Shaping the body as the weight comes off

Excess skin and tissue that’s left after weight loss is not only unsightly, it can cause health problems. Plastic surgeon Stephanie Kwei uses ‘body contouring’ to repair it.

Stephanie Kwei, MD works with patients who have already had a life-changing experience as a result of weight-loss surgery.

(November 2011) Erica Aurioso lost 115 pounds. That sounds like the end of a story, but it’s not. Yes, her diabetes disappeared immediately after surgeon Robert Bell, MD, performed her gastric bypass in 2010. Yes, strictly limiting her calories following the surgery brought her weight down to a much healthier 160 pounds. She can now keep up with Jesse, her 10-year-old sports enthusiast. And she is finally a match for Austin, 4, the son who was her inspiration for having bariatric surgery in the first place. “What if he runs away from me walking down the street and I can’t catch him?” Aurioso had worried.

Dr. Kwei draws pictures to give her patients an idea of how she will approach their surgery.

Despite her success, however, she lived with lingering reminders of the pounds she once carried. Like many people whose body weight changes dramatically after bariatric surgery, she had flaps of skin on her belly and breasts that rubbed and caused rashes. “They were so painful,” remembered Aurioso, a health care worker.

Even her exercise routine was held back, because the stretched out flesh on her new thinner form made it impossible to find pants that would stay up properly when she broke into a jog. Her sagging breasts gave her ongoing back pain and affected her posture. For help, she turned to plastic surgeon Stephanie Kwei, MD, who joined Yale Medical Group about a year ago. “She changed my life,” says Aurioso.

Each patient is different

Erica Aurioso visits Dr. Kwei for a follow-up. She says Dr. Kwei’s surgery made her feel normal again.

Dr. Kwei specializes in body contouring, removal of excess sagging fat and skin after major weight loss. Many patients come to her to complete their transformation process after already having a life-changing experience as a result of bariatric surgery.

She was attracted to the field, in part, because of the growing need and opportunity for surgeons to work with patients in bariatric programs. According to the Centers for Disease Control, 64 percent of American adults are overweight or obese. Dr. Kwei enjoys working with bariatric patients, who tend to approach contouring surgery with great enthusiasm. “They’re usually very satisfied afterward, and that’s really gratifying for me,” she says. “It allows them to do more with their lives.”

Though the procedures sound straightforward, they are anything but. “Everybody’s different,” says Dr. Kwei. Depending on the patients, she may recommend a variety of operations targeting the face and neck, breasts, arms, tummy or thighs. Often she will do one or two procedures on a patient, and then wait six months before doing additional ones. To reduce the risk of blood clots, she avoids prolonged operations during which patients are immobilized.

There are different techniques for performing body contouring procedures, and a patient’s individual circumstances can help to determine which is best. Dr. Kwei is a leader in this field, having published in the Annals of Plastic Surgery on an innovative breast operation. After significant weight loss, breasts can become pendulous, sagging so badly that the nipples are hidden. In these cases, breasts also typically become flat on top. Dr. Kwei developed a procedure that rotates extra tissue from the side of the chest into the breast, to lift and restore fullness to the breasts.

Body contouring “completes the weight loss process and restores people to feel whole,” says Dr. Kwei. It addressed the kinds of medical issues Aurioso faced, such as rashes and posture.

Aesthetic and psychological benefits

Dr. Kwei reviews the day’s cases with administrative assistant Mary Nusdeo

But there are aesthetic and psychological benefits as well. Aurioso’s problems started a few years ago, when she gained weight during her last pregnancy and kept it on after her son was born. She grew depressed and comforted herself with food. During the worst of it, she gained 60 pounds in just six weeks. She tried medical weight loss plans, but to no avail. “It was really terrible mentally, being big,” she remembers.

While Dr. Bell took off the weight, Dr. Kwei’s surgery allowed her to feel normal again. Before her dressings were removed, Aurioso made a stop at Victoria’s Secret and began planning her shopping spree. Now she’s down to 149 pounds and says she hasn’t stopped shopping. She avoided mirrors for years, but now finds herself drawn to them. “The truth is, I feel like a million dollars,” she says.

Story by Colleen Shaddox
Photos by Robert Lisak