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Bariatric Plastic Surgery
A Guide to Cosmetic Surgery after Weight Loss
By Thomas B. McNemar, John Lomonaco, Mitchel D. Krieger, Jack Kusler
Addicus Books, Inc.Copyright © 2008 Thomas B. McNemar, M.D., John LoMonaco, M.D., and Mitchel D. Krieger, M.D.
All rights reserved.
Contemplating Bariatric Plastic Surgery
* * *
If you've spent years battling excess fat, you should feel very proud of yourself for losing a large amount of weight. But shedding all those pounds may not have given you the body contours you desire. In fact, your massive weight loss may have caused a new problem you hadn't anticipated, namely, excess skin that hangs in folds on your body. This sagging skin may be preventing you from seeing your slimmer new shape and may actually make you feel disappointed with your new look. You may feel that the loose skin is an unpleasant reminder of your former self or that you still feel overweight when you look in the mirror.
Loose skin also may be causing hygiene and health problems and may be making it hard for you to find clothing that fits. And unfortunately, no amount of dieting or exercise is going to eliminate all that extra skin or make it shrink to fit your new shape. Plastic surgery can add an important psychological benefit to the health benefits you have already received from your weight loss.
Considering all the effort you put into losing weight, all this loose skin can be extremely frustrating. Fortunately, there are several cosmetic surgery procedures that can remove excess skin and give you the sleeker body you've worked so hard to achieve.
What Is Bariatric Plastic Surgery after Weight Loss?
Plastic surgery after weight loss is designed to enhance the shape of your body. It aims to improve the proportions of your figure and to improve your skin tone by removing the loose, sagging skin that often follows massive weight loss. Some of these surgical procedures also tighten underlying tissues or remove fat deposits to produce a more aesthetically pleasing shape. Cosmetic surgery can address the problem of loose skin on nearly every part of your body as well as on your face and neck.
Types of Bariatric Plastic Surgery
Several different surgical procedures are available to improve your body contours. Commonly performed procedures are designed to target sagging skin on the abdomen, thighs, buttocks, breasts, chest, back, arms, face, and neck. Following is a list of plastic surgery procedures that can be performed following weight loss to give you a more pleasing shape.
* Tummy Tuck: Also called abdominoplasty, a tummy tuck is a surgical procedure that resculpts the shape of your abdomen. It can give you a smoother, flatter-looking belly and a more well -defined waistline. The procedure removes excess skin from the abdomen, and it also can tighten underlying tissues and remove stubborn fat that hasn't responded to your weight loss efforts. The belly button also is reconstructed, and rejuvenation of the pubic area is frequently performed.
* Panniculectomy: This surgical procedure is designed specifically to remove a panniculus — also referred to as a pannus — a large apron of skin and fat that hangs from the abdomen and is a fairly common occurrence following massive weight loss. The goal of a panniculectomy often is to remove massive amounts of skin and fat that may be causing infection or serious limitations in your activity. A panniculectomy typically does not have the same aesthetic outcome as a tummy tuck but can still help redefine the shape of your abdomen.
* Thigh Lift: Also called thighplasty, a thigh lift can eliminate drooping skin from the inner and/or outer thighs to give you more shapely legs. By tightening the remaining skin, thigh lift surgery may rid you of unsightly saddlebags and, in some cases, also may reduce the appearance of cellulite.
* Buttocks Lift: This surgical procedure improves the shape of your posterior by getting rid of sagging skin and restoring skin tone.
* Pubic Lift: A pubic lift, also called monsplasty, can alleviate the severe sagging and bulky tissue buildup in the pubic area that sometimes accompanies massive weight loss.
* Body Lift: Also referred to as a lower body lift, belt lipectomy, central body lift, or circumferential torsoplasty, a body lift improves the contours of the abdomen, thighs, and buttocks. This surgical procedure typically combines a tummy tuck, pubic lift (monsplasty), thigh lift, and buttocks lift into a single operation.
* Breast Lift: With a breast lift, also called mastopexy, droopy breasts are restored to a more pleasing and youthful shape. With breast lift surgery, excess skin is removed, and the remaining, tightened skin provides better support to the breast tissue. In some cases, breast implants may be used to help fill out the shape of breasts that have deflated after weight loss. This is called a breast lift with augmentation.
* Breast Reduction: With breast reduction surgery, breasts that are too large following weight loss can be reduced to a size that is in better proportion with the new contours of your body.
* Male Breast Reduction: This surgical procedure aims to restore a more natural shape to the male chest by eliminating the breast enlargement that can result from being overweight.
* Arm Lift: Also called brachioplasty, an arm lift is a surgical procedure that can eliminate skin that hangs down from the back of your arms.
