Dr Amira Sanki talks Surgery Procedures for Excess Skin Removal after Weight Loss

Excess Skin Removal After Weight Loss with Dr Amira Sanki

Excess Skin Removal After Weight Loss with Dr Amira Sanki. Dr Sanki is passionate about weight loss patients and procedures, and she has so many success stories to share. As well as being a top plastic surgeon, she’s also really lovely – this is definitely one for anyone considering any type of weight loss procedure.

Excess Skin Removal
Dr Amira Sanki

Trish: Oh, good morning, listeners. I’m here today with Dr. Amira Sanki. Dr. Sanki is a specialist plastic surgeon. She’s from Southern Aesthetics, which is actually in Sutherland Shire. Where is it?

Amira Sanki: It’s in Kogarah.

Trish: Kogarah. I always get confused with the Sutherland Shire.

Amira Sanki: Look the Shire is a big and wonderful place but we’re at the very tip of it.

Trish: It’s huge. All right so it’s at Kogarah and we’re going to have a chat today about the different procedures that she’s performed and I know that Dr. Sanki’s really passionate about the weight loss patients because I’ve met so many in our group, lots of success stories so I invited her to come along. Thank you so much for joining us today.

Amira Sanki: Thank you, Trish. It is my pleasure.

Trish: Lovely so tell us, I know that you do a lot of weight loss procedures as part of your … in your clinic as your treatments that you do for people.

Amira Sanki: Yeah.

Trish: Tell us a little bit about the weight loss patient. What makes us so … and I can say us because I am a weight loss patient.

Amira Sanki: Yeah.

Trish: What makes us so different to other people when having surgery?

Amira Sanki: I think the weight loss patients are so much more rewarding, Trish. I think that there is a fine line between reconstructive and cosmetic surgery and the nice thing is that the weight loss patients really are both. I think a few plastic surgeons feel a bit empty when we do cosmetic surgery because you kind of wonder about the motivators but the weight loss patients, you know that you’re actually improving their quality of life. You are not just making them look better, you’re making them feel better and more confident. That’s why I enjoy them so much.

Trish: That’s awesome. Tell us about some of the procedures that you do to some weight loss patients like I spoke to one of your amazing patients yesterday. She’s went to have one treatment and started with another but could you just run through them with us so … ?

Amira Sanki: Yeah, so it is quite a journey. Usually most patients come in most concerned about their tummy because I think that’s the one that gets in the way the most of moving and wearing clothing. We often then also end up operating on their arms and doing a brachioplasty; on their thighs and doing wedge resections of the inner thighs. Then also the face and neck which I think is often a forgotten thing. I think too many people are very preoccupied with their body and forget about that one part of their body that’s actually on show to the rest of their world which is the face and neck area.

Trish: That’s so true. I’m going to go straight back down to the thighs now because I was taking with Kerrie Ann yesterday about the thighs and I know that the thighs must be really rewarding because I’ve seen some great results but it’s a huge recovery I think with the thighs.

Amira Sanki: Yeah, and look my analogy is I tell people, “Look, you’re essentially having two tummy tucks because the length of each wound on each thigh is the same as the tummy tuck wound.” Then on top of that it’s impossible to move without using your legs. That’s what makes it a bit of a tougher recovery I think than the other operations because those wounds are just going to move and pull a bit every time someone tries to move and walk. That also indicates just why it is such an essential operation because how can you move and walk comfortably and wear clothing comfortably with all that excess skin in the inner thigh area? It’s a real problem for patients and I think that’s why once they do finally get healed and recovered it’s very, very rewarding to have normal thighs again.

Trish: With the thigh lift do you just have one way of doing it or does it depend on the person? I know that there’s a couple of different options when…?

Amira Sanki: Yeah, there are. There are a few options with thigh lifts and I try to tailor make my procedures to each patient. I think that sometimes we even invent procedures for patients depending on what kind of problem they present with.

Most people have excess skin after massive weight loss that extends from the inner aspect of their thigh all the way towards the knee joint. The operation that lends itself to that problem is a vertical thigh lift where the incision runs along the inner aspect of the thigh like a seam and that allows us to remove all of that inner thigh skin excess and secondarily ends up tightening the fronts of the thighs as well.

Trish: Okay.

Amira Sanki: There are some people though that still carry a lot of weight around their thighs and you know everyone Kerries their weight in a different area. Despite 30 to 40 kilos of weight loss, there will be people that still just carry all their fat in their thighs and those patients are sometimes best served by having two surgeries by having liposuction in the first operation to just debulk and get rid of that fat that they cannot get rid off. Then to allow that skin to loosen up and then the second operation to remove that excess skin. That yields a really, really nice tight pretty result.

