The phenomenon of massive weight loss is a relatively new development being addressed by the medical community.
While some are able to lose weight on their own, others choose weight loss surgery. Bariatric Surgery and Gastric bypass surgery are growing in popularity. In fact, candidates for reconstructive surgery numbered over 50,000 people in 2009. As a result of these treatments for morbid obesity, body contouring after massive weight loss has become a focus of the plastic surgery community.
Body contouring procedures on post bariatric patients are inherently different than on patients seeking more localized cosmetic changes.
Because skin laxity cannot keep up with weight loss, the skin’s elasticity is permanently damaged. Innovations in plastic surgery procedures, treatment options, expectation management and your safety must all be carefully considered. Aesthetically altering multiple areas will necessarily be considered to give you the body image you have worked so hard to attain. Plastic surgery body contouring solutions are necessarily highly individualized.
Aesthetic reconstruction of patients losing significant weight is functionally and cosmetically handled differently than procedures in people with stable weight profiles.
While many surgeons are engaged in helping those with massive weight loss rediscover their body image, patients are advised to seek and demand a surgeon with the required astute aesthetic vision as opposed to those experienced in treating typical cosmetic patients. Surgeons who rely on more formulaic procedures will be frustrated (as will their patients) by the poor results they produce. MWL patients require significant soft tissue sculpting and modifications on the operating room table in order to deliver highly aesthetic results.
It ‘s important to draw the distinction between patients who have undergone weight loss procedures and those who have lost similar amounts of weight—often over 100lbs through exercise and diet alone.
While both patient populations are undergoing surgeries that require the healing of large body surface areas, they require large reserves in nutritional elements especially protein. But bariatric patients may have some degree of nutritional malabsorption. There are special nutritional formulas specifically designed for the complicated requirements of post bariatric population. Aside from helping the body heal post operatively it also aids in the healing of compromised skin. In obese patients, the underlying support structures of the skin are damaged and the fascia is stretched reducing its functional nature. Therefore the skin and underlying structure which function as an organ system are diseased and don’t function as well as healthy skin organ system. Both the circulation and inherent structure of fascia and skin including their elements—collagen and elastin are not normal in terms of function and amounts.
Massive weight loss patients understand one procedure in isolation will not deliver the return on investment, both in time and money.
Bariatric surgery or losing weight alone cannot lead to the body they envisioned. Excess skin can be almost as deforming as excess weight. The pivotal issue becomes the order in which to address the patient’s aesthetic priorities and the amount of surgery that can be accomplished in one setting. Health and safety must take priority over expediency. The consultation is key to prioritizing a surgical plan. For the vast majority of patients the first and most labor intensive procedure recommended comes with one of longest recoveries: thigh/buttock lift. It is the foundation by which all other reconstruction is based and followed by inner thigh, knees, calves and ankles. Breasts (for both men and women) can be addressed as can upper arms (batwings.) Necklifts and facelifts are usually the final procedure if necessary and/or desired. These often require non surgical skin tightening treatments, such as Ulthera®.