الفهرس 
THE SKIN ANATOMY
PATHOPHYSIOLOGY OF OBESITYOnly 14 pages are availabe for public view
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Abstract
Obesity is a rapidly growing disease that has spread widely
in the world and it is a major health risk factor because of
associated medical complications such as cardiovascular
disease, hyperlipidemia, diabetes, high blood pressure, cancer,
degenerative arthritis, and sleep apnea.
With the universal increase in morbid obesity and the
concomitant development of advanced laparoscopic techniques,
a large number of patients are opting for bariatric surgery to
reduce excess body weight and ameliorate the myriad of
associated medical problems.
However, the enormous benefits that the patients receive
also come at the cost of redundant, loose, hanging rolls of skin
and fat. Nearly every region of the body can be affected. This
has fueled a rapid increase in the number of patients presenting
to the plastic surgeon’s office for body-contouring procedures.
The individuals who seek the advice and expertise of a
plastic surgeon regarding the removal of excess skin have
undergone a major life-altering event. While their overall body
shape has changed dramatically, they retain a daily reminder of
their obese state in the form of loose, hanging skin. It is
important for the clinician to realize this, and to recognize that
patients may still view themselves as ‘fat’ and ‘different’.
Despite successful weight loss, self-esteem may be low. These
patients often state that they feel triply stigmatized: First for being morbidly obese,
Second for choosing surgical therapy to lose weight (the
‘easy way out’), and
Third for being considered vain and seeking the help of a
plastic surgeon.
It is essential that the plastic surgeon approach these
patients in a concise, well-thought-out fashion with safety as
the primary concern.
Careful preoperative evaluation and preparation are
essential in the postbariatric population. It minimizes
complications and maximizes the aesthetic and functional
outcome.
Proper evaluation including the following is very
important:
Calculating BMI at time of presentation and assessing
stability of weight.
Screening for residual medical problems associated with
obesity and gastric bypass.
Elucidating relevant psychosocial issues.
Diagnosing the deformities that result from massive
weight loss.
Understanding the patient’s goals and expectations.
Formulating a safe treatment plan.We have to ask patients to list the regions of their bodies
that they would like to correct in order of priority. We then
discuss surgical options that would effect changes in these
regions, including the location of the scars and the extent of
recovery.
The final component is a reasonable set of goals and
expectations. Patients should be willing to accept extensive
scars in exchange for loose skin, understand both the power and
limitations of the intended procedures, and appreciate which
areas of the body will not be affected by the planned surgery.