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Bariatric surgery: Meeting the challenges

Article-Bariatric surgery: Meeting the challenges

It is hard to pick up any newspaper or magazine without reading about the obesity epidemic in the United States.

Along with the rise in obesity there has been a concurrent rise in bariatric procedures. Now plastic surgeons are seeing in increasing numbers patients who have experienced more than a 100-pound weight loss over a relatively short period of time. Some patients have even lost 200 or 300 pounds.

Massive weight loss

The term massive weight loss (MWL) patient has been applied to this population. It also includes patients who have lost more than 100 pounds through diet and exercise. At meetings across the country the MWL patient has been a hot topic, with concerns expressed about safety, surgical approaches and techniques.

When I was first approached by a bariatric surgeon and asked to help him with his patients, I had no idea the ride I was in for! Soon he was sending me every single patient a year after bariatric surgery, and usually after a 100 pound-plus weight loss. The different bariatric procedures and their effects on the patient's health and ability to heal from plastic surgery was one of the first lessons learned, often the hard way. Restrictive versus malabsorptive or combined procedures — what did this mean for patients and their ability to absorb iron, or even antibiotics, in the postoperative period? These procedures had all been developed since I had been a general surgery resident.

Then there are the differences in surgical approaches — has the patient had an open procedure and now an incisional hernia, or was the surgery done laparoscopically? Not to mention the scars from previous surgery which can confound the raising of flaps.

The variety of patient presentations was and is still overwhelming — there is no one way to gain or to lose weight.

Patients may present with laxity everywhere, or just in the lower half of their bodies. I had never done a brachioplasty before I did my first one on a post-MWL patient.

The recent statistics from the American Society of Plastic Surgeons bears out that other plastic surgeons are having this same experience — the number of brachioplasties has risen from 338 in 2000 to 7,547 in 2004.

Post-op problems

As a surgeon sees more and more MWL patients, new and different postoperative problems become more common in the practice.

Seromas are, of course, the most prevalent problem, and this is certainly an area which begs for urgent research and study. Other previously uncommon problems also are seen — for example, recurrent skin laxity and scar migration.

Training programs and teaching courses at meetings are beginning to reflect the impact of the MWL patient on every plastic surgeon's practice. Safety must always be the first concern: How many procedures can be done at once? How long in between procedures? Are there some procedures which should not be combined?

However, when all is said and done, this is a stimulating area to be involved in, and most rewarding. Ted Lockwood M.D., was truly a visionary, and his work has set a high standard for lower body lifts and body contouring in general. At every meeting where post-MWL patients and plastic surgery are discussed, new ideas are being floated and new techniques presented.

Cosmetic Surgery Times has recognized this growing area, and we should look forward to interesting exchanges of ideas and new approaches and, hopefully, to solutions to some of the problems in caring for this most grateful, yet challenging, population of patients.

Cosmetic Surgery Times wishes to welcome Dr. Susan Downey as the newest addition to our editorial advisory board. Dr. Downey, a board-certified plastic surgeon and volunteer faculty member at the University of Southern California, Los Angeles, will help guide our coverage of post-bariatric surgery, one of the fastest-growing areas of plastic surgery. For full details about Dr. Downey and her work, turn to the Physician's Profile on this issue.

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