Body Contouring For Bariatric Patients

In May 2005, sitting in a conference room of plastic surgeons in Charleston, South Carolina, gathered at the table, each with just a legal pad and a pen, and a moderator who said little more than “discuss”. All the participants had been invited to this meeting by Ethicon, the nation’s leading manufacturer of suture material. They had noticed that in select practices across the country suture utilization had accelerated. The reason? As it turns out, it was post weight loss body contouring.

In 2005, bariatric surgery was just gaining popularity. It was still early, and many bypass procedures were still being performed with open techniques, rather than the laparoscopic methods so popular today. At that time, plastic surgeons were just beginning to encounter significant numbers of weight loss patients. Ethicon’s Shaping Futures series, as the conference was called, was designed to help facilitate the development of new procedures and address the needs of this new patient population.

Early on, procedures originally designed to rejuvenate changes that occur from pregnancy were being applied to weight loss patients, and at that time, there was little written in medical journals about the unique needs of this patient population. But if the early 2000’s represented the infancy of bariatric body contouring, the present time can be considered the Golden Age. There has been more than a decade of thought and innovation. Textbooks have been written. New procedures have been developed. The effects of weight gain and weight loss on tissue and lymphatics are better understood, and the nutritional consequences of bariatric procedures have been better assessed.

Bariatric surgery, and massive weight loss in the absence of surgery, vastly improves an individual’s health and wellbeing, eliminating physical discomforts as well as associated illnesses and conditions. Furthermore, weight loss can reduce the social burdens and even discrimination associated with obesity.

But, most weight loss patients realize the Achilles heels of dropping pounds. First, you do not get to pick the anatomic site from which you lose weight, and second, there are limits to how much your skin can retract. Weight loss patients often present with stubborn adipose deposits, body contour concerns, and loose skin.

Fortunately, modern body contouring procedures have been adapted and developed to address these changes and these challenges. There are circumferential belt lipectomies (body lifts) and tummy tucks, arm lifts and thigh lifts. There are ways to augment the breasts and augment the buttocks. Even signs of weight change visible on the face can be addressed with facelifts, neck lifts, and fat grafting.

A board certified plastic surgeon with a special interest in bariatric body contouring, and the experience to go with it, can do amazing things for this population. Look for a plastic surgeon who is well versed in the specific needs of this unique patient population. If you or someone you know has experienced massive weight loss and is considering surgery, this is a great time to do it.

By Larry Lickstein, MD, FACS