* Upper Body Lift: This surgical procedure is designed to improve the contours of the breasts (or the male chest), upper back, and arms. An upper body lift typically combines a number of procedures into the same operation.
* Facelift: With a facelift, also called rhytidectomy, you can achieve a more youthful, rested look. A facelift tightens the jowls as well as the underlying muscles to enhance your appearance.
* Neck Lift: Often performed at the same time as a facelift, a neck lift, also called cervicoplasty, provides greater definition to the jawline and neck by removing loose skin.
* Liposuction: One of the most popular of all cosmetic surgical procedures, liposuction is used to permanently remove fat from a variety of areas of the body. It is commonly used in conjunction with other bariatric plastic surgery procedures to help you achieve the sleeker contours you want.
Growing Popularity of Plastic Surgery after Weight Loss
The popularity of plastic surgery after weight loss is escalating rapidly. This rise is directly related to the increase in the number of Americans who are undergoing some form of bariatric surgery to accelerate weight loss. Bariatric surgery involves a number of procedures performed on the stomach and/or intestines either to restrict food intake or to alter the way food is processed and absorbed. The typical result is rapid weight loss.
Currently, each year, more than 200,000 Americans have some form of bariatric surgery to accelerate weight loss. And that number is climbing quickly. With the rapid weight loss experienced following bariatric surgery, sagging skin is an unfortunate by-product. That's why more than 55,000 men and women who have undergone bariatric surgery seek out some form of cosmetic surgery following weight loss.
Of course, having bariatric surgery isn't the only way to lose large amounts of weight, and it isn't the only reason that cosmetic surgery following weight loss is surging in popularity. If you shed pounds the old-fashioned way with diet and exercise, you can still be saddled with excess flesh, which can motivate you to seek a surgical solution. Rest assured that the plastic surgery procedures covered in this book are designed to improve your body contours regardless of how you lost weight.
Are You a Candidate for Bariatric Plastic Surgery?
If you've dropped a significant amount of weight and are now bothered by drooping skin, you may be a candidate for plastic surgery. The various procedures available can be tailored for women or men and are usually highly individualized to meet your specific needs. Provided you're in good overall health, dramatic improvements can be achieved whether you're in your twenties or in your golden years.
Plastic surgeons will look at several factors to determine if you are a good candidate for surgery. These factors include your weight, your overall health, your age, your expectations, and your attitude.
One of the key factors surgeons look at when deciding if you would make a good candidate for post-weight loss plastic surgery is your weight. More important than the actual number, however, is how long your weight has been stable. Stable means that your weight fluctuates no more than a few pounds. Most physicians recommend waiting to have surgery until your weight has been stable for approximately three to six months or more. With a stable weight, you are more likely to achieve the best results from surgery.
Some surgeons also take your body mass index (BMI) into consideration. Your BMI is the ratio between your weight and your height and is a good indicator of whether you are normal, overweight, obese, or morbidly obese. A BMI of 18 to 24 is associated with normal weight, 25 to 29 indicates you are overweight, 30 to 39 puts you in the obese category, and 40 or more suggests morbid obesity.
In general, the lower your BMI, the better your results will be. Ideally, your BMI should be below 30 in order to ensure the best possible outcome. You may still be considered a candidate for surgery if your BMI is in the 30 to 35 range or even slightly higher. In this range, however, you should be aware that the risk for complications increases and that the results typically aren't as satisfactory.
Your Overall Health
Your overall health is one of the most important things plastic surgeons take into consideration when determining if you're a candidate for surgery. Fortunately, your health may have improved significantly since losing weight. In many cases, shedding pounds can lessen or completely alleviate many medical conditions that are associated with obesity, such as type 2 diabetes, hypertension, sleep apnea, and heart disease.
You don't have to fall within a specific age range to have plastic surgery following weight loss. However, if you are older, your overall health condition may be of more concern. Anyone over the age of forty may be required to obtain medical clearance from your physician before surgery. Being sixty or beyond also may play a role in determining which procedures are most appropriate for you and whether or not you can have more than one procedure performed during the same operation.
Having realistic expectations is one of the most important qualifications if you're considering plastic surgery after weight loss. Plastic surgeons stress that the key word you need to focus on is "improvement" rather than "perfection." This is true regardless of which post-weight loss procedure or procedures interest you the most. If you're willing to accept this fact, you'll be a better candidate for surgery. In addition, you'll have a much higher chance of being satisfied with your results.