Trish: Okay, because I was going to ask you do you always do lipo as part of the thigh lift?

Amira Sanki: Yeah, I do. I do always do liposuction and in some people it is just to thin out the skin that we’re removing. What we’re actually doing is trying to leave behind the important lymphatic chAnnls, veins, live vessels in the area but still remove the skin and the way we do that is to liposuck the area that we’re actually planning to remove. That sucks out all the fat but it leaves behind the veins and the lymphatics and then we peel of the skin. It sounds gruesome but it ends up literally pealing off a banana skin. The skin just comes away really easily once we’ve sucked out the fat from underneath.

Trish: It’s going to give a nicer finish anyway then because it’s going to be less…

Amira Sanki: Yeah, you get a nicer result, a smoother result so you don’t get any knobbly weird bits where some fats being left behind. Most importantly, because you’re leaving behind those veins and lymphatics there’s a much lower chance of lymphedema and long term swelling which is the main complication we worry about after thigh lift surgery.

Trish: Okay, well that makes so much sense too. Another thing that Kerrie Ann spoke about yesterday was she had a … I don’t know what it’s called. I can’t remember what she called it but it’s almost like a double tummy tuck where she had the hip to hip and then under the bra line. What’s that called?

Amira Sanki: We call that a corsetplasty or a corset style tummy tuck. It’s such a cool operation. This is an operation that was introduced to all of us plastic surgeons at one of our conferences a few years ago by an American plastic surgeon.

Trish: I was there actually. I was there. That was my very first conference.

Amira Sanki: Yeah, that’s right. I think that’s where I met you Trish in that meeting.

Trish: Maybe.

Amira Sanki: Yeah.

Trish: I remember seeing it and thinking, “Wow”.

Amira Sanki: Wow, yeah. Exactly. It is the most dramatic tummy tuck. It really … Even my anaesthetist loves this operation because you just see a patient’s body unveiled, all that beautiful structure and their little waist line and the proportion suddenly gets shown off by this incredible procedure which is appropriately called a corset tummy tuck because it brings in the waistline and the torso area just like a corset does. But, instead of a piece of fabric, we’re using the patient’s skin.

Trish: You cut from hip to hip and then it’s under the breast almost from the left side of the body to the right side of the body.

Amira Sanki: That’s right. Yeah.

Trish: It gets rid of the fat from up the top.

Amira Sanki: That’s right so you end up look … The one problem with any plastic procedure is that you’re getting that tighter result but it’s at the expense of some scars. The scarring is a little bit more extensive. It’s shaped like an H on it’s side. There’s a scar that runs under the breast, in the fold of the breast, one that runs down the middle, the middle of the tummy where the belly button is and then one at the very bottom. The other way of thinking about it, because a lot of our listeners would be familiar with the fleur-de-lis abdominoplasty. It’s like the inverted T scar of a fleur-de-lis but it’s also combined with a reverse tummy tuck. In a reverse tummy tuck, the skin is pulled up into the bra line area rather than down into the under pant area.

Trish: Not everyone would do that, would they? I mean I don’t know doing it in Australia but-

Amira Sanki: Yeah, look. What can I say? I am a female surgeon with balls. You do have to have a little bit of gumption to entertain doing such a big operation to someone. There is a point in the operation where my assistant always goes, “Oh, my god. Is this all going to come together?” And there’s a little bit of panic. Of course, it always does. We remove huge volumes of skin in this procedure and you are recruiting the back skin to the front. It’s such an incredible tightening effect that I think especially in Kerrie I remember noticing a mole that she had around her waistline area on the side that moved almost to the very front of her tummy. There’s a huge grave movement with this procedure.

Trish: Yeah, right and of course it’s not for everyone. It’s whichever patient it’s going to suit to , isn’t it?

Amira Sanki: Yeah, exactly. It’s not an operation I would recommend to everyone. It is most suited to people that have a lot of loose skin around the torso area that seems to even be collecting around the back because as I said it’s going to bring around that skin from the back to recreate their tummy skin that we’ve removed. The other patient that I think it’s worthwhile doing in is people that seem to have multiple rolls of skin at the front of their tummy so they don’t just have that lower hanging abdominal pannus. They seem to have … we call it epigastric roll. They seem to have a top roll and then a middle roll and then that lower abdominal pannus roll. I don’t think there’s any other tummy tuck that can really get rid of that huge amount of skin.

Trish: It’s phenomenal the results they can do. All right so then we’ve gone from the legs down to the tummy and then we got the arms. I know that some … like the batwing arms on a massive weight loss patient can do a whole lot lower than past the elbow. Kerrie Ann was telling me that hers actually did. How low does one go?

