الفهرس 
Effect of Post Bariatric Massive Weight Loss on Body ContourOnly 14 pages are availabe for public view
 |  | from | 211 |  |  |
| | | from | 211 | | |
Abstract
O
ver the last few years bariatric surgery has become a successful and popular method to decrease weight and thereby contributes to the reduction of the diseases associated with obesity.
Along with the positive effects of massive weight loss the negative effect of developing excess skin is commonly observed. This skin and tissue redundancy not only leads to mechanical strains but also to subsequent limitations in physical activities, hygienic problems and intertriginous dermatitis, and severe aesthetic and psychological problems. As a result, excess skin has a negative impact on quality of life and may therefore contribute to the long-term post-bariatric problems.
Thus, paralleling the increase in bariatric surgery, there is also a greater desire for subsequent BCS. The most common procedures are abdominoplasty, breast lift, upper arm lift, thigh lift, and lower body lift.A number of systems for the objective classification of body contouring deformities have been developed, including the classifications of the abdominal wall and skin laxity and classification of brachial excess skin.
The Pittsburgh rating scale is a classification system directed at multiple body sites, addressing the amount of excess skin at 10 different body sites grading the deformity at each region from 0-3, where grade 0 indicates a normal appearance and grade 3 the most severe deformity. The main purpose of the above classifications has been to serve as a guideline to facilitate selecting the most appropriate surgical procedure for the individual patient.
The terms, body contouring or post-MWL body contouring, can be applied to any surgical procedures used to modify the skin envelope, subcutaneous layer, and/or investing fascia, and include a wide range of operations performed to treat the MWL patient.
In order to perform a safe body contouring, the combination of good patient selection and management of patients’ expectations are crucial factors. In terms of timing, surgery should be performed when the patient’s weight is stable, with recommendations of 12 to 18 months following the bariatric operation and 4 to 6 months without weight fluctuation. A complete evaluation of anatomic deformities is needed for planning the specific procedures. Skin redundancy and quality, lipodystrophy, and adherent folds have to be noted. Furthermore, varicose veins, lymphedema and overall scar evaluation are also important.
A perfect abdominal contour maybe difficult to achieve especially in the MWL population of patients, therefore the goal of abdominal contour surgery should aim at the aesthetic improvement of the abdomen with the least conspicuous scar feasible.
Various options are present to address the specific MWL female breast deformities, and regardless the type of surgery, special techniques with regards to glandular reshaping are important to minimize the incidence of recurrent ptosis. The skin is redraped over the mound, relying on parenchyma and not skin for shape maintenance. Most techniques described for the MWL breast usually include one or more of the principles discussed previously.
The chest area often is of concern to the male patient who has lost a massive amount of weight, and it may be the first area that he wishes to address with plastic surgery. Many male patients are concerned about visible scars although they wish an extensive removal of skin and fat. Therefore, different surgical methods need to be used for the male chest. Just to reduce the volume and leave the patient with visible scars, which continue to inhibit the man from participating fully in social and sporting events, does not accomplish the goals of the surgery.
Individuals that have experienced massive weight loss will often present with significant upper arm deformities. As with the other areas of the body such as the breasts, abdomen, buttocks, and thighs, significant fat reduction in the upper arms results in excess hanging skin and varying amounts of remaining fat. The increase in obesity and the concurrent rise in bariatric surgery has led to an increasing interest and popularity of the brachioplasty procedure.
The medial upper thigh area particularly, is often subject to ptosis and skin wrinkling, due to the thinness of the skin and frequent fat depositio. Medial contour deformities may occur secondary to weight loss and prior to pregnancy. Unfortunately, thigh lift procedures had a poor reputation among plastic surgeons and patients alike due to the high complication rate and unsightly aesthetic results.
There has been a growing demand for gluteal contouring, which has been attributed to multiple factors, such as the improvement in body contouring techniques, and evolving esthetic preferences. The MWL population has some alterations in the anatomy and physiology which include increased blood supply to tissues. This can be used to support larger and longer soft tissue flaps than possible in the non-bariatric population. Furthermore, a subset of MWL patients can benefit from autologous fat transfer as the primary or an adjunctive mode of gluteal contouring. Alloplastic implants remain a less frequently used option in the population that has experienced MWL.
Following massive weight loss, patients will often complain of premature aging. The patient may not be able to completely verbalize what it is that bothers them. It is, therefore, up to the surgeon to perform a complete facial analysis and determine the deformities from an objective stand point. In general, the forehead, brow, and eyelids do not undergo marked change related to weight gain and weight loss. The neck can also undergo severe alterations from MWL. Excess skin is almost universally present. Platysmal banding can also be prominent. The authors have noted that the deformities are not as severe in younger patients, typically those younger than 40 years of age, but can be quite severe in older patients. Rhytidectomy seeks to improve facial rhytidosis and overall sagging of the skin and deeper facial layers. Many different procedures of rhytidectomy exist. The differences are mostly the type of incision, the invasiveness and the area of the face that is treated. Restoration of the aesthetic neck contour is an integral component of facial rejuvenation. Multiple deformities of the neck and chin complex can make treatment of the cervical region daunting.