Are you among the tens of thousands of people who have lost a dramatic amount of weight? If so, congratulations! You did it! Those years of struggling and failed diets are behind you. Perhaps you did it through weight loss surgery. Or, perhaps it was through diet and exercise. Either way, you have created a new body and a new life for yourself.
But, now that the weight is gone, are you left with extra skin? If so, it likely causes you embarrassment and perhaps hygiene problems as well. Fortunately, body contouring surgery can help restore a more natural look to your body.
The authors of this book, respected plastic surgeons, have performed hundreds of body contouring procedures on weight loss patients, and they understand your concerns as you explore having reconstructive surgery. Among the questions they answer are:
• How soon after surgery can I have excess skin be removed?
• Which surgery should I have first?
• How many surgeries can I have at one time?
• Should I have a tummy tuck or a body lift?
• Will I have much pain after contouring surgery?
• Can my breasts be restored to normal?
• Where will scars from the surgery be visible?
• When can I return to work and resume physical activity?
• What about fees? Will insurance pay?
The book contains 136 color illustrations and photos, including dozens of "before & after" photos of surgery patients, as well as an appendix, resource section, glossary, and index.
|Product dimensions:||9.00(w) x 7.00(h) x 0.40(d)|
About the Author
Jeffrey Sebastian, MD, is a plastic and reconstructive surgeon. He lives in Los Angeles. Joseph F. Capella, MD, is a plastic and reconstructive surgeon with a special interest in cosmetic surgery. He lives in Ramsey, New Jersey. J. Peter Rubin, MD, is assistant professor of surgery at the University of Pittsburgh School of Medicine and a plastic surgeon who specializes in body contouring and other aesthetic techniques. He lives in Pittsburgh, Pennsylvania.
Read an Excerpt
Body Contouring Surgery After Weight Loss
By Jeffrey L. Sebastian, Joseph Capella, J. Peter Rubin, Jack Kusler
Addicus Books, Inc.Copyright © 2006 Jeffrey L. Sebastian, M.D., Joseph Capella, M.D., J. Peter Rubin, M.D.
All rights reserved.
Body Contouring after Weight Loss: An Overview
Remember the moment you stepped onto the scale and discovered that you'd finally achieved your weight loss goals? Losing a hundred pounds, two-hundred pounds, or perhaps more was no easy task. Congratulations! You made an important decision to improve your health. It took time, courage and a deep commitment. You were, no doubt, exhilarated over your accomplishment. But you may not have anticipated that the weight loss would leave you with excess skin over various regions of your body. You may even feel discouraged when you look in the mirror and realize that you do not look as good as you feel. Excess skin may also be causing considerable difficulty with hygiene and feelings of shame in social situations or even during intimate moments. Although your body may now be much smaller, you are forced to buy oversized clothing to hide the large folds of skin. There may be constant skin irritation, recurrent skin rashes, infections or back pain due to the weight of hanging skin.
No amount of exercise or healthful living will restore elasticity to your skin. However, there is a surgical option for removing the excess skin. It's called body contouring surgery.
WHAT IS BODY CONTOURING SURGERY AFTER WEIGHT LOSS?
Body contouring is plastic surgery designed to correct specific abnormalities or irregularities in the shape of the body. These are procedures that are aimed at restoring contour, proportion, and skin tone.
Although body contour abnormalities following massive weight loss can potentially involve almost every part of the body, it is often unpredictable as to which area will be affected the most and to what degree. There is a wide spectrum of unique post-weight-loss deformities that can be encountered, and, often the magnitude of problems exceeds what surgeons have traditionally addressed with plastic surgery.
For those who have lost more than fifty percent of their excess weight, body contouring surgery will remove significant amounts of excess skin and sagging fat from various regions of the body; these surgical procedures may include tightening underlying tissues and performing liposuction to remove local fat deposits. Often, an individual can qualify for a number of surgical options that cover multiple body areas.
Furthermore, body contouring surgery after massive weight loss can produce results that improve both psychological and physical health. Being rid of pounds of excess skin can mean not only a dramatic improvement in appearance, but an improved body contour may also mean greater self-esteem and confidence. The benefits to physical health include being able to exercise more easily, which may lead to further pounds being lost or at the least easier maintenance of your hard-earned new weight. You may also be relieved of neck and back pain as well as of rashes and infections that may have developed between folds of excess skin.
