Massive Weight Loss Patients
Obesity is a multi-faceted chronic disease. It is associated with multiple medical conditions that can significantly decrease one’s quality of life and lead to an early death. Health risks associated with obesity include diabetes, high blood pressure, heart disease, stroke, arthritis, cancer, sleep apnea, psychological disorders including depression and eating disorders and other serious medical conditions.
Obesity is defined as excess body fat. Men and women tend to deposit fat in different locations on their bodies. Females will likely accumulate excess fat around their thighs and buttocks and in general deposit fat in their lower bodies. Men tend to accumulate excess fat in the upper body and in particular at the waist.
Body Mass Index (BMI) is the most commonly used way to determine a patient’s weight status:
BMI = |
|
| Underweight | less than 18.5 |
| Normal Weight | 18.5–24.9 |
| Overweight | 25.0–29.9 |
| Obesity | |
| Mild | 30.0–34.9 |
| Moderate | 35.0–39.9 |
| Severe | >40 |
Medical management of obesity includes dietary changes, exercise, and treatment aimed at changing behavior. Certain medications are used as well including appetite suppressants, fat absorption blocking agents, and others. Much research is being done in these areas now.
Bariatric surgery is being offered now to patients who fail medical management. The current gold standard for surgery is a Roux-En-Y-Gastric Bypass operation. This method combines restrictive changes (the stomach is modified to be much smaller limiting the amount of food it can handle) with malabsorption (reduced absorption of food from the small intestine) to produce weight loss. This procedure results in loss of 70% or more of excess weight stabilizing after 9–12 months following surgery. Almost 100% of co-morbidities are improved or eliminated. Roux-En-Y GBP is particularly good at treating diabetes, hypertension, sleep apnea, lipid abnormalities, asthma, and the psychological disorders accompanying obesity including depression, anxiety, low self-esteem, and reduced quality of life.
There are other weight loss operations being done including adjustable gastric banding, biliopancreatic diversion, and the duodenal switch. Research is on-going in this very important area and further improvements and changes are inevitable.
The bariatric multi-disciplinary team includes a bariatric surgeon, mental health care professional, nutritionist, physical activity specialist, primary care doctor, spiritual advisor, bariatric cook, and support group leaders. The plastic surgeon is an important addition to this team helping patients through body contouring surgery to improve appearance, self-confidence, vitality, and the motivation to maintain weight loss.
Massive weight loss following bariatric surgery leads to redundant skin in the face, neck, arms, breasts, abdomen, and legs. This loose skin can be associated with medical problems including skin rashes, difficulty in performing certain activities like urinating, walking, or engaging in sexual activity. Embarrassment or dissatisfaction with appearance may adversely affect one’s psyche and lead to feelings of inadequacy and lack of self-worth. Studies have found that body contouring after bariatric surgery significantly improves physical and emotional status.
It is generally recommended that a person who has undergone bariatric surgery lose all the weight they need to and then stay at that new low weight for 6–12 months before having any corrective cosmetic surgery. The idea is to avoid significant weight fluctuations. Results of cosmetic surgery are more predictable by doing it this way.
Common plastic surgery procedures needed by massive weight loss patients include facial operations such as brow lift, blepharoplasty, and facelift. Many patients need arm tucks (brachioplasty) to excise excess skin and fat from the upper arms (“bat wing deformity”). Common breast surgery includes breast reductions or lifts with or without implants or sometimes a simple straightforward augmentation mammoplasty is all that is needed. Tummy tucks or lower body lifts will dramatically improve the lower trunk and abdomen and can help to lift the lateral hip and buttocks and upper thighs. For patients with excess thigh skin and fat they may be treated with vertical or horizontal thigh lifts depending on their deformity.
Cosmetic treatment of massive weight loss patients has been shown to have a very high satisfaction rate among the clients being treated. Often these treatments are dramatically transformative and make some patients look like different human beings. In general, the worse someone looks before corrective cosmetic surgery the more they can be helped and the likelihood of them being pleased with the results of their procedures is greater. Cosmetic surgery treatment of massive weight loss patients is a rapidly expanding area in the field of plastic surgery and for the patient really represents the finishing touches on a long hard road from significant unhealthy obesity back to a healthy status with a body the individual patient can be proud of. Looking good and feeling good are inter-linked and a great source of satisfaction leading to happier and more productive lives.
