I had gastric sleeve done went from 250 to 153 which is my current weight. What to do?

Sometimes patients contact us to perform procedures that are necessary to revise unfortunate side effects of other procedures. One such case presented itself in this week’s ACA Question of the Week. The patient asks, “I had gastric sleeve surgery done and dropped from 250lbs to 150lbs. What are my options for a tummy tuck and liposuction?”

Dr. Pane said that the first criterion is to ensure that the patient has established a stable weight plateau after the original surgery. If the weight loss has stabilized to a point where losses are minimal or no longer present, then it would be the time to start considering a tummy tuck and other procedures. Liposuction would actually be a secondary procedure, if it is appropriate at all, largely because with rapid weight loss, the skin tends to stretch and suffer damage to the collagen that keeps skin elastic. This means that there will be excess skin lapping over the abdomen, which needs to be removed and tightened before other procedures such as liposuction are considered.

One common misconception Dr. Pane addressed was the idea that the skin itself actually gets tighter. This is not in fact the case, because the damage to the area can be treated, but not wholly rectified. By removing the excess skin as much as possible, it will make the skin seem tighter, but a certain amount of additional aftercare will be needed to help restore some of the skin’s

natural elasticity. Drastic weight loss can lead to a more drastic overlap of the excess skin, which means that the traditional tummy tuck, which leaves a long, thin scar at the bikini line or slightly below, may not be an appropriate option.

If the skin overlaps at or above the level of the navel, or belly button, what is known as an extended or inverted-T tummy tuck may need to be performed instead. This procedure is generally not a preferred method, largely because it leaves a more pronounced and visible scar and is somewhat more extensive in scope to deliver more or less the same result. However, in cases where the overlap is more drastic and sits higher on the abdomen, this may be the best option to achieve a better cosmetic result, even despite the additional scarring that most likely will accompany it. One of the reasons is because old-school bariatric surgery used vertical scars, while today the emphasis is primarily on horizontal, more easily concealed scars. Either may be a valid choice, depending upon the patient’s preference and desired results, but one may be better and simpler from a surgical perspective than the other.

Before undergoing a tummy tuck for any reason, the patient should be familiar with the different options and methods available for treating the underlying reason for the procedure. In cases where patients are having a tummy tuck as an adjunct to liposuction, where the fat removal is more uniform and controlled, the methodologies available may vary from the methods that might be used in cases where the weight loss is rapid, uncontrolled and a direct result of another procedure, such as the side effects of bariatric surgery.

Another important factor that some patients overlook is aftercare. Aftercare can reduce the duration of healing time, help expedite healing and minimize the appearance of scarring. In some cases, especially when proper aftercare protocols are not followed, some patients may need to have scar revision surgery later to achieve the thin, white line associated with a “good” cosmetic surgical outcome rather than raised, reddened or angry-looking scars. Avoiding sun, cigarette smoke and pollution, following aftercare instructions and taking all prescribed medications as directed are all keys to making sure the patient gets the best possible result from their procedure.

If you would like to know more about whether a tummy tuck and/or liposuction is right for you, we at Atlantic Coast Aesthetics invite you to contact us on Facebook, send us an email at http:// acplasticsurg.com or call us at 561-422-4116. Your question could be an upcoming ACA Question of the Week, to be answered live on the air by our founder and Chief Medical Officer, Dr. Thomas A. Pane. In addition, you may be helping other patients obtain valuable information that they weren’t sure who to ask or how to find. The only bad question is the one you fail to ask, and we at ACA believe an informed patient is our best tool for delivering the great results our patients have come to expect from us. So ask away, and you may find your question getting a lot more attention than you expected!