Successful Bilateral Blepharoplasty, Mastopexy & Right Arm Lift Surgery Following Massive Weight Loss

Chief Complaints

A 36-year-old female patient with a body mass index (BMI) of 17 presented to the Plastic and Reconstructive Surgery Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of bilateral under-eye bags, Grade 3 breast ptosis (severe breast sagging), and excess loose skin of the right upper arm. The patient had experienced a significant weight loss of approximately 20 kg over the previous two years, following which she developed noticeable breast sagging, arm skin laxity, and prominent under-eye bags, prompting her to seek surgical correction.

The patient had no known medical illnesses or significant chronic health conditions. Her past surgical history was notable for a lower segment cesarean section (LSCS), bariatric surgery resulting in substantial weight loss, and bilateral arm liposuction performed. She reported a weight loss of approximately 20 kg over the preceding two years, which contributed to the development of breast ptosis and excess skin laxity. No other significant medical or surgical history was documented.

On physical examination, the patient was conscious, coherent, and cooperative. Local examination showed prominent bilateral under-eye bags with tear trough hollowing, Grade III bilateral breast ptosis, and marked laxity with excess redundant skin over the right upper arm. The patient was clinically stable, and no other significant abnormalities were noted on systemic examination.

Upon admission to PACE Hospitals, the patient underwent a comprehensive evaluation, including a detailed history taking and thorough clinical examination by the Plastic and Reconstructive Surgery team. The patient presented with complaints of bilateral under-eye bags, sagging of both breasts, and excess loose skin over the right upper arm, following a history of significant weight loss of approximately 20 kg over the past two years.

The diagnosis was primarily established on the basis of clinical history and physical examination findings. Clinical evaluation revealed bilateral lower eyelid fat prolapse with tear trough deformity, Grade III bilateral breast ptosis, and marked skin laxity with excess redundant tissue over the right upper arm. These findings, along with the patient’s post-weight loss changes, formed the basis for the final diagnosis.

A complete preoperative workup was also performed, including routine laboratory investigations and viral screening as part of the anesthetic fitness assessment. All investigations were within normal limits, and no contraindications to surgery were identified.

Based on the clinical and radiological findings, the patient was advised to undergo Bilateral Under-Eye Bags and Bilateral Grade III Breast Ptosis Treatment in Hyderabad, India, along with correction of the Sagging skin of the right arm under the expert care of the Plastic and Reconstructive Surgery team.

Following the diagnosis, the patient was scheduled to undergo Bilateral Transconjunctival Blepharoplasty with fat grafting, Bilateral Autoaugmentation Mastopexy Procedure in Hyderabad at PACE Hospitals, along with right arm lift to address under-eye bags, breast ptosis and upper arm skin laxity, respectively, under the supervision of the expert Plastic and Reconstructive Surgery team.

The surgical procedure involved the following steps:

• Anaesthesia and Preparation: The patient was taken up for surgery under general anaesthesia. The operative sites were prepared under strict aseptic precautions, including painting and draping of all planned surgical areas to ensure a sterile operative field.

• Bilateral Transconjunctival Lower Blepharoplasty: A transconjunctival approach was used to access the lower eyelids through the inner conjunctival surface. The central and medial fat pads responsible for under-eye bulging were identified and carefully excised to correct the lower eyelid fullness without creating any external visible scar.

• Fat Harvesting and Fat Grafting (Tear Trough Correction): Fat was harvested from the lower abdominal region using standard liposuction techniques. The harvested fat was then processed and purified before being injected into the tear trough area beneath both eyes. This was done to correct under-eye hollowness and improve the smooth transition between the lower eyelid and cheek.

• Bilateral Autoaugmentation Mastopexy (Breast Lift): Both breasts were addressed for severe Grade III ptosis. The patient’s own breast tissue was reshaped and repositioned to achieve an uplifted and more natural contour. Excess skin was adjusted to improve breast shape, projection, and symmetry without the use of implants.

• Right Arm Short Scar Lift and Closure: The right upper arm was treated for significant skin laxity by excising excess redundant skin using a short scar brachioplasty technique. The remaining tissues were tightened and contoured to improve arm shape. All surgical wounds were closed in layers using appropriate sutures, hemostasis was secured, and sterile dressings were applied.

Postoperatively, the patient had an uneventful recovery and was managed with medications to prevent infection, reduce gastric acidity and stress-related gastric irritation, and provide pain relief and comfort after surgery. Eye lubricating drops were used to protect the ocular surface and prevent dryness following eyelid surgery, along with antibiotic eye drops to prevent local eye infection. Strict wound care with sterile (aseptic) dressings was maintained, and the surgical sites were regularly monitored for any signs of infection, redness, or discharge. Ice packs were applied to reduce swelling and bruising and to improve postoperative comfort.

Upon discharge, the patient was advised to take medications to prevent infection and support overall recovery. Medicines were given to reduce the risk of infection, control stomach acidity, prevent stress-related gastric irritation and manage post-operative pain and inflammation. Treatment was also provided to prevent nausea and vomiting after surgery.

Additional medications were prescribed to reduce swelling and support healing during the recovery period. Multivitamin supplements were recommended to aid tissue repair and improve overall recovery. For eye-related procedures, lubricating eye drops were advised to prevent dryness and protect the ocular surface after surgery, along with antibiotic eye drops to prevent local eye infection.

The patient was advised to follow a high-protein diet to support wound healing, tissue repair, and overall postoperative recovery.

She was instructed to maintain proper wound care with regular dressing and hygiene measures to prevent infection. Application of ice packs over the periorbital region was recommended to reduce swelling and bruising. She was also advised to avoid strenuous physical activities and heavy exertion to promote optimal healing and prevent strain on the surgical sites.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, increasing pain, swelling, redness, wound discharge, or any signs of infection at the surgical sites.

The patient was advised to return for a follow-up consultation with the Consultant Plastic, Reconstructive & Aesthetic Surgeon in Hyderabad at PACE Hospitals after 2 days.

This case highlights a comprehensive post–massive weight loss deformity presenting as bilateral under-eye bags, Grade III breast ptosis, and right arm skin laxity. The patient was successfully managed with a combined aesthetic surgical approach, including transconjunctival blepharoplasty with fat grafting, autoaugmentation mastopexy, and right arm short-scar lift. The outcome was an uncomplicated postoperative course with stable recovery and satisfactory contour improvement.