Post-Bariatric Body Contouring Patients Face Increased Risks to Safety, Says ASAPS
NEW YORK, NY (November 1, 2004) — The increase in bariatric surgery as a treatment for obesity has resulted in a new breed of plastic surgery patient, a new set of highly specialized plastic surgical skills, and heightened awareness of surgical risks involved in treating massive weight loss patients. "The post-bariatric surgery patient requires plastic surgical techniques and safety measures that are extraordinary," says Peter Fodor, MD, president of the American Society for Aesthetic Plastic Surgery (ASAPS), the nation's most prestigious organization of board-certified plastic surgeons specializing in cosmetic surgery.
According to the National Institutes of Health, the number of bariatric procedures topped 120,000 in 2003. However, Dr. Fodor believes that many patients who plan to have bariatric surgery are not adequately informed about the subsequent need for extensive plastic surgery to achieve a more normal body contour. In addition, he says, plastic surgeons must effectively address the increased risks to patient safety when lengthy operations are necessary. "Physician education on the treatment of post-bariatric surgery patients is a key element of ASAPS' expanded patient safety initiative and a major focus of my presidency."
Post-bariatric surgery patients may be nutritionally deficient, and this can have consequences for surgery and recovery. Patients may be referred for nutritional counseling and advised to wait a year or longer following their weight loss before undergoing plastic surgery. It is also important for the patient's weight to stabilize before body contouring begins.
Patients may be surprised to learn the extent of plastic surgery that is required to bring their body back to a more normal and aesthetic appearance. "Most of these patients will need a total body lift. While surgeons may define this term somewhat differently, treatment most likely would include a tummy tuck, circumferential lower body lift, thigh and buttock lifts, removal of back rolls, breast lift and upper arm lift," explains Iowa City, IA, plastic surgeon Al Aly, MD, who is featured in a panel discussion on body contouring after massive weight loss in the current issue of Aesthetic Surgery Journal , the peer-reviewed journal of ASAPS. "Many patients will also need face and neck procedures to get rid of loose, hanging skin in these areas."
Dr. Aly takes a team approach to operating on massive weight loss patients, performing surgery simultaneously with another plastic surgeon to reduce the length of time patients spend under anesthesia. "Using the team approach allows us to accomplish a great deal in one surgical session and still avoid the increased risks of a more extended operating time."
It is not uncommon -- depending on individual patient factors, the extent of surgery needed and surgeon preference -- for massive weight loss patients to have multiple operations performed in stages. In such cases, the waiting period between surgeries ranges from weeks to several months or longer.
Safety precautions can help reduce risks for post-bariatric surgery patients undergoing plastic surgery. First, surgeons confer with the patient's medical doctor to ensure that the patient is a good candidate for plastic surgery. Precautions include the routine use of mechanical compression devices on the legs during surgery to help avoid potentially fatal blood clots.
Most patients undergoing extensive plastic surgery following massive weight loss will require a short hospital stay. Due to the extent of surgery and potential blood loss, many patients require blood transfusions. The most common complications of this type of surgery, according to the ASJ panelists, are seroma (a collection of fluid that often can be removed with a needle) and problems in wound healing that typically can be controlled without hospitalization.
"I always stress to patients that this will probably be the most extensive surgery they will ever have," says Dr. Aly. "Although the incisions are significant," he adds, "I find that patients who have sustained massive weight loss are frequently less concerned about scars and more concerned with their contours."
ASAPS has developed a new patient education CD-ROM, Restoring Aesthetic Contours After Dramatic Weight Loss , which describes what patients can expect when undergoing plastic surgery after massive weight loss, whether the result of bariatric surgery or other weight loss methods.
"It is important for patients to recognize that there are limitations to what can be achieved in body contouring after such dramatic weight loss," says Dr. Fodor, who plans to moderate a panel, "Aesthetic Contouring in the Massive Weight Loss Patient," at the ASAPS Annual Meeting in New Orleans next spring. However, he emphasizes that "the skills of a board-certified plastic surgeon with ample experience in the cosmetic aspects of plastic surgery can go a long way toward restoring an aesthetic appearance."
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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