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Bariatric surgical patients increasingly seek cosmetic procedures

Article-Bariatric surgical patients increasingly seek cosmetic procedures

Vancouver, B.C. — The demand for cosmetic rehabilitation by the post-bariatric surgical patient continues to rise significantly.

According to 2003 American Society for Aesthetic Plastic Surgery statistics, several body contouring procedures used for post-bariatric surgical patients significantly increased over 2002, including a 42 percent increase in abdominoplasties to 117,693 procedures; a 127 percent increase in lower body lifts to 10,964 procedures; a 109 percent increase in thigh lifts to 8,806 procedures; and a 68 percent increase in upper arm lifts to 10,595 procedures.

Multiple surgeries With some patients seeking up to six procedures, multiple surgeries require careful planning, says Zachary Gerut, M.D., who practices in Long Island, N.Y.

Dr. Gerut
Sometimes a staged approach is recommended. The duration of surgery and the amount of blood loss are the most important considerations, he says. Dr. Gerut says he limits post-bariatric surgery time to six or seven hours.

Dr. Gerut says he does not operate on very heavy patients, but strongly advises them to lose some weight before he will consider surgery.

"Some of these patients have been close to 500 pounds. These patients, when they come to me, have already lost 300 pounds, but they just have a tremendous amount of skin hanging down. Many patients that are only half finished with their weight loss, want body contouring surgery; they feel ready to have the skin reduction procedure."

However, he delays body contouring on these patients until they are thinner to decrease the surgical risks and to gain an improved outcome.

Results over three years Dr. Gerut described his experience in performing 215 body-contouring surgeries over the past two and a half years.

"Some procedures are easily done in combination; the abdomen and buttock should be done together, because doing them separately limits the completeness of the result," explains Dr. Gerut.

During mastopexy, all the usual landmarks are variable. Even the intramammary crease has to be recreated. Note patient before mastopexy (left) and after (right) the procedure.
However, arm procedures should be avoided at the same time as abdominal procedures because of movement limitations: "Getting out of bed without the use of abdominal muscles and arm muscles can be nearly impossible," Dr. Gerut explains.

Realistic expectations "Managing expectations in these patients, I find, is not as difficult as managing expectations in the typical facelift patient," Dr. Gerut notes. "These people have come from a place where their body was grotesquely different from the norm. They have travelled a very long journey, from being incredibly unhealthy, and when they have finished losing weight and they are much healthier and they have redundant skin draped all over their body, their expectations are very realistic."

These patients are generally very grateful for the surgery, even if they have problems healing, Dr. Gerut says.

Dr. Gerut's pre-operative work-up includes a full medical clearance, complete set of blood tests, and obtaining information on the patient's psychological profile. He notes that most patients have already seen a psychologist before undergoing their bariatric surgery.

Possible complications of body contouring surgery include hematoma, infection, seroma formation, wound dehiscence, skin necrosis, pulmonary embolism and hypertrophic scarring.

The abdomen and buttock should be done together, because doing them separately limits the completeness of the result. Note patient before (left) and after (right) surgery.
None of Dr. Gerut's patients experienced hematomas; post-operative infection rates have been normal, he reports. Hypertrophic scarring has occurred in 20 percent of the cases and scar revision in 40 percent. The high rate of scar revision is more than partially due to the healing differences of the post-bariatric skin.

"Their skin and therefore their cutaneous blood vessels have been attenuated. Diminshed blood flow impedes proper healing," he says.

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