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We talk a lot about losing weight… but rarely about what it actually feels like to live in that new body. And for a lot of people, that experience includes the physical and emotional impact of excess skin.

Excess skin isn’t just about appearance. It's the rashes, the infections, the discomfort that makes everyday movement harder than it should be. It's the frustration of working so hard to transform your body and still not feeling fully at home in it.

I recently sat down with Dr. Beckman, a board-certified plastic surgeon based in Carmel, Indiana, who specializes in body contouring for post-weight loss patients. Today, I'm walking you through her most important insights, from when to seek a consult, to what life looks like on the other side of surgery.

Plastic Surgeon vs. Cosmetic Surgeon 

This is one of the most important things to get right before you even start looking for a provider. When it comes to body contouring procedures (surgeries designed to remove excess skin and reshape the body after significant weight loss), you are specifically looking for a board-certified or board-eligible plastic surgeon. Not a cosmetic surgeon. 

The titles sound similar, but the training pathways are very different. A plastic surgeon has completed either a general surgery residency with plastics training or an integrated plastic surgery residency. That level of specialization matters enormously when someone is operating on your body, so please don't skip this step when vetting your provider.

When Should You Actually Seek a Consult?

The good news is you don't have to wait until you've hit your final goal weight to start the conversation. Dr. Beckman is happy to meet with patients wherever they are on their journey.

When it comes to scheduling the actual surgery though, she recommends being close to your ideal weight with at least six months of weight stability first. There are two reasons for this: longer lasting results, and safety. 

If your weight is still fluctuating or your nutrition isn't optimized, it increases surgical risk. She also doesn't have a strict BMI cutoff. She looks at the full picture, including any underlying health conditions like sleep apnea, heart disease, or diabetes that could affect surgical risk.

The Most Common Procedures for Post-Weight Loss Patients

Here's what Dr. Beckman most commonly performs:

• Tummy tucks
• Body lifts
• Arm lifts
• Thigh lifts
• Breast lifts and reductions

Most patients have more than one area of concern, so procedures are typically staged over time rather than done all at once. Dr. Beckman usually starts with the trunk — a tummy tuck or body lift — to reset the frame, then works outward from there.

Tummy Tuck vs. Body Lift vs. Fleur-de-lis — What's the Difference?

A standard tummy tuck (abdominoplasty) involves a hip-to-hip incision addressing loose skin on the front of the abdomen, and can include a muscle repair. A body lift extends that incision all the way around (circumferential) addressing the front, sides, flanks, and lower back. 

A fleur-de-lis adds a vertical incision in the front to handle extra tissue in the horizontal direction. For patients who have lost 100, 200, or more pounds, these more extensive approaches are often necessary to achieve the best result. The right option depends entirely on the individual, which is exactly why a consult matters.

How to Prepare Your Body for Surgery

Dr. Beckman's top recommendations before surgery:

• Weight stability — at least six months
• Nutritional optimization — your body needs to be properly fueled to heal
• Avoid smoking — it significantly increases complication risk

These aren't just suggestions. They directly affect both the safety of the surgery and the quality of your results.

What Recovery Looks Like

For a standard tummy tuck, Dr. Beckman recommends one to two weeks off work. The first two weeks are the most intense, and having help at home during this time is a good idea. After that, you'll see gradual improvement, with most normal activities resuming around four to six weeks and exercise cleared at the six-week mark.

For scar healing, she recommends silicone strips starting about two to three weeks after surgery, once everything is fully healed. The evidence behind silicone is solid. It keeps incisions hydrated, reduces tension, and prevents the overproduction of collagen that leads to thick, raised scars. You'll need to wear them most of the day for two to three months, but the results are worth the commitment.

The Biggest Misconception

Body contouring is not a weight loss procedure. It's specifically designed to address excess skin. And to do that, incisions are necessary. Many people come in hoping liposuction alone can solve the problem, but when skin laxity is the issue, it needs to be surgically removed. 

The good news is that incisions are placed strategically and hidden wherever possible. For example, the arm lift incision sits in the inner seam of the upper arm, making it largely invisible when your arms are at your sides.

Things That Can Go Wrong (And How to Minimize Risk)

No surgery is without risk, and Dr. Beckman is upfront about the most common complications:

• Delayed wound healing — usually managed with local wound care
• Fluid collections — typically addressed with drains
• Infection — uncommon when you've properly optimized beforehand

The best way to minimize risk is to do the prep work: get your nutrition dialed in, reach weight stability, and eliminate habits like smoking before going in.

What Life Looks Like on the Other Side

This is the part that matters most. What Dr. Beckman sees in her patients after surgery isn't just a physical change, it's a complete shift in how they feel about themselves. 

The confidence that returns, the relief from chronic skin issues, the ability to move more freely. As she put it, losing the weight is the hard part. Once the excess skin is removed, patients feel like the whole transformation is finally complete.

