Excess Skin Removal After Extreme Weight Loss (cont.)
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Preparation for the procedure involves losing weight and reaching a stable body weight prior to the procedure. This is unlike the preparation involved for liposuction. If problem areas persist, liposuction may be performed prior to the excess skin removal procedures or, if only small areas are involved, at the same time as the surgery for excess skin removal. There are inherent significant risks when liposuction is performed in areas adjacent to flap excisions required for body lifts due to the altered blood flow to the tissue, which is already compromised due to the tissue excess.
Many options are available with excess skin removal surgery. Thus, many people choose to meet with a surgeon at least twice or to seek a second opinion before embarking on such procedures. When choosing the timing of these procedures, considering the fact that people are at risk for nutritional depletion after massive weight loss is important. Discussing this issue with a primary-care doctor or bariatric surgeon may be useful. The usual preoperative health check, blood work, possible banking of one's own blood (if needed) and avoidance of any blood thinners (for example, aspirin, and ibuprofen) are all necessary and desirable for safety and a favorable outcome. Many of the procedures are performed in stages, with several months of recuperation between each stage. Additionally, many procedures are being performed by teams of plastic surgeons with at least two surgeons plus assistants in order to minimize the operative time and reduce risks to the patient.
Additional concerns of nutritional deficiency must be addressed in people who have undergone bariatric surgery. Folate, vitamin B-12, and iron deficiencies must all be corrected prior to major surgery.
The planning of multiple procedures is also important. Individuals need to decide which areas of the body bother them the most and work with the surgeon to come up with an individual surgical plan that best meets their needs. People commonly elect between one and six procedures, depending on their wishes. Excess abdominal skin is often the most bothersome and can be addressed by abdominoplasty, panniculectomy (the removal of superficial abdominal fat), or body lift. An example of a three-stage procedure is as follows:
With potential revision surgeries, as many as six stages are possible.
For major lifts, the body is often marked for surgery the day before the surgery.
Gregory Caputy, MD, PhD
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