 Good morning, everyone. Dr. Saul here in Beverly Hills. I'm ready to go. We got some great cases today But starting with this fine gentleman here incredible story 30s Exercise lost 90 pounds 90 pounds I really admire people that have the persistence and you know the get go to do that That's a lot of pounds 90 pounds You've tried to lose nine pounds and see how it is this gentleman lost 90 I'm in awe of people that are so persistent and get where they want to be so what happens when you lose weight Unfortunately, the skin does not retract Remember skin is like a rubber band you can expand it expand it But when you want to use it on something tighter It may not have the retraction because of the elasticity and the collagen is gone Important facts to know there's nothing that we know that really puts back collagen or elastin back into the skin To make it have that elasticity back. It's true with some RF technology and Lasers you could get some retraction, but we're talking millimeters not inches Let's look at this fine young gentleman here. Yeah, he looks fantastic. All this is skin He's lost it. He could be in the gym seven days a week 24 hours a day He's not going to get any smaller because he did it all that he looked. This is all skin. It's hollow So that's why it brings it to dr. Saul He's around 44 inches around his waist, but what we're going to do is we're going to take out the fat from the sides Make sure he's he looks very stealth Guys are stealth. They're not curvy. We're going to make them look stealth and You could see the contour of his out of the out muscles. The lateral aspect is right there and Look at the amount of skin. I'm going to take out off of him It's I'm predicting over 10 inches from here to down here. It's going to be about 10 inches plus He's going to look fantastic. We're going to make him ready for summer. He's learning look fantastic Fabulous all this is going to be gone. It's exciting for me because he's done the hard work I'm going to do only some of the work, but he's going to get some amazing result because when all this is gone It's it's like the apron is gone. You'll feel freedom better to exercise run All activities will be improved. So let's get going Let's get this guy where he needs to be get him ready for the summer Although it's already summer. He'll be ready by about six to eight weeks. So I'm all geared up I hope you guys are because we're going to start on this case. Let's get going So here we are. This is what we have marked out with the patient in laying position Look at how much we're trying to take out. We're trying to take out This is 10 inches plus if we stretch it. I said 10 inches So we're going for the blue line to above the belly button We're going to pull all this together like that. It's going to be a great case. Stay tuned as we film it for you Hi everyone moment with Dr. Solid this sink. Okay, so we're getting ready for this big case I'm really excited for this patient really 90 pounds is a lot when you think about it People have a hard time losing five pounds. This guy was so motivated To lose 90 pounds. So we have to deliver the goods today We're going to go And take out as much skin as possible make him as tight as possible and give him the desired look he's looking for Remember these these patients when they lose this much weight It's not just one surgery later. He's probably going to need other things For his chest for his buttock and other things to Take off the excess skin. So it's a journey Just like the weight journey the surgery is a journey too And we're going to embark on the journey today. Stay tuned if you guys look at all the pictures I forgot to show this to you guys earlier But look his this is the line coming from the pubic up This is the midline of the chest coming down His belly button is not in the middle Although the stock was in the middle because of excess skin and other things It gets pulled to one side or the other He might have more skin on the right side. So it's getting pulled more just millimeters But you could see there's a straight line and it's towards the right it happens So we're going to try to fix that. So as you vision and we're going to start up top come down And just go right all the way across you could see our incision is going to be in the hair bearing area It's very important your incision is always in the hair bearing area other on then with our tummy tuck We're doing the internal corset because he actually did have separation But in this case it wasn't because of course he's male. It wasn't because of childbirth It was because he actually gained so much weight That the fascia had thinned out and he had a separation because his visceral fat was Quite big and it just expanded remember whenever you gain weight Or you have a baby there below you have bony pelvis. So you can't extend Further down in the back you have the spine and the muscles and you can't expand posteriorly And superiorly you have the rib and the diaphragm And the diaphragm, you know, you have the lungs above it So it can't go up. So the only way it has Way to expand is anteriorly because it's muscle and that's how God created us So what have we done? We double layer closed the internal corset. He did have some separation of the muscle Now look at this. I'm putting in tension sutures Something a little bit more creative and new this will help Close out the pockets for saroma and take off tension and give a better closure So what we're doing is we're actually Suturing the anterior wall to the muscle in the midline. So it gives them a kind of like a six pack look too Remember, I told you guys I want to go 10 inches plus So from the line that I want to cut to here is six From here to here is another six. That's 12 inches And another inch 13. So I just made it over 10 13 inches and we're ready So here we are measuring this side. That's six inches That's 12 inches and there's another 13 inches. Perfect So this is what we took out of patient. Hey, let's take a look even without putting it on stretch Measuring it. That's a ruler six inch ruler There it is 12 inches remember when you take it off traction it kind of Retracts itself and here it is 18. So 12 by 18 inches We took out look at how much this was the pubic area. You could see the hair follicles This was the belly button. Look at that. That's the length of his abdomen right now And the thing I told you look at how thin he is as I told you before he's lost a lot of fat It's just skin. Look at how thin it is. Usually you've seen him be about two inches his is about Maybe what is this like not even half an inch It's about a quarter of an inch Remember when you always pinch the skin You're pinching two folds of skin. So you might think oh, there's a lot of fat But remember it's the fat on one side with the fat on the other that makes it look thick But in actuality it's less than a quarter of an inch Okay, so we're done with the case I want you guys to appreciate the length of what we took out as we reveal his abdomen So remember we did lipo of the pubic lipo of the flanks lipo of the neck tummy tuck Muscle tightening And here's the reveal babam. Look at that beautiful tight stomach Nice nice any Invaginated belly button. Look at the length of the skin. We took out is what he has left from the pubic to the sternum. Look at that Boom, he looks fantastic. We got him very nice and tight and we're done with our first case