And I want to be clear about something she emphasized: this is not a vanity conversation. 

Excess skin causes real, significant functional limitations such as hygiene issues, chronic rashes, and mobility problems. These are medical concerns that deserve to be taken seriously.

Want to go even deeper? Listen to the full episode with Dr. Beckman for more on procedures, recovery, and everything to consider before taking the next step. 

You can connect with Dr. Beckman through her practice, My Plastic Surgery Group, based in Carmel, Indiana.

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.   

 Welcome back to another episode of the podcast. We're gonna talk about something today that has become increasingly something that everyone's asking me about. What I see as a clinician right now is that as more and more people are able to experience sustainable weight loss, a new set of questions has come up around excess skin and what to do about it.

And while it's a really personal decision, this isn't right for everyone, but many of my patients, this isn't just about appearance. This is not a cosmetic thing. It's really about managing skin infections, improving mobility, and really feeling more confident in their bodies that they've worked so hard to come into. In this episode, we're breaking down when to get a consult, how to think about surgery in a different informed way. And so hopefully after today you can know how to go forward a little bit more easily. Dr.

Beckman, thank you so much for coming on. Can we start with you just introducing yourself, a little bit about you and your clinic, and then can you tell us a little bit about why you got into plastic surgery? 'cause I'm always so curious. Thank you so much for having me on your podcast. This is something that is very different.

I haven't done anything like this before, so hopefully it goes smoothly. My name is Beckman. I am a plastic surgeon in Carmel, Indiana. My specialty is aesthetic procedures of the face, breast, and body. I did do extra training in an aesthetic fellowship that emphasized body contouring, those procedures are definitely very near and dear to my heart.

The body countering procedures in post weight loss patients, the patients work so hard to lose the weight, and I'm just grateful to be a part, often the final steps of their journey. Yeah. Do you know what occurs to me here as you're talking, that I don't think that the regular lay person understands how much training goes into this.

So when you mentioned how you did additional training with body contouring, I think, 'cause there's a lot of surgeons that just say they do the procedures right? Like they're, am I wrong with this? Like they come from general surgery and they can just do that. Versus when you actually have the training that you have, I think it's very different.

Am I wrong with that conclusion? No, no, you're correct. So for these procedures, you really are looking for a plastic surgeon, a board certified or board eligible plastic surgeon. That can look like general surgery training, or now you can do an abbreviated training of just direct plastics in an integrated plastic surgery residency.

Okay. But what you're looking for is a plastic surgeon, not a cosmetic surgeon. That's what I was referring to, so thank you. 'cause I feel like the language, even I get it confused so everybody that's listening, please write that down because this is very important because it's, there's nothing more devastating than someone operating on you.

You didn't really vet them, you don't know their credentials. It's, this is something that you really need to care about. When is the time when someone, let's assume that they've lost a lot of weight assuming that they want skin removal surgery. When should they actually seek out the consult?

So that depends. You know, I love to chat with patients, so I'm really happy to chat with them wherever they are on their journey. Okay. You really do want to be close to your ideal weight before undergoing the surgery. I like to see at least six months of weight stability, and that's for two reasons.

So first reason is, just longer lasting results. If you get the surgery and then you lose. A ton more weight after that, you might notice some of that extra skin recurring. Yeah. And the second reason is just safety. If you're not weight stable, especially if you're losing a lot of weight, maybe in an unsafe way, your nutrition may not be as optimized.

Yeah. So. In those case, it makes for a safer surgery if you are weight stable for at least six months. But I'm happy to have that conversation whenever. I love to educate, I don't have a strict BMI cutoff.

Okay. Usually if it's, if your BMI is over 35, I start looking at other factors, you know? Comorbidities. So sleep apnea, heart disease, lung disease, diabetes, all of these things can make for a, more surgical risk. Okay? So certainly if you are a higher BMI, you do need to take those things into consideration.

But I don't have a strict cutoff. I'm just here to have conversation with the patient and discuss their goal. I love that. I love that. Perfect. What are the most common procedures that you're performing right now? For post weight loss patients? Yes. For post weight loss? Yeah. Yeah, there are a few. Tummy tucks, body lifts, arm lifts, thigh lifts, breast procedures like breast lifts and reductions.

I would say those are the most common. Okay. Mm-hmm. And do you, how do you decide, do you do multiple at one time? Do you stage it out? How does that decision get made? Oh, that's a great question. It's very individualized. Oftentimes a patient will come in and they have an idea of what.

Area bothers them the most and I'm certainly, happy to oblige if they have extra skin everywhere. I usually start with maybe emphasizing the trunk in a tummy tuck or a body lift to just reset their frame. And then, yeah, staging procedures after that, whether it's with breast or arms and legs.

