If the patient has lost at least 50% of the excess BMI, Plastic Surgery (PS) is often necessary and recommended. This second operation removes skin and subcutaneous fat, “skin folds” excess.
In general these operations are done 18 months alter the original Bariatric-Obesity Surgery (BOS), when weight loss has been maximal and it has become stabilized.
The need of PS Surgery should be a good one for the patient. It means that the BOS has been very effective, the main aim of Obesity surgery.
PS operations are necessary in this order:
- Abdominoplasty.” Tummy-tuck” Surgery. This is the most common required operation in PS alter weight loss (WL). The abdominal fold can huge (often weighting over 30 lbs. in some patients) or sometime the excess skin is enormous but with very little weight.
In general these operations are of very low risk, since the patient has lost all co-morbidities due to the obesity (diabetes, hypertension, sleep apnea, and so on) and they tolerate very well a surgery that is very superficial in the body and there is no need to enter the abdominal cavity or other organs. If the patient has a hernia (much less common today after BOS done by laparoscopy) it should be repair always at this time with the use of a synthetic mesh. Oftentimes if no hernia is present the abdominal muscles are too loose and the approximation of these muscles give further strength to the abdominal wall.
The umbilicus is situated very low in general in the morbidly obese, and more so after losing a great deal of weight. This is the reason to make a transposition of the umbilicus to a level much higher in the abdominal wall and centred in the belly.
This operation has a short post-op period and the patient may be discharged in 24 hours to be followed at the office and then remove the stitches.
Seroma is the main complication of this surgery. Seroma is liquid accumulation under the wound flaps. Prevention is done with adequate haemostasis and drainage, but…sometimes the seroma has to be drained after surgery or it may impair or delayed wound-healing.
2- Thigh lifts. Some patients, mostly women, have alter BOS significant folds in the inner part of their thighs. PS is indicated not only for esthetical reasons but cosmetically and hygiene to prevent rubbing the thighs each other. The scars are cosmetically placed in the groin fold or on the inner thigh.
3- Arm lifts = Brachioplasty. Excess skin and fat sometimes accumulate in the inner part of the arms and can be removed since it prevent patients the use of bathe suit. The scar is hidden in the inner part of the arm and it is well concealed.
4- Breast lift. When the breast tissues fat is lost the breast drops significantly in some patients. Most of these patients need a lift but occasionally a silicone prosthesis implant is also required.
5- Body lift" . This operation is the most extensive operation required by some patients, The abdomen, umbilicus, buttocks are lifted. It is a very complete PS and a circular scar remains at the pubis and just above the buttocks that can be hidden by a bikini. Few PS surgeon can perform it properly.
We do recomend the
Instituto de Cirugía Plástica Dr. Federico Pérez de la Romana.
“De la Romana” Plastic Institute
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