Bariatric Body Contouring – A New Plastic Surgery Subspecialty

New areas in any surgical specialty do not arise very frequently, usually only one or two per generation of new surgeons. Usually it is a new device or technology that causes a new subspecialty to arise, such as the laparoscope in General Surgery. Plastic Surgery subspecialities, however, have had their origins in new anatomic understandings of diseased, traumatic, or congenital tissue problems. The last subspecialities that have emerged in Plastic Surgery  are Craniofacial and Microsurgical Reconstruction which had their origins in the late 1970s and 1980s…and blossomed into widespread practice in the 1990s.  This latest subspecialty of plastic surgery is the result of tissue problems caused by bariatric surgery and extreme weight loss, Bariatric Plastic Surgery.

In large weight loss patients, through bariatric surgery or rarely from their own dieting program, excess skin is always left behind. If the excess skin is considerable, this results in a ‘new’ problem. The body may be smaller, but the large folds of skin cause problems of personal embarrassment, the need to still buy larger clothing, and the potential for problems of skin irritation, rashes, or infections from the overhanging heavy skin. No amount of dieting, exercise, or wishful thinking can make this skin snap back into place or make it go away. This is often a sad realization for the bariatric patient who is thrilled with their weight loss but did not envision that their body would look like a ‘sharpee’. 

Reshaping the body after weight are plastic surgery procedures that are specifically designed to remove excess skin and fat and reshape specific body areas. Body contouring surgery can remove large amounts of sagging skin and fat that are often dramatic in size. While the removed pieces may look large, they often weigh a lot less than you would think. Think of body contouring surgery as restoring shape and contour to certain areas of the body rather than any more significant weight loss. These surgical procedures will not only remove excess skin but will tighten areas as well. Almost every body contouring surgery is about the actual excision (cutting out) of loose tissue, liposuction (fat removal only) actually plays a very minor role in this type of plastic surgery although it is occasionally used.

While body contouring surgery can produce some dramatic changes that can improve a patient’s physical and psychological health, there is the trade-off of extensive scarring. Every body contouring surgery results in significant scarring…that is the long-term price that the patient must pay. I have yet to find a large weight loss patient who balks at that trade-off because the hanging skin problem is so significant and limiting. Bariatric plastic surgery is unique from pure cosmetic body contouring in that the goals are to make the patient look good in clothes…not to be critically judged out of them.

Bariatric Plastic Surgery largely uses traditional cosmetic surgery operations that have been modified for these extreme skin excess problems. A traditional tummy tuck becomes an extended wrap-around procedure known as a body lift. Sagging deflated breasts use extensive lift and reshaping procedures that may or may not need an implant. Bat wings or arm flaps need skin cut-outs that cross the armpit into the side of the chest wall. Thigh lifts need to develop vertical extensions down to the knees and sometimes beyond. Innovation and intraoperative adjustments are the norm, not the exception to treating these body excesses.

Like any difficult body tissue problem, plastic surgeons are uniquely equipped to handle the challenges and complications that lots of loose skin can cause.  Bariatric Plastic Surgery is a true cross between cosmetic and reconstructive surgery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

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