Bariatric Times - January 2009 - (Page 28)

28 Body Contouring Perspective Bariatric Times • January 2009 Body Contouring after Massive Weight Loss: Optimizing the Results by Amy S. Colwell, MD From the Division of Plastic Surgery, Mass General Hospital, Boston Massachusetts There has been a dramatic rise in the number of bariatric procedures performed in the US, and this has inspired a new growth field in plastic surgery: post-bariatric body contouring. While bariatric surgery successfully induces long-term weight loss and improves or cures such ailments as diabetes and osteoarthritis, it does not reduce the patient’s excess skin. ¶ Instead, loose rolls of skin drape around the patient’s frame and detract from the overall success of the bariatric procedure (Figure 1). The goal of post-bariatric body contouring is to maximize the results of weight loss surgery by removing the excess skin and reshaping the body into its normal proportions. ¶ This review will discuss advances that have been made in patient selection, technique, and safety to OPTIMIZE RESULTS IN THIS UNIQUE POPULATION. PATIENT SELECTION After surgically induced massive weight loss, the patient often inquires about removal of the sagging skin that remains despite the fatty tissue loss. Although the patient may look good in clothing, he or she embarrassed to take off his or her clothes to reveal this disfigurement. Before embarking on surgical correction of these deformities, several criteria must be met to enhance the outcome for the patient. Stable weight. A plateau in weight loss is achieved following bariatric surgery, and this is an ideal time to consider body contouring. Premature surgery prior to this point is not advisable as further weight loss will detract from the patient’s overall result with recurrent skin laxity. It is sometimes difficult to discourage the patient from having contouring procedures before his or her plateau as the skin deformity can be significant. However, a gentle reminder that the outcome would be enhanced after weight loss is complete and that insurance is unlikely to pay for revisions is often enough to encourage the patients to wait. Body mass index (BMI). It is well recognized that patients plateau at different BMIs and that further weight loss may not be recommended after this level has been achieved. For technical and

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Bariatric Times - January 2009

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