You also need to anticipate a significant amount of scarring as a result of surgical procedures that remove excess skin. These scars may appear on several parts of your body depending on the procedures performed. It's important that you fully understand that these scars can be quite extensive. Fortunately, in many cases, the scars can be placed strategically so they will be hidden from view by your clothing or even by a bathing suit. If you're like most people who opt for plastic surgery, scars are a very acceptable trade-off for a better body contour.
Be aware, too, that the recovery period following plastic surgery after weight loss can be rather lengthy. In fact, it can take quite a bit longer to recover from post-weight loss surgery than it does to bounce back from bariatric surgery itself. Depending on the specific surgical procedures you have, you may be required to spend a day or two in the hospital, and your recovery may take several weeks or even more than a month. Because of this, you should be prepared to miss work for some period of time after having your procedure.
Having a healthy attitude is another desirable factor in candidates for plastic surgery after weight loss. It's best if you're emotionally stable and have a positive attitude about yourself. Of course, living with unsightly, droopy skin can wreak havoc with your self-esteem and self-confidence. It's understandable that you might have some lingering negative feelings about the way your body looks. These feelings can often be alleviated once surgery removes that extra baggage. However, if you harbor negative feelings about yourself in general, your new look may not remedy these feelings.
A good attitude also means being willing to take an active role in the experience. This involves taking the time to learn about the various procedures that might be right for you, asking questions, communicating your goals clearly, and following instructions carefully. By being an active participant in the surgery process, you greatly increase your chances of achieving optimal results.
Understanding the Limitations of Plastic Surgery after Weight Loss
Good candidates realize that even though plastic surgery procedures can reshape your body to give it more pleasing contours, there are physical limitations to what can be achieved. For instance, no amount of surgery can alter your basic bone structure. If your hip bones are wide or if your rib cage is asymmetrical, removing excess skin won't change that and may in fact make it more noticeable. Also, it's important to note that the more loose flesh you have, the harder it is to obtain optimal results.
Remember that these procedures are designed mainly to eliminate and tighten loose skin; they aren't considered a treatment for obesity, cellulite, or stretch marks. Yes, some fat can be removed along with your excess skin, but plastic surgery shouldn't be viewed as a weight loss method. Tightening the skin and removing fat deposits may reduce the appearance of cellulite in some cases but can't be expected to make it disappear. And only stretch marks that are located within the areas of skin to be removed will be eliminated.
When Bariatric Plastic Surgery Is Not Recommended
Having plastic surgery following massive weight loss isn't right for everybody. For example, if you suffer from certain medical conditions, plastic surgery may not be suitable for you. Health problems that may prevent you from being considered a good candidate for surgery include:
* Heart disease
* Lung disease
* Kidney disease
* Liver disease
* Uncontrolled diabetes
* Uncontrolled hypertension
* Bleeding disorders
* Connective-tissue diseases
* Endocrine diseases
* Autoimmune diseases
If you are still severely obese, you may not be considered a good candidate. In this case, a plastic surgeon may recommend that you postpone surgery until you are closer to your goal weight. Likewise, if you hope to continue losing weight, it may be best to wait until you've reached a weight you would like to maintain.
In general, smokers do not make good candidates for post -weight loss procedures. That's because nicotine — whether it's delivered via cigarettes, gum, the patch, or chewing tobacco — can diminish the body's ability to heal wounds after surgery. And because the incisions for these procedures are extensive, proper wound healing is critical to a successful outcome.
Having unrealistic expectations usually indicates that you aren't an ideal candidate for surgery. That's because even if you achieve the best possible results, you probably still won't be happy with your outcome.
Timing of Your Surgery: How Soon after Weight Loss?
Even though you may be eager to have cosmetic surgery to complement your weight loss and to complete your new look, it's best to wait for some time after shedding those extra pounds. Depending on your surgeon, you may be asked to delay surgery until you've stabilized your weight for three to six months or even longer.
Excerpted from Bariatric Plastic Surgery by Thomas B. McNemar, John Lomonaco, Mitchel D. Krieger, Jack Kusler. Copyright © 2008 Thomas B. McNemar, M.D., John LoMonaco, M.D., and Mitchel D. Krieger, M.D.. Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
1 Contemplating Bariatric Plastic Surgery,
2 Choosing a Plastic Surgeon,
3 Your Consultation,
4 Preparing for Bariatric Plastic Surgery,
5 Bariatric Plastic Surgery: What to Expect,
6 Recovering from Bariatric Plastic Surgery,
7 Abdominal Procedures,
8 Thigh and Buttock Procedures,
9 Combined Abdomen, Thigh, and Buttock Procedures,
10 Breast Procedures,
11 Arm and Upper Body Procedures,
12 Face and Neck Procedures,
Appendix A. Checklist of Questions to Ask Your Surgeon,
Appendix B. Body Mass Index Table,
About the Authors,