Hospital based cosmetic procedures includes


i.  Arms (brachioplasty)

A combination of aging, uneven body fat distribution, and weight loss can result in the sagging of the skin and underlying fat on the inner aspect of the arm. This is most noticeable when the arms are lifted horizontally. Heavy arms with good skin tone can be improved by removal of the fat only by liposuction. If the skin is in excess and especially if the tone is poor; this has to be accompanied by excision of the skin along the arm. The scar lies on the inner aspect of the arm and can extend from the elbow to the armpits. Sometimes it may be necessary to extend the excision of the skin onto the chest wall. The scars remain mainly unnoticeable when lying against the body. Restoring the shape of the arm is usually the primary goal of this operation.

ii.  Abdomen (mini and full tummy tuck)

This is in general part of a mummy makeover operation. Pregnancy results in stretching of the all the tissues of the abdomen. The extent to which the tummy returns to original is dependent on multiple factors. In the fortunate few patients there maybe no tell tale signs of a previous pregnancy. In the majority the most commonly seen after effects of pregnancy are:

- Stretch marks.
- Excess skin and fat mainly in the lower abdomen.
- Bulging abdomen because of the weakened muscular wall of the abdomen.

Depending on the extent of the problem the patient may qualify for a full or minitummy tuck. The suture line is usually positioned such that it is hidden in swimwear and underwear. The minitummy tuck as a further advantage of limiting the scar anteriorly without extending onto the sides of the tummy. Skin with stretch is completely or partially eradicated and a process of plication may also tighten the muscular layer of the abdomen. The ideal patient for a tummy tuck is one that is not overweight and the correction that can be achieved is very desirable. Patients that are obese with a BMI > 30 are best managed by weight loss followed by the surgery. If this is not achievable then the operation can still be performed. Further refinement with the use of liposuction can improve the contour of the abdomen. The extent of devacularisation of the skin can be extensive therefore smoking history is a relative contraindication. Stopping for a minimum period of 6 weeks can also reverse the effects of smoking.

Male patients sometime also request for a tummy tuck. Not unless the patient presents after massive weight loss will theyqualify. The protuberant abdomen is usually more as result of intra-abdominal fat. The tummy tuck does not attend to this. Appropriate lifestyle and diet change is mainstay of management.

iii.  Flanks or love handles

This area has a tendency to accumulate fat even in a relatively thin patient. This results in a fatty bulge just above the waist band of a trouser or a skirt. This is easily managed with liposuction and it is seldom that skin excision is required. Reduction in this often accentuates the figure into an hourglass appearance making the definition of the buttock more distinct.

iv.  Thighs (medial thigh lift)

The medial thighs have a tendency to accumulate fat in the upper zone near the crutch. Also with aging this section tends to sag. As result the aesthetics of the region is less than satisfactory and the rubbing of the thighs can sometimes be a major source of discomfort. A major improvement can be achieved by inner thigh liposuction followed by excision of the skin excess and lifting of the thigh. The scar is hidden in the inner groin crease line and is easily hidden in underwear and swimwear.

v.  Massive weight loss

Massive weight loss usually in the excess of 30 kg results in fat loss without the accompanying skin retraction. The skin excess and the sag can present in several regions of the body including:

- Face and neck
- Arms
- Breast
- Torso both front and back
- Abdomen
- Thighs

The usual techniques of facial, breast and body contouring apply. In addition body lifting procedures may be essential.