SKIN ELASTICITY: WHY WE LOSE IT
Thanks to collagen and elastin, which are fibrous connective tissues, the skin has elasticity. When skin with normal elasticity is pressed, pulled, or stretched, it springs back. Skin that has been overstretched for a long period of time, however, loses its elasticity, similar to a rubber band that has lost its stretch. A number of factors affect the structure of skin over the course of a lifetime.
Significant Weight Loss
Gaining a few pounds and losing them over the span of a few months gives skin the opportunity to adjust to these changes and shrink back into position. But, if you have been obese or overweight for many years, your skin has experienced prolonged tension — it's been overstretched across your entire body for a long period of time. Many of the elastic fibers in the skin have broken down. The more weight you lose, the greater your chances of having loose skin.
Aging and Genetics
Skin elasticity diminishes naturally in all of us as we age. The older we are, the less elastic our skin becomes. Pinch the skin of a healthy eighteen-year-old, and it springs back immediately. Pinch the skin of a healthy fifty-year-old, and it may not spring back as quickly. Your genes play a role, too, in determining how well your skin springs back, or how much excess skin you're left with after you lose weight.
Your skin type also affects your skin elasticity. People with fair skin have a greater tendency to develop loose skin as they age, regardless of body weight or size.
Too much time in the sun will damage the skin, both externally and internally. You may be aware that sun can damage the surface of the skin and cause premature wrinkling, sun spots and even skin cancer. Excessive exposure to the sun's intense rays over time can also cause damage to the underlying tissues in the skin, causing the skin to lose elasticity.
Not only is smoking bad for your heart and lungs, it's also bad for your skin. If you smoke, or if you're regularly exposed to second-hand smoke, the nicotine you absorb causes blood vessels to constrict, reducing blood flow to your skin. As a result, your skin is deprived of oxygen.
Smoking also causes collagen, a skin protein important for maintaining good skin elasticity, to break down at an accelerated rate. This results in more wrinkles and looser skin. If you quit smoking you will drastically improve the health of your skin, whatever your current weight level may be.
ARE YOU A CANDIDATE FOR BODY CONTOURING?
Whether body contouring is right for you depends on several factors. One of the criteria for determining whether you are a good surgery candidate is your current weight. Your weight is evaluated according to the body mass index.
Your Body Mass Index
Your body mass index, or BMI, is the ratio between your weight and your height. As your weight increases, so will your BMI, and this may negatively affect the results of body contouring surgery. Why? Body contouring is primarily effective in removing an individual's loose, hanging skin. However, it is not effective in producing an improved contour if an individual is still significantly obese. These are not procedures for treating obesity. Contouring surgery will not drastically change a severely obese individual's shape because of the excessive fat that underlies the skin. The closer you are to your goal weight, the more ideal your BMI will be, and this will allow contouring surgery to produce the best possible cosmetic result.
Beyond the contouring issues, however, there are greater health risks for patients who have a high body mass index. There is an increased risk with undergoing anesthesia. In addition there may be healing complications; fatty tissues have relatively poor blood supply, increasing the risk for infections. The risk for forming a dangerous blood clot that then travels to the lungs is also increased.
Is there a specific BMI requirement for body contouring surgery? The guidelines are not etched in stone. A plastic surgeon will consider each person's unique circumstance and decide accordingly; however, many surgeons prefer that patients have a BMI of 30 or less to take full advantage of procedures to restore contour. Many surgeons do not recommend extensive body contouring procedures if the BMI is greater than 35. See appendix A to determine your own BMI.
Other Determining Factors
A number of other factors will determine whether you're a good candidate for body contouring surgery.
 Are you are in good health overall?
 Are you committed to a healthful lifestyle that includes proper nutrition and a fitness routine?
 Can you undergo general anesthesia?
 Are you experiencing post-bariatric surgery issues (persistent nausea and vomiting, stomach ulcers, gastrointestinal bleeding, problems with gallstones, weight gain)?
 Are you financially prepared for the costs associated with body contouring surgery?
Advanced age, sixty-five or older, is not necessarily a limiting factor if you are in excellent health with good exercise tolerance. However, if you are this age, your overall medical condition will require greater scrutiny and may limit your options with regard to extensive or lengthy operations. In general, the best candidates for major body contouring work are age fifty-five or younger.
ARE YOUR GOALS AND EXPECTATIONS REALISTIC?
