The Question
Cosmetic surgery isn’t strictly reserved for people who want to look better. Although that is often an intended result, the aesthetic benefits are frequently secondary outcomes of addressing a real medical issue or complex of issues arising from injuries, accidents, illness or rapid weight gain and/or loss. Bariatric surgery, in particular, helps patients lose weight when all other methods have failed, but it can and does affect the appearance and function of the body in ways which often require surgical intervention to correct as one of its side effects. The focus of this week’s Ask Dr. Pane segment is a prime example of this. The viewer asks, “What are my post bariatric plastic surgery options? Also, should I start on the upper or lower body first?”
The Case
The patient did not include pictures, any medical history or specify what sort of cosmetic surgery the patient underwent. Because of this, Dr. Pane noted his answer is going to be very general and schematic in nature, as there is not information to make the answer specifically relevant to a particular patient, situation or condition.
The Answer
Post-bariatric weight loss is commonly accompanied by an excess of skin. Because the patient loses weight so rapidly, the skin is not able to shrink properly, or may not be able to shrink in proportion to the amount of weight lost because the skin loses flexibility and elasticity over time. Therefore, cosmetic surgery is often employed as a solution for this sort of weight-related excess skin, as well as other related issues.
The first question, Dr. Pane says, is where the excess skin is located. On the upper body, it may be located on the face, neck, arms, breasts or sides. On the lower body, typically the upper legs, thighs, groin, buttocks and lower abdomen. The corrective procedures for the upper body include face, neck, arm and breast lift and possibly abdominoplasty, while for the lower body abdominoplasty, thigh lift and beltectomy, where excess skin is excised all or most of the way around the body, creating a belt effect from which the procedure derives its name, are common options.
Dr. Pane says the location and severity of the excess skin is typically the best guide for where to begin. Normally, a patient with a great deal of excess skin in the trunk would be best served to begin with the lower body. Depending upon how much skin is present, where it’s located and in what relative proportions, Dr. Pane notes he generally sees optimal results from starting with an extended abdominoplasty, which firms and tightens the skin of the abdomen, flanks and upper thighs, as well as the abdominal muscles. In many patients, this obviates the necessity of a thigh lift or more intrusive procedures lower down, and may also eliminate most, if not all, need for surgery higher up on the body as well.
However, every patient’s situation is a little different, and the manner in which the procedures are approached may vary based on the patient’s insurance carrier’s guidelines and the patient’s overall needs. Because of this, how the procedures are framed for both the patient and the insurance may or may not make any overall difference in the procedure itself, but how it is explained may very well make the difference in whether or not the carrier accepts or rejects the claim.
RealSelf Patient Reviews of Thomas A. Pane, MD
Regardless of the type of procedure and the patient’s intended outcomes, the cosmetic procedures which can correct the side effects of bariatric surgery are still surgeries in their own right, and carry the same potential risk as any other form of surgery. These risks can be greatly reduced by ensuring your surgeon and clinical staff are aware of your full medical history, including any medications you currently take or have taken in the past and surgical procedures you have undergone. This information, coupled with an in-person clinical evaluation, is vital to ensuring the best possible outcomes with the lowest possible associated risk.
If you have a question about anything related to cosmetic surgery, the staff of Atlantic Coast Aesthetics is always pleased to discuss your points of concern. Simply call us at (561) 422-4116; email us through our website’s Contact page; or follow us on Facebook, Instagram, LinkedIn and Twitter. Your question might even be chosen as the focus of an upcoming Ask Dr. Pane segment, allowing us to answer your question while educating others who share your unique interests. Remember, at ACA we believe the only bad question is the one you don’t ask!