What is obesity, and what is cosmetic surgery after weight loss?

Post-bariatric cosmetic surgery, or post-bariatric reconstructive plastic surgery, is a highly specialized field focusing on body contouring for individuals who have experienced significant weight loss and are now dealing with resulting physical deformities.

In 1997, the World Health Organization (WHO) declared obesity a global epidemic ("globesity") due to its increasing prevalence. Obesity is linked to cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, and osteoarthritis. For severely obese individuals (BMI ≥ 40), life expectancy is reduced by approximately 10 years. Weight loss significantly improves these associated health conditions.

Bariatric surgery (sleeve gastrectomy, gastric bypass, gastric banding, biliopancreatic diversion, etc.) is often the only effective treatment for achieving significant and sustainable long-term weight loss. However, rapid and substantial weight loss can lead to severe, functionally and aesthetically disabling deformities, primarily due to excess skin. Body contouring procedures address these issues and are increasingly sought after due to better awareness and understanding of their corrective capabilities.

Who is a good candidate for cosmetic surgery, and why?

Ideal candidates for post-bariatric cosmetic surgery generally include:

• Adults with stable weight loss for at least three months;
• Individuals in good health with no medical conditions that could impair recovery or increase surgical risk;
• Non-smokers;
• Individuals with a positive attitude and realistic expectations;
• Individuals committed to maintaining a healthy lifestyle, including proper nutrition and exercise;

Excess skin after significant weight loss can cause various problems, including intertriginous ulcers and infections in skin folds, unpleasant odors, back and neck pain, pain during work and exercise, skin lesions from friction, difficulty finding suitable clothing, and a discrepancy between appearance and age. The abdomen is the most affected area, followed by the breasts and thighs. This excess skin can lead to further stigmatization, social isolation, and reduced quality of life.

The risk of complications from post-bariatric body contouring surgery varies based on factors like the procedure's size and extent, nutritional status, smoking, and the degree of prior weight loss. While medical comorbidities don't automatically preclude surgery, they can limit procedure options due to increased complication risk and potentially suboptimal results.

Smoking increases the risk of postoperative complications, infections, and delayed healing by two to three times. Preoperative smoking cessation can significantly reduce this risk, ideally with at least four weeks of abstinence.

Before post-bariatric cosmetic surgery, patients should have good nutritional status, healthy hemoglobin levels, and satisfactory physical fitness. Any gastrointestinal pain following weight loss surgery needs to be addressed before evaluation for plastic surgery, as it can be difficult to differentiate from post-abdominoplasty pain. Patients with a history of deep vein thrombosis or lymphedema should be informed of the recurrence risk, and appropriate thromboprophylaxis should be implemented.

What are the cosmetic surgery procedures after weight loss?

Common body contouring procedures include:

• Arm lift or brachioplasty: Excess arm skin is typically removed from an incision running from the armpit to the elbow, creating a smoother contour. Liposuction may be combined with this procedure. The amount of skin removed can vary significantly depending on the individual.
• Breast lift, gynecomastia, and breast reduction: Excess breast tissue is removed, repositioning the breasts and often requiring implants to compensate for tissue loss. In women, scars are usually concealed within the bra line.
• Abdominoplasty and Lipectomy: Excess skin hanging over the pubic area is addressed with liposuction on the abdomen and hips, and removal of excess skin from the back and sides. Incisions are strategically placed to be hidden by underwear and swimwear.
• Thigh lift: Excess inner thigh skin is removed through an incision from the groin to the knee, often combined with liposuction. Outer thigh and buttock lifts utilize a lateral incision, sometimes alongside buttock augmentation.

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