Do I Need Plastic Surgery After My Bariatric Surgery?

Bariatric Surgery and Public Attention

Bariatric surgery, the stomach shrinking procedure that is sometimes referred to as weight loss surgery, has worked its way into the American vernacular in recent years, and continued media attention is keeping the controversial procedure fresh on public tongues.  In the last twelve months Medicare has removed language from official documents stating that obesity is not an illness, health insurers like Michigan's M-Care have added benefits including discounts on weight loss programs and bariatric surgery, and clips of the surgery being performed made its way into the blockbuster documentary Super Size Me.  The amount of surgeries being performed reflects this trend.  The number continues to increase, and, according to Georgeann Mallory, executive director of the American Society for Bariatric Surgery (ASBS), more than 140,000 are expected for 2004, the most since the procedure was first performed in 1954.

As obesity and associated diseases is on its way to replacing smoking as the number 1 preventable death in America, there is no end in sight to the attention that this surgery is getting.  Despite a mortality rate estimated from 0.1% to 1-2%, the majority of patients enjoy benefits including weight loss and the reversal of life threatening diseases such as type II diabetes.  Many overweight patients find the risk to reward ratio acceptable and make the life altering commitment that comes with the surgery.  The spin off of this increase has meant a boom for the plastic surgery field.

Behind the Numbers

In 2003, more than 52,000 post-bariatric plastic surgery procedures were performed according to the American Society of Plastic Surgeons (ASPS).  Many patients are loosing excessive amounts of weight in a short period of time, and in many instances the remaining skin is not elastic enough to shrink back down.  What results is a lot of saggy or drooping skin, especially in the arms, stomach, thighs, breasts, and buttocks.  For some, these issues are ones of aesthetics, for others, personal hygiene is a concern, but whatever the reason, these patients come to surgeons' offices, posing a new challenge.

Though tummy tucks, lower body lifts, and liposuction are not new to the cosmetic surgery world, performing these (and other) procedures on post-bariatric patients often requires a different approach.  In fact, the demand and relative newness of these types of procedures have occasioned both the ASPS and the American Society for Aesthetic Plastic Surgery (ASAPS) to devote several-hour long seminars to it at their annual meetings in 2004.

The Post-Bariatric Patient and the Plastic Surgeon's Dilemma

As in all cosmetic procedures, the consultation is an important step in determining what and how procedures should be performed to achieve desired results.  During this time surgeons get to know their patients, their medical history, what expectations the patients have following surgery, and their physical and mental health, both of which must be in good shape in order to undergo intensive surgery that can last up to six hours or more under general anesthetic.  In turn, patients are educated on procedural practices and common results.  This is the time for patients to ask all of their questions, familiarize themselves with possible risks, and become comfortable with their doctor.

What makes body contouring, or body reshaping, more difficult after bariatric surgery is that the skin has usually been permanently damaged by being so extremely stretched.  The result is that the patient's skin will loosen with age faster than a normal patient's.  Bariatric patients desiring such reshaping after surgery should find a specialist with experience dealing with this type of situation.