs show her result after I performed a breast lift or mastopexy using a short scar technique that leaves behind scars in the shape of a “lollipop.”
This 37 year old woman reached her plateau weight after losing 91 pounds following bariatric surgery. She had a breast lift or mastopexy using a technique which leaves behind scars in the shape of an “anchor.”
A breast lift or mastopexy is an operation which rearranges breast tissue so that the new breast shape is typically shorter and rounder. Unfortunately, patients who have lost a large amount of weight often do not have enough breast tissue remaining to rearrange into a naturally appearing breast. This woman was fortunate to have enough breast tissue after a 90 pound weight loss to achieve the breast shape that is visible in her post surgery photographs.
While an implant can provide the volume that is lacking after massive weight loss, the weight of the implant can also be very taxing on compromised skin, such as that which is typical after massive weight loss. Commercially available skin substitutes can provide the strength needed for successful use of implants in such cases.
This case depicts a 33 year old woman who was fit, slender and had never been pregnant. She had, however, a genetic tendency to accumulate fat in the mid-body- front and back. Because she had excellent skin tone and skin elasticity, this type of individual was the optimal candidate for liposuction.
Once the excess fat is removed from beneath the skin, the skin will shrink down and hug the new body contour without any sagging. The incisions required for this type of body contouring are a few millimeters in length. Notice the significant change in this woman's body shape to a desirable "hourglass".
This individual underwent a breast reduction in which almost two and a quarter pounds of weight was removed from the breasts. The breasts were shortened in length and lifted to give a rounder appearance. This photograph was taken at approximately four months following surgery.
Liposuction of the tissue that lies between the upper outer quadrant of the breast and the upper arm as well as the side of the body directly beneath the arm pit area can decrease bra band size and give the breast a narrower appearance after surgery.
This 24 year old woman had a breast lift or mastopexy to correct sagging of her breasts that occurred as a result of changes related to pregnancy. I used a short scar breast lift or mastopexy technique which leaves behind scars shaped like a “lollipop.” Some breast lifts or mastopexies are performed using a technique that results in scars that look like an “anchor,” but I prefer to use this shorter scar technique because scars are never visible in the cleavage nor on the side of the body beneath the arm. This makes swimsuit selection much easier.
How the breasts will change as a result of pregnancy varies from one woman to the next. Some women’s breasts look very similar after pregnancy. Others change drastically in their appearance after even a single pregnancy.
This woman was fortunate to have enough breast tissue to rearrange into a relatively full and natural appearing breast without the need for an implant.
Skin elasticity, which refers to the ability of skin to “snap back” after being stretched, also varies from one woman to the next. In people who have poor elasticity, surgical results do not last as long. In such people, using an implant to replace volume can predispose that individual to an earlier recurrence of the initial problem because the implant has weight and taxes already compromised skin. Commercially available skin substitutes can provide the strength needed for successful use of implants in such cases. Use of such substitutes adds expense and complexity to the surgery, however.
This case depicts a 44 year old woman who had borne four children and was most concerned with excess skin, which was severely affected with stretch marks, on her abdomen. Such individuals are optimal candidates for an abdominoplasty or "tummy tuck." While many of the stretch marks can be removed during this surgery, even those that remain are less noticeable when the skin is taught. An abdominoplasty is also designed to tighten the abdominal musculature, which may also be stretched or malpositioned as a result of pregnancy.
The post-operative photographs depict this woman's appearance approximately one month after surgery.