|
With the growing popularity of bariatric, or gastric
bypass, surgery as a treatment for obesity, body contouring
after significant weight loss has become a field of
special interest for many plastic surgeons.
By applying the latest techniques in body sculpting
individualized to each patient's specific needs and
priorities, your plastic surgeon can help you realize
the new shape that is hidden beneath the excess skin
that remains after your goal weight has been achieved.
With significant weight loss over a relatively short
period of time (usually 15-18 months), the remaining
skin often does not retain the elastic qualities necessary
to "shrink back down" to your new underlying
shape. This often leaves patients with excessive amounts
of hanging skin that creates a multitude of problems
such as daily hygiene and finding clothes that fit properly.
A comprehensive approach to the bariatric patient is
necessary to achieve the optimal figure following weight
loss. One of the most important considerations for a
plastic surgeon to realize is that a bariatric patient
must be treated differently from non-bariatric body
contouring patients. What has worked well for many years
on other patients simply does not provide adequate shaping
and contouring for the bariatric patient.
Patients who have undergone gastric bypass surgery and
the subsequent significant weight loss may have numerous
but similar areas of concern. These areas include:
-Breast ptosis, or droopiness, as well as a loss
of breast volume (Mastopexy is a procedure to lift
the breasts and may be performed with or without the
addition of breast implants to improve shape, fullness
and cleavage.)
-Sagging of the facial skin (Facelifting, forehead
lifting and eyelid surgery may be necessary to achieve
complete facial rejuvenation, or you may be a candidate
for endoscopic or minimally invasive techniques)
-Excess abdominal skin and a laxity of the muscles
of the abdominal wall, sometimes with an accompanying
hernia. (Abdominoplasty or a lower body lift procedure
can contour the abdomen, hips and buttocks)
-Hanging skin under the arms (Brachioplasty is
a technique to lift the arms)
-Wrinkling and excessive bagginess of the thighs
(A medial thigh lift can lift the inner thighs)
Obviously all of these concerns cannot be addressed
simultaneously during one operation. However, two procedures
usually can be safely combined. During your consultation,
your plastic surgeon will assess your anatomy as well
as your own priorities to help you develop a comprehensive
plan, or blueprint, for your body contouring. It is
not uncommon to combine a tummy tuck with a breast lift
(with or without the addition of breast implants), or
a thigh lift with an arm lift, as well as other combinations
of procedures.
|
|
|
|
46 YR OLD
AFTER
GASTRIC BYPASS
AND 170 POUND WEIGHT LOSS
|
AFTER BREAST LIFT WITH IMPLANTS,
TUMMY TUCK,
ARM LIFT, AND THIGH LIFT
|
The cornerstone of a successful approach
to body contouring is to individualize treatment to
your specific circumstances and goals and to ensure
that you have an adequate understanding of the issues
involved so that you are able to make a fully informed
decision. This will help you achieve the appearance
you desire with the least invasive procedure available,
thus creating a mutually rewarding experience.
If you think you might be a good candidate for body
contouring following significant weight loss, this article
will give you a basic understanding of the procedures
and the results you can expect. You may also wish to
read about specific procedures in greater detail which
may be found on Dr. Revis' website, www.SouthFloridaPlasticSurgery.com
The Consultation
During your initial consultation, your plastic surgeon
will inquire about your medical history, prior procedures,
medications, allergies, and your motivations for seeking
plastic surgery. It is very important that you be thorough
when providing your medical history, as this information
helps to prevent complications during your care. When
asked about medications, be sure to include any vitamin
or herbal preparations, as these can affect your blood
pressure and clotting ability. Honesty regarding your
use of tobacco and alcohol is also very important, as
these may have a profound impact on your recovery period
and your ability to heal following your procedure.
After reviewing your medical history, your plastic surgeon
will discuss your concerns, priorities and motivations
for pursuing plastic surgery, as well as your fears.
