© 2008-2010 Dr. Glynn Bolitho, M.D.
Weight control is a constant battle for many Americans. According to statistics, nearly 50% of the population is considered overweight and about 10 million Americans are 100 pounds or more over their ideal weight and fall into the morbidly obese category. As a result, many of these individuals are now undergoing bariatric surgery, also known as gastric bypass or weight loss surgery, a procedure in which the size of the stomach is significantly reduced so that less food can be consumed.
Patients who are considering weight loss surgery, and those who have already had it, should be aware of the changes that occur in the body following the massive weight loss that results from this procedure. With very few exceptions, these patients develop generalized or specific areas of excess skin because the elastic fibers in the skin have been broken and the tissue has been permanently damaged.
According to San Diego plastic and reconstructive surgeon Glynn Bolitho, M.D., F.A.C.S., plastic surgery can be a viable option for reducing the amount of excess skin in individuals who have had weight loss surgery.
"The number of bariatric surgery procedures is steadily increasing and with it, more and more people are having post operative plastic surgery once they see how much weight they've lost, and the amount of excess skin they have," Dr. Bolitho said. "After losing all of that weight, they want to look and feel good about themselves, and plastic surgery can help them do that."
Dr. Bolitho explained that there are several factors related to the redundant tissue and skin a patient will have following the weight loss surgery, but one of the most important is the patient's age. Younger patients tend to have more elastic skin which has the potential to recoil. As a rule, the older patient's are, the more loose skin they'll have after surgery.
The next most important factor is the amount of weight loss they experience. A person who loses 200 pounds is likely to have more excess skin than one who loses 80 pounds, simply by virtue of the amount of extra weight being carried and the additional tension, or stretching, on the skin tissues caused by that extra weight. Other factors include complexion, cumulative sun exposure, heredity and smoking.
Treatment options for excess skin can include exercise, which increases muscle tone and tightens the connective tissue between muscles and overlying skin. A regular exercise regimen is helpful for maintaining weight after the procedure, but it is limited in its ability to tighten the skin.
According to Dr. Bolitho, body contouring with the use of plastic surgery is the most effective option, particularly for those who have lost 80 to 100 pounds, thanks to the new techniques and advancements in plastic surgery procedures.
Weight loss following a bariatric procedure is often generalized and consequently, excess skin is not confined to just one area. The abdomen is the area of greatest concern for most patients, but often the thighs, buttocks and upper arms are affected. Many surgeons will perform a body lift on their weight loss patients, which involves an abdominoplasty, or tummy tuck, and a thigh and buttock lift all at one time. This procedure is most effective in reducing the appearance of loose skin and cellulite along the thighs, buttocks and abdomen, and the resulting scar is confined to the waistline and hidden by underwear or a bikini. Both men and women find the surgery very rewarding.
Treatment options for women's breasts following massive weight loss involve either implants or a breast lift, or a combination of the two. If a woman desires larger and fuller breasts and has little sag, an implant may be sufficient. For women who are concerned about sagging and want to be larger, a breast lift along with implants may be necessary.
For men who end up with sagging breasts, or larger breasts relative to their torsos after the weight loss, liposuction alone may be adequate. But many surgeons prefer to perform a two-part procedure, consisting of liposcution to remove fat and excess glandular tissue and then a skin tightening procedure after several months once the skin has retracted.
There are three surgical options to improve the appearance of excess skin on the arms. Liposuction alone may provide a satisfactory result, but usually an arm lift is performed along with it whereby the excess skin is tightened only from the armpit. The classic arm lift procedure involves a scar in the armpit as well as along the inside of the arm, and is often combined with liposuction. This procedure is the most effective for those with large amounts of excess skin at the arms.
Massive weight loss can accelerate the appearance of facial aging, as laugh lines and wrinkles become more prominent. Patients also frequently complain of excess skin and fat around the neck. A facelift, which almost always incorporates a neck lift, can effectively treat the deep wrinkles of the face as well as excess fat and skin of the neck.
The timing and approach to plastic surgery following the bariatric procedure is critical to success, Dr. Bolitho explained.
"Body contouring procedures should be considered only after the patient's weight has stabilized following surgery, which can be anywhere from seven to 18 months," he said. "Performing a skin tightening procedure prior to stabilization could result in the need for further tightening in the future."
Patients often want all of their body contouring performed as soon as possible, but Dr. Bolitho explains that providing the highest quality plastic surgery means undergoing just one procedure at a time. Several operations might be needed to achieve desired results, and it is recommended that patients wait three months between surgeries.
© 2008-2010 Dr. Glynn Bolitho, M.D.
