Morbid obesity is a new epidemic afflicting nearly one third of all Americans. One of the most effective ways for permanent weight loss has been "Bariatric" surgery, including gastric bypass and gastric banding. Successful patients will lose 100 pounds within 18 to 24 months of surgery. Having successfully battled obesity, these people are now faced with a new challenge- excessive and hanging skin folds of the abdomen, arms, thighs, breasts, and face. Thinking that once they loose their massive weight they will be attractive again, men and women are disappointed and frustrated with unsightly folds of skin which cover their groin like an apron, hang off their arms like bat wings, and wiggles from their legs when trying to jog. It also creates a problem for personal hygiene. This challenge has led to the development of new ways of body contouring, designed specifically for after massive weight loss. In 2005, 68,000 men and women underwent body contouring after massive weight loss. After weight loss, almost all patients face multiple problem areas which require multiple surgeries. Before surgery, the patient's health needs to be optimized since many develop anemia or vitamin deficiency after bariatric surgery. Next, the sequence of multiple surgeries needs to be wisely devised with the help of an experienced plastic surgeon who specializes in body contouring following massive weight loss. The most common post-bariatric body contouring surgery is a tummy tuck or abdominoplasty. These are not standard tummy tucks, but rather extensive or "High Tension" tummy tucks designed to also lift the sagging hips and thighs; while tightening the loose abdominal wall muscles. A more extensive form of this tummy tuck is call a body lift or belt lipectomy which removes the excess skin of the abdominal fold, as well as that from the back, resulting in a greater lift of the sagging buttocks and the thighs. Panniculectomy is a more specific form of a tummy tuck selected for those with an extremely large, heavy, and hanging abdominal pannus. Often, obesity results in the over-stretching and the weakening of the abdominal wall, which produces a ventral hernia. This and other types of hernias can also be repaired at the time of a tummy tuck or body lift. The second most common body contouring procedure after massive weight loss is breast lift or breast reduction surgery. These procedures are not limited to women, since men also develop hanging breast/chest folds after weight loss. In women an Inverted-T or Anchor Mastopexy is used. Often breast implants are added to replenish the lost breast volume. This procedure is at times combined with an upper body lift which removes the excess skin folds of the upper torso which extends to the upper back. Breast reduction surgery after massive weight loss in men has a different aim and design. Its goal is to create a flat and masculine chest. The third most common body contouring surgery following massive weight loss is brachioplasty. Brachioplasty or arm tuck removes excess hanging skin of the upper arms. In its extended form, it also removes the redundant skin folds of the outer chest and the axilla or the armpit. The fourth most prevalent post-bariatric plastic surgery procedure is a thigh lift. Thigh lifts address the excess skin folds of the inner or medial thighs, that of the outer or lateral thighs, or that of the entire thigh. It can rather be extensive, extending along the entire length of the thighs and legs. Finally, the least common plastic surgery procedure performed as a result of massive weight loss is a facelift. This is due to the fact that people gain relatively far less weight in their face than their body. Therefore, after massive weight loss there is relatively less loose skin of the face, as there would be on the other areas of the body. Never the less, patients can face, hanging neck folds, jowls, and cheeks after weight loss. A variety of facial cosmetic surgeries including neck lift, facelift, mid-face lift, or a forehead lift can address problems associated with sagging facial skin. In planning for body contouring procedures after massive weight loss special attention has to be given for optimizing safety and minimizing potential complications for these types of procedures that are rather lengthy, complicated, and performed on patients that might have other associated risk factors such as sleep apnea, obesity, diabetes, heart disease, venous insufficiency, malnutrition, etc. Therefore, these patients need to be medically optimized and cleared by an internist, pulmonologist, or a cardiologist prior to surgery. Furthermore, the surgery facility must be equipped and staffed to provide specialized care for such surgeries, as well as to provide extended post-surgical monitored care.
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