Following massive weight loss, a crucial determining factor of the success of body contouring surgery will be the establishment of realistic goals and expectations. It is important to recognize that surgery will deliver dramatic improvement but not perfection.
Self-Image and Emotional Issues
The way you view yourself is likely to be negatively impacted by the appearance of and the problems associated with your skin excess. This obstacle to building proper self-esteem and self-confidence will be lifted with body contouring surgery. However, the surgery improves the exterior of your body, it will not serve as a cure-all to any negative attitudes or emotions you have prior to surgery. You may continue to have self-image issues.
Depending on the severity of skin excess, the scars may be quite extensive, sometimes extending beyond the usual boundaries for scar placement in plastic surgery. In the end, the trade-off for significant improvement in body contour, alleviation of medical conditions, and lifting of physical limitations is quite acceptable. But, you must give this careful consideration. With strategic planning, scars are typically placed in areas that are hidden by bathing attire or clothing; this may not always be possible, however. If you should need surgical scar revision, it will usually be delayed for eight to twelve months.
The Recovery Period
The recovery period after body contouring surgery can be substantial. You may have had bariatric surgery performed laparoscopically with very small incisions. Unless you suffered a setback from surgery, you probably felt close to normal within a week, having experienced minimal discomfort from the actual surgery. However, due to the length of incisions and tightening of underlying tissues, the recovery from body contouring surgery can be more involved, depending on the type and number of procedures performed. For example, if you have a body lift procedure, you are likely to be in the hospital for at least two days, with another four to six weeks at home for recovery. During this time you may have to wear a special garment that could interfere with your usual clothing and may restrict outdoor activities. You will be advised to avoid direct sun exposure to new scars for a minimum of 6 months but preferably until the scars have faded to your own skin color.
When you return to work, you'll need to schedule half days for the first few days if possible, or take a half-hour nap at midday. If you have a desk job, plan on standing up and stretching your legs at least every hour to help with your circulation and the resolution of swelling.
You'll need to wait at least two to three months to buy new clothing, since your waist will continue to decrease in size and your shape will improve as swelling subsides. In fact, you may lose two or more sizes.
As with any plastic surgery procedure, results don't last forever. Age, weight fluctuation, gravity, sun exposure and other factors will, over time, lead to some sagging of the skin. However, following massive weight loss, skin elasticity may be so poor that sagging skin recurs with much greater frequency after body contouring surgery. Maintaining good exercise and eating habits will significantly lessen your chances for this to occur, but additional surgery may sometimes be necessary.
Physical Limitations of Surgery
Although body contouring surgery offers options to reshape your body and establish a more youthful look, there are limitations. In particular, if you have suffered from severe obesity most of your life, your underlying skeletal or bony framework has hypertrophied or enlarged significantly to support the weight of your tissues. In particular, the chest or rib cage may protrude or the hip bones may be prominent. With weight loss, the size of your skeleton will not change significantly. Redraping and tightening the skin and underlying soft tissues with body contouring surgery at times may make bony asymmetries more noticeable. For example, in women, it may pose limits to obtaining the ideal breast shape due to prominence of the rib cage.
Will contouring surgery eliminate cellulite, the dimpled or "cottage cheese-like" appearance of the skin? Although tightening the skin through body contouring surgery is the best treatment for improving the appearance of cellulite, it will not make it disappear completely. Striae, commonly known as stretch marks, will be eliminated only within the areas of skin removed.
WHEN BODY CONTOURING MAY NOT BE FOR YOU
Some medical conditions, such as heart failure, bleeding disorders, and advanced diabetes, may mean that body contouring is not a viable option for you. A history of vascular disease or lymphedema may also limit your options. Or, if you have scars from previous surgeries that have altered blood supply to your skin, your surgeon may advise against having a specific body contouring procedure and may recommend other procedures for you instead. Financial considerations, discussed in chapter 2, may also be a limiting or prohibitive factor.
BODY CONTOURING: HOW SOON AFTER WEIGHT LOSS?
If you have had rapid weight loss as the result of weight loss surgery, you will need to wait at least several months before having body contouring surgery. Typically, your plastic surgeon will want your weight to be stable for at least three months, and preferably four to six months. "Stable" means a fluctuation in weight of no more than a couple of pounds. On average, individuals who have had gastric bypass reach a stable weight and are evaluated for body contouring procedures twelve to eighteen months following their surgery. Weight loss for those with an adjustable gastric band typically occurs at a slower rate, requiring a longer wait before contouring surgery can be performed. See appendix B for a description of bariatric surgery.
