For cosmetic surgeons, this means that an ever-increasing number of patients will be presenting for body contouring surgery after their weight loss, according to Michael Rosenberg, M.D., plastic and reconstructive surgeon, Plastic & Reconstructive Surgery, P.C., Mount Kisco, N.Y.
"As cosmetic surgeons, we need to appreciate the unique aspects of this particular patient population and the problems they present with," he tells Cosmetic Surgery Times. "These patients are unique in two ways: They have special nutritional issues and they typically need a combination of (contouring) surgeries."Dr. Rosenberg presented several key points in his address at the recent meeting of the American Academy of Cosmetic Surgery here.
Patient education, safety
After people lose a massive amount of weight, they are often disappointed because they end up with a tremendous overhang of skin, especially in the abdomen, thighs and arms. Because of TV shows and reports in other media, many patients believe they can have one 10-hour operation and that's the end of it, according to Dr. Rosenberg.
"It's my theory to avoid this extreme approach, and that becomes an issue of patient education," he says. "It's the physician's role to really guide the patient into understanding that optimal safety is best done using a staged approach."
Dr. Rosenberg believes it's crucial for physicians who undertake this type of surgery to understand that, after massive weight loss or gastric bypass surgery, nutritional issues affect healing and recovery. Cosmetic surgeons need to be part of a care team that includes nutritional counseling and, in some cases, psychological counseling.
In addition, it's important that the patient has reached a steady state in his or her weight.
"Patients tend to be anxious to get their contouring done, and some come in right after reaching their goal weight," Dr. Rosenberg says. "It's our belief that the body contouring component should follow the weight loss surgery by about 12 to 18 months, and that the patient should be at a stable weight for at least three months prior to surgery."
In addition, the patient needs a medical work-up prior to surgery and should give thought to where he or she will recover after the operation. In some cases, it might be appropriate to have the patient in a monitored situation overnight.
"These are all issues that need to be discussed up front," Dr. Rosenberg says. "In my view, surgery shouldn't even be contemplated if the physician isn't putting safety issues first."
Dr. Rosenberg would like physicians to realize that because of the amount of skin and laxity often seen with body contouring, a second surgery to retighten skin is not uncommon.
"I think it's important to remember that this is not a complication or even an adverse effect," he says. "We need to educate our patients about these realities and discuss their expectations."
But body contouring surgery after massive weight loss is not for all cosmetic surgeons, and some are intimidated by it, according to Dr. Rosenberg.
"It's a significant commitment of time and effort," he says. "You need to be committed to making this an important part of your practice.
"Having said that," he adds, "it is extraordinarily rewarding. Oftentimes, it's that last body contouring surgery that makes the difference and brings the patient where they wanted to be."