After examining you, he or she will be able to offer
advice and options to help you achieve the appearance
you desire. He or she will explain the advantages and
disadvantages of the different options you have before
you.
At the completion of your consultation, you should be
given a written estimate of the cost of your procedure.
At this time, you will also have the option to schedule
your procedure if you so choose. The decision to undergo
surgery is a very important one, and the final decision
should be given very careful consideration. You are
also encouraged to bring your spouse, significant other,
family member, or a friend to your consultation.
Where Your Procedure Will Be Performed
Most patients undergoing body contouring following significant
weight loss choose to have their surgery performed in
a full service hospital, and many also choose to stay
overnight following surgery. Sometimes an overnight
stay is required, depending on the procedure you choose
and your overall health status. Alternatively, some
plastic surgeons have a private duty nurse available
to care for you in the comfort and privacy of your own
home, or your family or friends may care for you during
the early postoperative period.
Type(s) of Anesthesia
Anesthesia is an essential part of any surgical procedure
and must be performed safely. General anesthesia is
preferred for most of these procedures and is the deepest
form of anesthesia. You are asleep, feel no pain, and
will not remember the procedure. This is the most common
type of anesthesia used for body contouring after gastric
bypass surgery because these procedures tend to be lengthy
and require full muscle relaxation for maximum tightening
intraoperatively.
Intravenous sedation, called "twilight sleep,"
is a combination of local anesthetic administered at
the surgical site by the surgeon and intravenous sedation
administered by the anesthesiologist. You breathe for
yourself, but you are in a deep sleep throughout the
procedure. You should feel no pain, and you will not
remember the procedure. This is more commonly used for
facial rejuvenation procedures.
An intermediate form of anesthesia, the laryngeal mask
airway (LMA), is a relatively new technique. This technique
is similar to twilight sleep in that you are breathing
on your own, but the method of sedation differs. With
an LMA, you actually breathe anesthetic gases administered
by the anesthesiologist, rather than receive intravenous
sedation via your intravenous line. These anesthetic
gases cause you to sleep during the procedure. At the
completion of the procedure, the gases are turned off
and you wake up from your sleep. You will feel no pain,
and you will not remember the procedure.
The prevention of postoperative nausea and vomiting
is also an important component of body contouring. To
improve your overall experience and ensure you feel
better faster following your surgery, a new medication
has been developed that has resulted in a very low incidence
of postoperative nausea and vomiting. You should be
given an intravenous dose of Zofran at the beginning
of your operation. Zofran is a new drug that is currently
the best medication available to prevent nausea and
vomiting. This is a very important consideration to
make sure that your experience is as pleasant as possible.
Your plastic surgeon will discuss all of these options
with you more thoroughly at the time of your consultation,
and please ask about anything you do not understand.
Details of the Procedures
As mentioned previously, it is important to develop
a comprehensive approach to your body contouring. This
has evolved into several specialized techniques meant
to optimize your results. These include:
-Developing a clear overall strategy during
the consultation process and reviewing this plan during
the preoperative visit. This plan will be reviewed thoroughly
so that you have a full understanding of the procedures,
incisions, and results you can expect.
-Precise preoperative skin marking prior to surgery.
While you are standing, your plastic surgeon will make
marks on the skin identifying certain landmarks as well
as the intended incisions. Not only does this provide
information necessary during the operation, but it also
allows you to review the operative plan one more time
with your surgeon before undergoing the procedure.
-Using various positioning techniques on the operating
room table to optimize visualization intraoperatively
that enables him to provide smooth, natural contouring
from one body region to the next.
-Precise cutting, redraping and sculpting techniques
-Careful but considerable suture techniques to provide
support to the incisions during the healing process.
By using multiple layers of strong sutures beginning
deep in the tissues and finishing superficially, the
resulting scar is optimized and heals into an acceptable
thin line. Even with this suture technique, your plastic
surgeon should be able to use sutures beneath the surface
of the skin that do not require removal. Not having
to undergo suture removal has greatly improved patient
comfort and satisfaction postoperatively.
