What Happens After Bariatric Surgery? We’ve Got the Skinny on Follow-up Procedures to Deal with All that Extra Skin
I think in some ways we all want a microwave result in life. I use the term microwave in that most of us want a quick fix solution – and a microwave is emblematic of that. You put your food inside – and voila! In mere minutes, it's cooked! Whereas years ago you had to actually wait while a slow flame cooked your food, these days it's as easy as popping it in a microwave pushing a few buttons and letting electricity be your guide. And when it comes to our appearance – and weight loss in particular - we are all in search of that little magic pill that will produce microwave results. We want to believe we can pop a pill and our unwanted fat will just melt away. Of course, no such thing exists and any person who has experienced extreme obesity can attest to the fact that there are NO MAGIC BULLETS and no microwave results. Everything comes with a price tag and takes time, energy and dedication.
Ultimately however, the closest thing to a magic bullet or microwave result when it comes to eliminating a massive amount of extra poundage on your person is bariatric surgery. But let me be 100% clear: It does not even come close in that the results are not immediate – and while the pounds may fall off a bit faster with a newly shrunken stomach, most patients are still left with a large amount of excess skin that can be unsightly and may cause other problems. In fact, a large percentage of patients who have undergone bariatric surgery will need a few plastic surgery procedures to remove the excess skin to complete their weight loss process.
So just what happens to this skin? John F. Zavell, MD, FACS, a board-certified plastic surgeon gives us some insight into the procedures one might need to remove irritated or bothersome hanging skin and/or stretch marks and improve their self-image.
Melissa Chapman: What are the most common procedures needed after a large weight loss or bariatric surgery?
Dr. Zavell: The most common body contouring request after massive weight loss or bariatric surgery in our practice is circumferential lower body lift (or belt lipectomy). Following lower circumferential body lift is either breast surgery (lift and augmentation) or arm surgery (brachioplasties).
MC: Is scarring extensive and unavoidable or can they be hidden?
Dr. Zavell: As Patrick Maxwell, MD, said at a body contouring seminar years ago, "the longer the incision, the better the result" (when referring to massive weight loss patients). The scars are designed not only to be difficult to see, but also to give the best results. A hidden scar is less of a priority than a great result.
MC: What are the major risks, complications and side effects of plastic surgery after weight loss?
Dr. Zavell: The major risks/complications/side effects of plastic surgery in the weight loss patient are the same as the average person having surgery with some exceptions. Massive weight loss patients often have nutritional deficits which need to be corrected prior to surgery. These patients may be at higher risk of DVT (deep vein thrombosis) as their surgeries are often lengthier than an average weight person would require. Weight loss patients are at a higher risk of recurrent skin laxity and poor wound healing and require more revision/ touch-up surgeries.
MC: How soon after a significant weight loss must or should a patient wait before having surgery and when do you know the weight loss is completed?
Dr. Zavell: When a patient has reached a point in their weight loss where they remain at that same weight for 4-6 months, then I believe that their weight loss has plateaued. Once they have plateaued, then the patient is a potential candidate for surgery. In addition, the patient should have had a significant weight loss from their bariatric surgery and be happy with their new lower weight, without desiring further weight loss.
MC: What wound care, other care and diet must be done after the plastic surgery for skin removal?
Dr. Zavell: Hopefully, candidates for weight loss body contouring surgeries would have their individual concerns about peri-operative diet and daily activities addressed before the surgery to maximize the post-op experience. When this is done, the post-operative needs of these patients are very similar to an average weight person undergoing a comparable procedure.
MC: Who would not for medical or other reasons be a candidate for this surgery and is general anesthesia required?
Dr. Zavell: Patients who would not be good candidates for the body contouring procedures include those who have failed to maintain a lower weight despite the bariatric surgery, patients with unrealistic expectations, and those who have medical problems that preclude them from having the surgery. The majority of the body contouring procedures most likely will require a general anesthetic.
Extreme weight loss is a tough road, but one that is rewarding in the end. Choosing a plastic surgeon that will be a partner in your post-bariatric surgical procedures, in my opinion, is sure to make the journey to the body of your dreams far less daunting and ultimately your new reality.