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Some patients are candidates for brachioplasty or inner thigh lifts or arm lifts that have not had massive weight loss and then we combine these surgical procedures with incisions, small incisions, and liposuction and tightening of the skin, but other people that have had the gastric bypass type surgery have lost so much weight that the skin is so loose and so saggy that it has to be removed in some way, and so these would be the patients that would be candidates for total body lift where we lift the outer thighs, the buttock area, the stomach area, and sometimes at the same surgery, some of the patients have very lax or loose thighs that we need to do an inner thigh lift and some people need a brachioplasty for their arms, and for that matter some people need surgical skin tightening for the face, either the neck area or the face and even the breasts. We have to consult with the patient and then determine their priorities because all these procedures can be done at the same time, they have to be staged. So, we work with the patient on prioritizing what is their most concern and where they need the most help first. I have to say that bariatric surgery is one of the most rewarding procedures that I have done. The patients who undertake this type of surgery are in a life’s journey of total reconstruction of themselves, and one of my most rewarding surgical procedures was a patient who came to the Bariatric Center in a wheelchair with diabetes and high blood pressure, in her early 60s, could not walk because her abdomen was so large. After having that bypass surgery done the bypass specialist, she came back to me about a year and a half later on a walker, now because the abdomen was so loose that is was almost down to her knees and I still have her card of thanks today where she is back walking without assistance, not on any hypertension medication, not on any diabetic type medication, and living a full back to normal life. For body recontouring, there are other areas of concern, which include the arms. Loose arms skin can occur after gastric bypass or weight reduction type surgery or can just come with time and aging or even weight loss by an exercise program or something like that. In patients that have lost a tremendous amount of weight, we often times have to make a very long incision from the elbow up into the armpit, but that is becoming more and more rare. There are ways that we are finding to place incisions in the armpit area and combining that with liposuction, and hopefully now with some of the new internal laser liposuction techniques that we will be able to tighten the skin without producing as much scarring as we had in the past. However, with very large skin hanging down the scar, it still is necessary, but I would say that is probably less than 50% of the time that we have to utilize that type of scar for brachioplasty. You will be able to see some of the fore and after photos of patients that have had brachioplasty and have an idea of how nice the recontouring can be.