Most certainly, everybody is usually staged. 'cause these procedures are quite. Long and, you don't want, the longer you get with certain procedures, you just don't wanna keep adding time. Yeah, definitely. Can you explain the difference between for people to understand what does a tummy talk, what does a body lift?

What does that actually entail? Oh yes, I get asked this quite a bit. A tummy tuck traditionally is a standard adominoplasty, that usually is an incision, hip to hip, and that's addressing the loose skin in the front, in just your abdomen. And that can have, a muscle repair with that as well.

Now a body lift or a lower body lift. Typically that is an extension of the tummy tuck of the standard incision. So now your incision is circumferential and that not only addresses the front, but now you can address extra skin on the sides extending to the flanks and lower back. Yeah, so you'll hear a few terms.

360 circumferential. Sometimes it's very different between what surgeons are calling it too. So it is important to clarify those incisions. Yeah. Yeah. 'cause I feel also, like I'm hearing like Flo DeLee, which that's, what is that's circumferential around and what else is happening there? Oh, Flo DeLee.

So, yeah, so that's a great question too. lee is the vertical component that you can add to a tummy. Tuck, often circumferential. So if there is somebody with a lot of extra skin to be removed, they may need the circumferential incision to handle all of the excess tissue in the vertical direction.

Okay. And then that vertical component of the incision in the front handles extra tissue in the horizontal. Direction. Got it. Yeah. To really get maximum body contouring, if that makes sense. Yes. Sorry, that wasn't clear. Totally. I think the channels that I'm following, they've lost like 200 plus pounds.

I think that's why, these different incisions are needed. What are your top, like if someone's going into surgery, do you have any things where you're like, Hey, I really recommend you do X, Y, Z, whether it be like nutrition or, or any other type of things leading up to surgery.

Yeah, so we cover that with being weight stable I think is very important, but also, yes, nutrition, nutritional optimization is important. And then also avoiding, bad habits like smoking. 'cause it really does increase complication risk. Definitely. Yeah. Mm-hmm. And then when people get surgery afterward, and I know this probably has, this is gonna vary based on what procedure, let's just say they have a simple tummy tuck.

How long are they out of work or kind of out of commission? Out of work. Usually I recommend, one to two weeks out just taking time off of work. Depending on the procedure and what they do. It's definitely, the recovery's definitely the worst, as you can imagine in the first one to two weeks, it does get better after that gradual improvement.

But the first one to two weeks is the most intense. It's not a bad idea to have some help, at home. And yeah, take off those two weeks from work and then you can see some gradual improvement from there. But exercise, things like that's a little longer term. You can get back to most of your.

Normal activities by four to six weeks with exercise being at six weeks. Yeah. Awesome. Is there anything afterward that you recommend they do, that they get the best results? I don't know, is there anything that you actually, is there any validity to anything that you can do that actually helps with scars not being as bad or anything like that?

Oh, great question. There's not a ton of great evidence on certain scar creams, but the, there is good evidence on silicone based treatments, so we recommend silicone sheets, just the silicone strips that you can apply to your incisions, usually about two to three weeks after the surgery when you're fully healed and there are no scabs.

Mm-hmm. That those silicone sheets. Put pressure on your incisions and they keep them hydrated. Healing incisions like hydration and that prevents this overproduction of collagen, which creates the angry looking scars. And there's also some evidence that it downregulates fibroblast activity, all sorts of collagen related things, but it reduces tension on the scars.

That's what we usually recommend, but you have to stick with it for. About most of the day for two to three months. Wow. Yeah. Yeah. A lot of scars. A lot of scars. But they do. Well, you know, we put 'em discreetly. Yeah. Yes.

Strategically. I feel like a lot of people, at least a lot of people listen to my podcast. They're not necessarily right in a city where they have access to a great surgeon. Many of them will travel. What is realistic with travel? Do people stay by the surgery center afterward? How does that work for someone that's not living really close to that place? Yeah, that's okay if you travel, sometimes people do travel several hours or longer just to find a surgeon that's. Doing their procedure mm-hmm. That they're interested in. I would say, it is a lot more planning, definitely have some help with the transportation.

I would s. Plan to stick around town for at least a couple days to a week after the procedure, depending on what it is. And then you do have to work out with your surgeon, ranging for follow-up appointments. Mm-hmm. Mm-hmm. That nature. Me personally, I would love to see my patients way more often than not, so it doesn't make me uncomfortable if they, get back on a flight right away.

Definitely. Are there any, what kinds of questions are the most common that people ask you when they come in for a consult? What am I missing that everyone asks you? Oh, a lot of people do need clarification on the different types of procedures. People don't know what is available, what you can do for the extra skin and what the different types are, what we talked about with the tummy tuck, standard abdominal plasty versus that circumferential versus the floriday.