Amira Sanki: Yeah. I think it really depends on the patient and if someone says to me, “Oh, look. I find that I can’t even … That my forearm skin is getting in the way.” Then I show them pictures of the scars and what it looks like and we weigh up the pros and cons. If they feel that those scars are worth getting a bit of contour, then I think it’s worth doing. I’ve had some patients where that excess skin around the forearm area is such a nuisance that they burn themselves when they’re cooking. That’s just such a horrible problem. I think it’s definitely worthwhile extending down the incision to nip in that extra skin. Again, I just listen to my patients and if they’re troubled by an area, I will think of a way of helping them out to neatly bring in that skin to give them a better contour and of course give them a better functional outcome.

Trish: Yeah, and a like that, that you’re prepared to … Of course, you’ve got to get comfortable with that but you’re prepared to try things that might not have been done before and that’s how innovation happens, isn’t it?

Amira Sanki: That’s right. Absolutely. I mean that’s how I’m sure Dr. Moya came up with the corsetplasty that a patient said to him, “I really hate this top roll in my tummy,” and he thought, “Oh, why not come up with a different operation?”

Look just this week, I did something that I haven’t done before which is to combine an extended abdominoplasty with the reversed tummy tuck as well. This is for a patient that just seemed to have a very high riding roll of skin that I knew would not be released by a normal tummy tuck but at the same time she didn’t need to go to the extreme as a corset either. It’s about tailoring the procedures and having the experience and the understanding of a person’s anatomy so that you know what’s safe and what will work.

Trish: Yeah, of course. That’s so true. All right so we’ve done the arms now. I hear a lot of people lately talking about and probably because I think about it myself is the back fat like the fat when you’ve lost weight, the side of your boobs gets this back fat. Do you do just wedge surgeries where we just get rid of a wedge here and there?

Amira Sanki: Yes, so again there’s a few ways of targeting that and I think it comes down to … I always try to kill two birds with one stone so if that side boob area seems to be extending round to the back, then we’ll take care of that in a bra line lift. That’s a scar that runs and it gets hidden by the bra strap line at the back and it helps to lift up their mid back loose skin and then also tuck in the excess skin at the side boob area. If they don’t have too much of that back skin but they’ve got a lot of side boob and a lot of arm excess skin then we might do an extended brachioplasty instead which is where we do the wedge resections of skin in the arm area and then we take them up into the arm pit and then run them down as a vertical line on the side of the chest.

Trish: Okay and with the procedure like that, is that a long stay in hospital? I just think the arms must be … I mean you don’t think of them but you can’t do anything without your arms like you said you can’t do anything with your legs but what’s the stay in hospital like for … ?

Amira Sanki: Look, it’s not too bad. I usually keep patients in that are having that procedure just for one night, just to make sure they’re okay that they are coping with their pain because everyone copes with their pain very differently. A lot of patients look at me the next day and say, “I don’t know why I’m here,” which is wonderful but just in case, just in case they are quite sore then everything is at hand and we’ve got our nursing staff and myself to look after them.

Trish: Yup and so how did you actually get into the weight loss surgery? How did that become something that you’re really passionate about?

Amira Sanki: My niche, yeah. Yeah, I think it found me, Trish.

Trish: Yeah.

Amira Sanki: Look what happened was one of my bariatric surgeons that I know who … lovely man who actually took me through my first appendix a million and one years ago, he referred me a patient for body contouring and I just remember having this wonderful, very emotional surgeon’s moment where at the end of the operation of doing her breast lift and her body lift, I stood back from the table and you know it’s just this spectacular sensation of I have completely changed this woman’s body and her life is now going to change. It was such an important moment for me a real epiphany moment where I knew it’s just what I wanted to do. It was very fulfilling. It was everything I’ve ever wanted to do as a doctor to help people but to actually be able to see how I’m helping them.

Plastic surgery is such a beautiful thing because it’s so tangible and so visual. Then the lovely thing is word of mouth so she then told all of her friends and I did all of them and then they then told all of their friends and next you know this is what I’m doing. About 85% of my practise now is massive weight loss body contouring.

Trish: Wow and I mean I’ve seen a couple of procedures being done. I’ve seen a tummy tuck and a breast reduction being done and it’s freaking hard work. You’ve got to be really fit don’t you?

Amira Sanki: Yeah, look the patient that I do a corset tummy tuck on last week, she said to me, “What were you doing for five hours?” I said, “Well, the stitching takes a really long time.” Yeah, so it is endurance surgery and most of my wounds are closed with three to four layers of closure and it’s all dissolving stitches. There’s no machine. There’s no sewing machine. It is all done by hand so the analogy I say to people is think how long it takes to hem a dress and then do that three times over. But, it’s fun and my team loves it. It’s not just about me, it’s my anaesthetist, my nurses, we’re all watching the transformation together and it’s a real thrill, it’s a real joy to see this body being unravelled during those five hours.

