Cosmetic Surgery after Morbid Obesity Weight Loss

Morbid obesity continues to increase worldwide and is defined by the World Health Organization (WHO) when the ideal body mass index (BMI) is greater than 35 and associated with potentially life-threatening diseases.  There is no consistent data on the most effective way to achieve long-term weight loss other than a healthy diet, regular exercise, and bariatric surgery.  As more patients reach their ideal weight (BMI between 18.4-24.9)  and manage their common co-morbid conditions (type 2 diabetes, hypertension, cardiovascular disease, osteroarthritis, sleep apnea, and severe psychological challenges), increasing numbers of patients become candidates for aesthetic and functional body contouring procedures.  Deformities after massive weight loss can significantly affect a person’s body image and self-esteem and also cause functional impairments due to rashes, hygiene, and poor-fitting clothes.  Although face and neck lifts, breast lifts, and abdominoplasties represent the most common contouring procedures, there has been a gaining interest in brachioplasties, thighplasties and lower body lift procedures.

A multi-specialty team approach is necessary to surgically treat the massive weight loss patient even before an aesthetic plastic surgeon performs any contemplated surgeries in a safe, effective manner with minimal complications.  To ensure these goals, comprehensive evaluations, medical/surgical planning, and nutritional and psychological support are formulated together in a scheduled format.  The patient’s reasons and expectations have to be aligned with what the surgeon can offer.  Although operations involve primarily skin and subcutaneous structural adjustments, the surgeon must assess the patient’s suitability for long general anesthesia and have a postoperative pain management team in place when large and multiple areas of surgery are planned.  Management of medical comorbidities, such as hypertension, diabetes, nutritional supplementation, are to be optimized because of the complexities of surgery and long recovery times.   

The surgeon and the patient usually delineate the many anatomic areas that require correction.  Staging procedures may be required to minimize the operative time, surgical morbidity, and avoidance of opposite vectors of tension closures.  The surgeon will review the most common complications such as deep vein thromboembolism (VTE), delayed wound healing, separation of closure sites, seroma collections, hematoma formations, skin loss, infections, lymphedema and scarring.   Some combinations of procedures can be performed together, whereas other combinations are advised against.  For example, procedures commonly combined include abdominoplasty with breast lifting, upper body surgery with lower extremity surgery, or lower body surgery with upper extremity surgery.

Precise markings are done preoperatively in the holding area so that the patient can appreciate the length and location of the eventual scars.  In special extensive cases, the surgeon and anesthesiologist will formulate a proper program to address venous thromboembolism  prophylaxis, body temperature management, antibiotic coverage, fluid resuscitation, possible blood transfusions, and body positioning on the operating table to minimize VTE.  In general, patients are encouraged to ambulate postoperatively on the evening of surgery, treated with VTE prophylactic medications, instructed on antibiotic use and drain placements.  If used, drains are maintained for about 1 to 2 weeks.  Showering may begin 24 to 48 hours after surgery.  Compression garments are recommended for at least 6 weeks.

Procedures

• Brachioplasty (removes skin and fat from upper extremity; long scar from inner elbow to armpit onto lateral chest)

• Thighplasty (removes skin and fat from lower extremity; long scar from inner knee to mons pubis along groin crease line)

• Male and Female Mastopexy (removes skin and fat from breast and re-arranges breast tissue and nipple reposition; variations of inverted T-shape scar)

• Abdominoplasty (removes skin and fat from abdomen with repositioning of umbilicus; long scar from hip-to-hip slightly above abdominal crease line; periumbilical scar)

• Torsectomy (removes skin and fat circumferentially around entire or portion of waist; long scar around torso)

• Buttock lift (removes skin and fat from upper portion of buttocks; long scar across upper buttock crease lines) 

Summary

Body contouring procedures are usually longer and have more extensive post-surgical morbidity problems than other aesthetic surgeries.  Secondary refinements or staging are common to these surgeries.  Comprehensive evaluations, surgical planning, precise techniques to reduce surgical complications with a multi-specialty team approach are paramount.  Dr. Sasaki and his hospital team are experienced in these extensive surgical procedures and can provide you safe and effective outcomes.  Dr. Sasaki is board-certified in General Surgery, Plastic and Reconstructive Surgery with special training (US Army Medical Corp) in anesthesia and Inhalation Therapy.