Tuesday, January 17, 2012

Surgery After Massive Weight Loss

Now that the New Year is here, and everybody is accomplishing their resolutions.  We will deal with the effects of losing a substantial amount of weight.  Losing weight will improve your health and mental disposition in many ways. Just losing a small amount of your current weight can make a difference in the way you feel and look. Some weight loss benefits include increased energy level, lowered cholesterol levels, lowered blood sugar, reduced  blood pressure,improved mobility.  It can also help with sleep apnea so you wake up more refreshed and with more energy. Also it has been shown to decrease depression and can be as effective as antidepressant medicine. With enough of a weight loss you might be able to significantly reduce or elimanate many of the medicines you are taking as well. 

Once you reach your weight loss goals you may find you do not have the fit and healthy body image you expected.  After moderate to massive weight loss, the skin and tissues that have been stretched over the years, lack elasticity and cannot snap back into the new, smaller size of the body.  As a result, sagging pockets of skin may form around the face, neck and jaw line, at the upper arms, back, the abdomen region and around the hips, buttocks, groin area and thighs. 

The surplus, sagging skin that is left behind after weight loss, can cause considerable hygienic problems, skin irritation, skin breakdown, pain and even infection. This loose, sagging skin can look abnormal and potentially gets in the way of normal activities or movement.  Aging, pregnancy, some genetic skin conditions, also can result in severe hanging skin.  This excess skin for some people is far worse than having the excess weight. The excess skin will not go away by itself. Therefore surgical correction of the excess or sagging skin is the answer.

Some typical post weight loss surgeries are Abdominoplasties(tummy tucks), lower body lifts, Total Body Lifts, Brachialplasties(arm lifts), breast lifts or reductions, face/neck lifts and Thigh Lifts.  An Abdominoplasty will remove the excess skin from the front of the abdomen, tighten the abdominal wall muscles and make you much flatter.  The tummy tuck can have liposuction of the sides and or back added for additional body contouring.  For patients who have lost significant weight and have excess skin on the sides and lower back a beltectomy might be the best addition to the abdominoplasty.  The beltectomy removes excess skin from the lower back and side.  It also helps lift up the butt to give a higher and more youthful back side.  A lower body lift will combine an abdominoplasty and beltectomy with or without liposuction or other procedures. It is very common to add a breast lift with or without breast augmentation at the same time.
 If you have lost a lot of weight then you might need to get an arm lift and or thigh lift.  Generally speaking the thigh lift is done to remove excess skin from the mid to upper thighs.  The arm lift will help with “batwings” that some people get after weight loss. The thigh lift is commonly done at a different time then the tummy tuck.  This can decreases the risks of some complications for some patients.  The arms can be easily done with the tummy tuck.
For those patient that have lost a tremendous amount of weight then I commonly recommend my signature procedure the Total Body Lift.  The Total Body Lift is a procedure that is commonly done on patients that have lost 70 -200 lbs or more.  These patients have severe sagging skin. It can be on their upper and lower abdomen, back, bra rolls, also breast or chest (depending if male or female) arms, thighs.  These patients need a complete change of their bodies.  The Total Body Lift can include some or all of  the following: abdominoplasty, a reverse abdominoplasty, corsetplasty, beltectomy, bra roll excision, breast lift with or without implants, and brachiaplasty.  The thigh lift is done 4-6 weeks later or when the patient chooses along with any touch ups.  This procedure in my hands takes 3.5-5 hrs on average depending on the size of the patient and number of procedures.  No blood is transfused and the patients are done as an outpatient. The patients are also walking around within several hours of the completion of the operation. They are usually back to light work in 10-14 days.
The Total Body Lift is not done by many surgeons due to various factors.  If you are a candidate for this procedure please make sure this is a procedure that your Board Certified Plastic Surgeon does on a regular basis.  Most surgeons elect to break up the Total Body Lift into 2-4 surgeries instead of one.  Therefore ask the surgeon how she/he does the procedures, how many surgeries will you have, how often do they do the procedure, etc. Do they use various state of the art techniques and instruments to decreases blood loss? What type of facilities do they use for the surgery?  This should not be done in an office based facility.

A good candidate for a body lift are patients in good health who underwent bariatric surgery (Gastric Bypass Surgery, Sleeves, Lap Bands), or anyone who has lost 30 or more pounds leaving them with excess skin.  Previously obese people experience a marked loss in skin elasticity due to the prolonged periods of stretching while they were putting on weight over the years.  People who have medical problems can be a candidate for the procedures with the assistance of your primary care doctor. 
Normally post bariatric surgery patients have some residual medical problems.  The Board Certified Plastic Surgeon should prepare the patient for the rigors of surgery along with the primary care doctor.  Some of the methods we use are iron supplementation and other techniques to alleviate the chronic anemia very common with these patients.  My team also utilizes protein supplementations and other nutritional aids to help minimize the malnutrition that post bariatric patient have.  I also require that the patient walks twice a day for at least 30 minutes or once a day for 45 minutes daily.  The reason for this is that walking after surgery prevents or minimizes the vast majority of significant complications. Therefore the patient needs to build up their exercise tolerance prior to surgery.

As with any surgical procedure whether it is a simple tummy tuck or a full scale Total Body Lift you will experience some pain, bruising, and/ or swelling.  This is normal and will subside quickly.  Remember it can take a year to see the final results from a body contouring surgery.  While you may not be able to stand fully upright, it is important that you begin to walk for 5-10 minutes per hour the day of surgery to facilitate blood flow in your legs and decrease the chance of lung issue. Your absorbable stitches will dissolve with time. However non-dissolving stitches will be removed in approximately one-two weeks.   Most patients are able to return to work in one to three weeks, however, it may take six to eight weeks before you feel able to return to full normal activity including heavy lifting and strenuous exercise.  After surgery, with a proper diet and exercise, the results from a body lift can be maintained for many years.   
In closing, a body contouring procedure can safely help patients restore normalcy to their life, it enables them to make lasting changes to their looks so they can regain confidence in their image and feel comfortable in their body again.  Good luck with your New Year Resolutions!



About the author
 Anire Okpaku MD FACS is a Board-Certified Plastic Surgeon and the Medical Director of Ocean View Plastic Surgery, serving the needs of Florida as well as a national and international clientele. He specializes in cosmetic plastic surgery.
He is an active member of the Bayside Medical Center at Mercy Hospital where he performs most of his surgeries. He also holds privileges in several other South Florida Hospitals.
Dr. Okpaku graduated from the prestigious Jefferson Medical College in Philadelphia, relocating later to Miami to where he completed his general surgical residency at Jackson Memorial Hospital University of Miami. He went on to complete a Plastic Surgery Fellowship at the University of Texas Health and Science Center, in San Antonio.



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