Depending on the combination of procedures you choose,
surgery will probably last between four and eight hours.
After you are properly anesthetized, your plastic surgeon
will make the incisions necessary for removal of excess
skin and fat. After the incision has been made, he or
she gently elevates the skin and fat off of the underlying
structures. For a tummy tuck, the muscles of the abdominal
wall are usually tightened using strong, permanent internal
sutures. Some patients have hernias in the abdominal
wall, and these may also be repaired during a tummy
tuck.
After removing the excess skin and fat, your plastic
surgeon will redrape the skin over the underlying structures.
One or more drains may be placed beneath the incisions.
These slender, rubber tubes assist in draining any fluid
that may accumulate beneath the incisions and delay
your healing. Your plastic surgeon may also chose to
use a new product called Tissue Glue. This product helps
your body heal and minimizes the fluid that may empty
into your drains, allowing the drains to be removed
earlier.
At the completion of the operation, a sterile dressing
is applied to the incisions, and a compression garment
is applied to the region of the body being treated.
This compression garment helps support your incisions
during healing, decreases postoperative swelling, and
helps decrease any bruising that may occur.
After Your Procedure
If you are staying overnight in the hospital, you will
be transported from the recovery room to your own room.
You will have a PCA pump (Patient Controlled Analgesia)
available so that you will only need to push a button
to self-administer pain medications when needed.
Your plastic surgeon will visit you in your room the
evening following surgery to check and make sure everything
is going well and that you are comfortable. He or she
will also visit you again the morning after surgery
to change the dressings and discharge you from the hospital.
You will also be provided with thorough postoperative
instructions and a phone number so that you may reach
your plastic surgeon directly at any time with any questions
or concerns you might have.
Alternatively, if you decide to go home in the company
of a private duty nurse, you will be discharged after
spending one to two hours in the recovery room.
The antibiotics that were prescribed during your preoperative
visit (usually Augmentin) should be taken twice daily
beginning on the evening prior to surgery. Continue
this medication until it is gone. The pain medication
(usually Lortab or Vicodin) should be taken fairly regularly,
every four hours or so, during the first twenty-four
hours (when you are not asleep, of course). Most patients
find that they are able to transition to Tylenol after
four to five days. You should not take Tylenol AND your
pain medicine, because the pain medicine also contains
Tylenol and this excessive dosing of Tylenol has been
known to cause liver damage. It is not safe to drive
a car within twenty-four hours of taking pain medication,
as your reflexes and alertness may be altered.
You should plan to take it easy following your surgery.
No strenuous activities, heavy lifting (over 20 pounds),
aerobic exercises, swimming, contact sports, tennis,
or golf should be planned for the first three weeks.
As your plastic surgeon monitors your recovery, he or
she will advise you when it is safe to resume specific
activities.
You should plan to wear the compression garment for
three weeks following surgery. Your plastic surgeon
will remove the drainage tubes within several days following
surgery as the drainage decreases to an acceptable level.
The Results You Can Expect
You will notice an improvement in your body contour
immediately. However, your shape will continue to improve
in the following weeks as the mild swelling subsides.
You should be up and walking the day following surgery,
although you will be sore for several days. You should
be able to resume your normal daily activities within
several days following surgery, and you should be able
to resume all of your physical activities within three
to four weeks of surgery.
As a result of your body contouring,
you should be able to look as good as you feel and enjoy
your new body.
About the Author
Don Revis, MD, FACS, is a double board certified plastic
surgeon in private practice in Ft. Lauderdale, Florida.
He has chosen body contouring as an area of special
interest and focus for his practice, and it presently
makes up 50% of his surgical schedule. You may visit
his website, www.SouthFloridaPlasticSurgery.com,
to read more about the various procedures described
herein or visit his BeautySurg.com Dr.
Revis specialist page for more details. If you have
further questions or would like to schedule a complimentary
consultation with Dr. Revis, please contact his office
at 954-630-2009.
return to articles
index page
|
