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Prioritizing is key for post-bariatric surgery patients

Chicago — Staging cosmetic surgery procedures in post-bariatric surgery patients is a lot like rehabbing a house.

"You have to start with what bothers you the most," Susan E. Downey, M.D., tells her patients. "When I re-did my house I would have liked to do it all at once, but I had to start with one room because moving out for the duration of the project wasn't realistic or practical. It's the same with weight-loss surgery patients," she says.

"Most people don't have the resources — time and money — to tackle more than one procedure at a time, which is why prioritizing is so important."

Dr. Downey is associate professor of clinical surgery at the Keck School of Medicine, University of Southern California, Los Angeles. She spoke about maximizing outcomes of post-bariatric cosmetic surgery here at the annual meeting of the American Society of Plastic Surgeons.

What are the patient's priorities?

While prevailing thought might suggest that an upper or lower body lift — or both — would top every post-weight-loss surgery patient's "to do" list, Dr. Downey says many of her patients actually opt for brachioplasty first. The desire to go sleeveless without sagging, redundant skin is a strong incentive, especially among her patients who are teachers and who spend a good part of the day pointing at a blackboard.

"I really try to focus on what bothers the patient the most," she says, "because there's a chance that follow-up procedures will not materialize."

Planning ahead

"I plan for the next stage but do not assume the next stage will occur soon — if at all," Dr. Downey tells Cosmetic Surgery Times. "Sometimes they come back for a second and third procedure once the initial procedure has healed and their health is back to baseline. Other times they decide they can't take more time off of work or they can't afford additional surgery. I have patients who are still coming in for surgeries 10 years after their bariatric surgeries."

As the surgeries may not dovetail, Dr. Downey says it's crucial to mark the patients carefully so they won't have "dog ears."

"I don't want them to have to stay that way if for some reason their next stage gets put off for a while," she explains.

Synergistic surgery

If the patient is interested in multiple procedures, Dr. Downey says it's important to discuss how one surgery will affect another.

"For example, if we're going to do an extended brachioplasty where we're extending beyond the underarm and down the side, we talk about what the implication of that will be on the breast with respect to where the scars are going to be, and how that will tie into breast surgery if it's done at the same time or in the future," she says.

According to Dr. Downey, some surgeons say they get a better result with a lower body lift rather than with a separate abdominoplasty and thighplasty. She says she'd rather convert an abdominoplasty into a belt lipectomy later on if that works better for the patient's pocketbook and lifestyle.

Exercise and cosmetic surgery

Dr. Downey says she gets her best results in patients who have been working out.

"While this is completely anecdotal, it seems to me that the skin retracts better in patients who exercise and that they have less pain and are out of bed more quickly," she says.

An additional benefit is that the skin is being draped over more toned muscle, which, she points out, makes it look better.


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