Those are all. Very different options. Yeah. Yeah. Mm-hmm. Definitely. And does insurance ever, ever cover it? So it, it can cover procedures like a pen colectomy, which is a little bit different from an abdominalplasty, pen colectomy. You're removing just extra tissue that's functionally apparent,

There has to be a medical indication. For those procedures, that's well documented before insurance will wanna cover it. Unfortunately. Look, I do think most of these procedures, not just the pan colectomy. Like you were saying earlier, improved patient's function. It's not just a cosmetically based, we're not just dealing with appearance.

It just improved patient's mobility and comfort and hygiene. Yeah. But unfortunately insurance companies are a little slow, so I know they do cover pan colectomy, which is just removing that extra tissue in your tummy. There's no muscle repair or there's nothing with the belly button that you're doing.

Yeah. But it does have to have some medically documented reason. Yeah. Okay. Off its rashes. Yeah. Yeah. Yeah. Let's see, what, uh, um, what do you think the biggest misconception is when people come in and work with you? I guess there's two things.

You're kind of related. Body contouring isn't weight loss, you know, it's not a weight loss procedure. It's really to address. Extra skin. And to do that, you do have to place incisions. A lot of people will think, oh, can I just handle this with liposuction and with a skin issue, you need the incisions, unfortunately. But they are placed strategically, they're hidden. For instance, the arm lift incision is in the inseam. Mm-hmm. Of your upper arms, so when your arms are at your sides, you don't see it as much. Mm-hmm. And then they do gradually heal and fade over time, is liposuction involved with, I would assume that it's, partly used with some of these procedures. Is it. Yes, it is. It's a great adjunct for body contouring. For instance, tummy tuck. I always like to do some flank liposuction just to smooth out the trunk contour. So it's a lovely adjunct and by itself, but it can't do, it's not perfect either.

Yeah. Yeah. This is not a fun part to get into, but I know that there are complications, right?

Things that can go wrong. Are there any things that you make sure to highlight for people? When you're placing those incisions, you can run into wound healing issues. I would say that's pretty common. Most of it is addressed with just lo extra local wound care. Some ointment, it's called delayed wound healing.

It just takes a little bit extra. You can get fluid collections. That's usually managed with drains for certain procedures. And then, I would say the last most common complications, maybe infection, it's not very common if you were optimized prior to surgery with all those things that we talked about.

You get your nutrition minimized, your risk factors like smoking and excessive alcohol use.

Yeah. Do you think that that there's any last words that you would wanna leave people with? Maybe any words of encouragement? Because I, I feel like for me, having almost lost a hundred pounds and needing to still lose more and knowing that.

Uh, not to overshare on the podcast. Actually, I've never talked about this on the podcast, but the, like the yeast infections and things, it is honestly it is so unpleasant. The pain, the point is it's very emotional, but I think that, when I see my patients and people get these surgeries, it is so life changing.

Do you have any words of encouragement maybe for them that, yes, it's hard to go through these surgeries, but what do you see on the other side? What do you see afterward that patients, maybe their emotional state being different? Do you experience that in the clinic? Oh yes. That's why these procedures are so near and dear to my heart.

They, it is just so empowering when they go through and they, get through the recovery, everything. They've worked hard for all the weight loss. That is the hard part. You know, the extra skin it's hard to treat that. So once you can get that removed from the surgeries, then they just feel like the whole transformation Yeah.

Is complete. And I see that just being very empowering in terms of restoring confidence and quality of life. And I do want, your listeners to know that it's not cosmetic. There is that what you mentioned with the rashes? This is. It can be significantly, there's can be significant functional limitations, with hygiene and comfort and mobility.

So, yeah. Yeah. Thank you for providing that. I really appreciate today I'm very sensitive to , the energy of people that I have on. 'cause I feel like, people that have, had obesity in their lifetime, they've been highly. There's lots of bias and stigma and we're just very sensitive to the energy, right.

And I just feel like it's been really great what's come from you. So just thank you for that. 'cause that really means a lot to me. Can you tell everybody a little bit about how can they find you and your clinic? How can they find more how to work with you, things like that. Well, thank you. Let me start off by saying thank you so much.

I really do try to create a safe space for my patients and just provide the education where they need it in the judgment free zone. So I really appreciate you saying that. How you can find me. So my name is Dee Beckman. We're based in Carmel, Indiana. My practice is named my plastic surgery group.

And you can, we're pretty accessible so you can reach us via Instagram, our website. Or give us a call. Yeah. Love it. We'll make sure everyone that's listening, we're gonna make sure to link all of this either in the show notes below where you're listening or you go to rent to clinic.com and you click on podcast.

We have everything linked there. Thanks again for coming on. I know that this is going to give hope to a lot of our listeners, so just thank you so much. Oh, thank you for having me. Thank you. It's been a pleasure.