Trish: Yeah, I totally get that because having watched a couple of procedures, it’s quite mind blowing. It’s like, “Wow, this is just … ”

Amira Sanki: Yeah, and even in breast surgery when you do the one breast and you sit the patient up and there’s one that’s perky and gorgeous and the other that’s looking sad and miserable and everyone has this moment of, “Wow! What a difference.” It’s pretty cool stuff.

Trish: Yeah, totally. Another question I was going the to ask you, do you do … Because I know that when people lose weight, it affects the face on a lot of people as well. Do you do many necks or faces or … ?

Amira Sanki: Yes, I do. I do and again that’s the one where there’s a lot of pressure in that operation, isn’t there, Trish? That’s the one where people can’t hide the result. That’s the one that really has to be perfect. There’s no room for error and no one comes to you wanting an okay face lift. It’s got to be absolutely perfect. Again, I think that’s why we spend a little bit more time in that procedure again. A face and a neck lift takes about four to five hours. But I think the thing that a lot of people don’t realise is that we can use fillers and Anti-wrinkle injections quite judiciously and quite beautifully in massive weight loss patients and a more permanent version of that would be fat grafting. We sort of talked about that a little bit at the nonsurgical symposium last week. Just to restore that fat that people have lost in their face with fillers.

Trish: Yeah, it’s amazing what can be done what with fat transfers. It’s almost like the longer you wait the more stuff comes out that you can do.

Amira Sanki: Yeah and the sad thing is when people go to this incredible effort to lose all their weight and someone will say something so hurtful like, “Oh, but you look really sick. You’ve lost too much weight.” It’s a good way to pop someone’s balloon, isn’t it? You know they’re feeling so good about themselves and yet some people think they look worse. I think that’s because of the facial descent and a lose of fat volume in their face and they end up looking a little bit old and a little but unwell. What we aim to do is just put back the fullness in their cheeks and bring up the corners of the mouth usually and also get rid of the loose skin of the neck with a neck lift. All of a sudden, they’re looking gorgeous and they can go back to that person that told them that they look old and sick and say, “Ha”.

Trish: I think sometimes as well, I think what happens is because a massive weight loss patient, if they’ve done it with a sleeve or something like that you’re not getting as much dense nutrition in your body as someone else. You might get the dark bags and they might not be looking after themselves as well as they should because it’s…

Amira Sanki: Look there are very few patients I meet that aren’t iron deficient, and it’s really, really hard to stay on top of your nutrition. You’re right people do have to look after themselves in this day and age we’re all so busy that even taking a vitamin pill takes up too much time.

Trish: I know I’m going to go and take my vitamins as soon as we get off the podcast.

All right well that’s being so interesting and it’s been really, really great to talk to you about this. I can’t wait to get you on the Facebook live because I know we’ve got a huge group of women that want to have a chat with you about weight loss surgery so that will be great. I really appreciate your time today talking to us about it.

Amira Sanki: Thank you, Trish. I appreciate your time. Thank you.

Trish: Can I just ask you if you had one takeaway that you wanted to give to listeners here today like when choosing a surgeon or working out a procedure, is there something that you would just say, “Look no matter what just make sure you do this?”

Amira Sanki: I think these are big procedures with multiple stages and it’s really important to pick a surgeon and a team that you like because it’s not just about having a surgeon who’s a good operator. It’s about picking a surgeon that you know you can talk to and be honest with.

Trish: Yeah, that’s so true and it’s funny because Kerriee Ann said to me yesterday she booked in to see four surgeons and you were the first one on the list and when she’d met with you she thought, “No, I know that, that’s the right surgeon for me.”

Amira Sanki: Aww that’s just the loveliest thing to hear.

Trish: Yeah, she loves you.

Amira Sanki: That’s beautiful.

Trish: Well thank you so much for joining us.

Amira Sanki: Thanks, Trish.

Trish: No worries.

Amira Sanki: Looking forward to talking to you soon.

Trish: Yeah, awesome so listeners, if you’re out there and you want to look up Dr. Amira Sanki you can do so on our website or just Google her or otherwise just drop us an email to [email protected] and sorry about that little static bit at the end. I’m not sure what happened there on the recording but yeah, thanks so much for joining us Dr. Sanki.

Amira Sanki: Thank you, Trish. Bye.

Trish: Have a good day. Bye.

To listen to Kerrie Ann’s amazing weight loss story, as mentioned in this podcast, click here.

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