WHY WAIT BEFORE CONTOURING SURGERY?
Allow Your Body Time to Recover
Your body needs time to stabilize or reach equilibrium. During the weight loss period, metabolism is altered, and your body may not have the necessary resources for wound healing following major surgery. Your immune system is also likely to be depressed, making you more vulnerable to infection.
For individuals who have had rapid weight loss through weight loss surgery, there may be some degree of malabsorption — the inability to absorb proteins, vitamins, and minerals from food. This is especially true for those who've had gastric bypass surgery or a biliopancreatic diversion. Adequate nutrition is essential for wound healing, and the chance for developing poor nutrition or malnutrition is greater during the rapid weight loss period. See appendix C for nutritional information.
You may also become malnourished if you lose too much lean body mass, which can occur if you are losing weight without exercising. Lack of exercise also leads to poor cardiovascular fitness. With approval from your doctor, you will want to engage in an exercise program. Walking is probably the best form of exercise at first. Later, aerobic exercise and the use of light weights can be included. An exercise program will become a vital component to maintaining your weight long-term.
Overcome Weight Loss Plateaus
It is common to hit a plateau prior to reaching your goal weight. With perseverance and proper guidance, however, you can usually overcome this. Remember, your BMI decreases as you get closer to your goal weight, and this provides greater opportunity to obtain the best possible shape, while decreasing the risks associated with surgery.
Acquire New Eating Habits
As you essentially relearn how to eat during the first few months after bariatric surgery, nausea and vomiting may occur frequently. This can lead to abnormalities in electrolytes, which are substances in the blood that help to regulate the proper balance of body fluids. An abnormally low level of the electrolyte potassium, for example, could put you at risk for complications while undergoing anesthesia. Regular follow-up and dietary counseling with your bariatric program is key to your success with long-term weight management and prevention of electrolyte abnormalities.
Allow Time for Skin to Adjust
You will also want to give your body ample opportunity to accommodate any excess skin on its own. Given the elastic properties of skin, there will be some degree of recoil, and this may take three to six months to be fully realized. This recoil capacity, however, diminishes significantly with age and increasing severity of skin excess.
UNDERGOING MULTIPLE PROCEDURES
If you have excess skin in various regions of your body, as do most people who've lost a great deal of weight, you may benefit from more than one contouring procedure. For example, you may have excess skin over your abdomen, but a tummy tuck may not be enough. You may also benefit from a buttock lift and a thigh lift. But instead of performing three separate procedures, it may be possible for your plastic surgeon to perform these procedures in one operation in a procedure referred to as a body lift. Similarly, you may be a candidate to have a breast lift and an arm lift done on the same day.
The advantage to doing several procedures at one time is you have only one exposure to anesthesia and one recovery period. The result following surgery is also more dramatic, perhaps bringing you closer to your overall goal. However, there is a limit as to how many procedures can be safely performed during one surgery, and your procedures may need to be staged.
Excerpted from Body Contouring Surgery After Weight Loss by Jeffrey L. Sebastian, Joseph Capella, J. Peter Rubin, Jack Kusler. Copyright © 2006 Jeffrey L. Sebastian, M.D., Joseph Capella, M.D., J. Peter Rubin, M.D.. Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
CHAPTER 1 Body Contouring after Weight Loss: An Overview,
CHAPTER 2 Choosing a Plastic Surgeon,
CHAPTER 3 Your Consultation,
CHAPTER 4 Preparing for Body Contouring Surgery,
CHAPTER 5 Your Surgical Procedure: What to Expect,
CHAPTER 6 Post-Surgical Pain Management,
CHAPTER 7 Abdomen and Waist Contouring,
CHAPTER 8 Thigh and Buttock Contouring,
CHAPTER 9 The Body Lift,
CHAPTER 10 Restoring Shape to Female Breasts,
CHAPTER 11 Arm, Chest, and Upper Body Lifts,
CHAPTER 12 Face Lifts and Neck Lifts,
Appendix A BMI Chart,
Appendix B Weight Loss Surgery Procedures,
Appendix C Nutrition,
Appendix D Medications and Natural Supplements to Be Avoided Prior to Surgery,
About the Authors,