"Preparing for PS" - Article

Congratulations on your weight loss! You are healthier and more energetic. Unfortunately, your excess skin is a constant reminder of the former life you desire to leave behind. To help complete your weight loss journey and the transformation into a new and healthier you, you’ve decided to have contouring surgery to improve upon a few body areas. Before you take this next step, there are several important things to keep in mind as you prepare for your surgery. Attention to these issues will make you a safer and healthier plastic surgery candidate.

Good Nutrition You must have good nutrition. With any kind of weight loss, especially if you had surgery to help you lose weight, your body undergoes significant changes, making it easier for you to develop nutritional deficiencies. Normal protein levels can be a challenge to maintain, and low iron or vitamin B-12 levels can make you anemic (low blood count). You can also become deficient in other vitamins and minerals, such as vitamin D, potassium and calcium. All these nutritional deficiencies can make it more difficult to heal from contouring surgeries. Remember, these contouring surgeries you are preparing for are elective surgeries, so get yourself in the best physiological and nutritional shape you can to minimize your chances of developing wound healing problems. If you had laparoscopic weight loss surgery, your skin incisions are likely measured in inches, but the incisions from your contouring surgery will be measured in feet.

Weight Stability Your weight should be stable. If you are still actively losing weight, it is easier for you to have nutritional issues that may adversely affect your wound healing, as discussed above. Also, if you have additional weight loss after your contouring surgery, your skin will relax faster than if you had maintained a stable weight. All skin relaxes after contouring surgery, but skin relaxes faster in patients who have had cycles of significant weight gain and loss. This relapse in skin tightness after contouring surgery is expected and is a common reason for “touch-up” surgery.

Stop Smoking If you smoke, you must stop smoking. Contouring surgery requires skin to be excised, which reduces blood supply to the remaining skin. When combined with the tight skin closures needed to give good contour, this can lead to ischemia, a condition where there is insufficient blood flow to allow for proper healing. Smoking just one cigarette will further decrease blood flow to your skin, increasing the likelihood of wound-healing problems. Small wounds that develop can heal with dressing changes, assuming good nutrition, but large wounds may require additional surgery to close them. To be in the best shape possible for your elective contouring surgery, you must stop smoking. Most plastic surgeons will ask you to stay off tobacco both before and after your surgery to ensure optimal wound healing.

Staging of Surgeries After your weight loss, you may have several body areas you wish to address with contouring. Your plastic surgeon wants to help you achieve your contouring goals, but may not be willing to perform all of these procedures at once. Because your safety is of utmost importance, he or she may recommend separating the procedures into stages in order to keep each of your surgeries to a safe length of time and provide for a logical or natural grouping of procedures. When a patient wants “everything done,” I commonly recommend beginning with the lower body, performing either a belt lipectomy or a lower body lift. This may also include liposuction of the outer thighs and buttock augmentation with your own tissues. In a second stage, I commonly reshape the breasts and remove the remaining excess around the upper body, completing an upper body lift. As a third stage, I perform contouring surgeries on the upper arms and inner thighs, and in the final stage, face and neck lifts can be performed. Besides safety, one additional advantage of performing surgical procedures in stages is that it allows for minor touch-ups of prior procedures. Of course, if patients have other priorities, the stages can always be reordered to conform to patient desires.

Picking Your Plastic Surgeon Last, but not least, you must choose the right plastic surgeon for you. A good place to start is by looking for a plastic surgeon certified by the American Board of Plastic Surgery (ABPS), the only board certified by the American Board of Medical Specialties to perform the full spectrum of plastic surgery from head to toe. You can search for an ABPS-certified surgeon by navigating their Website (www.abplsurg.org), but an easier way is through the Websites of the American Society of Plastic Surgeons (www.plasticsurgery.org) or the American Society for Aesthetic Plastic Surgery (www.surgery.org). If you had weight loss surgery, your bariatric surgeon may also be able to recommend a plastic surgeon who has performed contouring surgery on his or her other patients. Of course, the ObesityHelp Website also has links to help you find a plastic surgeon in its Plastic Surgery Forum.

When you consult with an ABPS-certified plastic surgeon, inquire about the surgeon’s experience with patients who have lost significant weight. Get a sense of how frequently he or she performs these types of procedures and how committed the surgeon is to patients like you. Find out where the surgeries are performed and whether the surgeon has hospital privileges. Ultimately, you must feel comfortable with your plastic surgeon before you proceed with any contouring surgery.

Summary Again, congratulations on your weight loss and for taking these final steps in your weight loss journey. Remember to get in the best physical shape you can through optimal nutrition, achieving weight stability and stopping tobacco use before embarking on any contouring surgery. Finally, remember to choose your plastic surgeon carefully based on qualifications, recommendations and experience.

Michael S. Wong, MD, FACS, is the Director of Body Contouring after Weight Loss at the University of California Davis Medical Center.

March 2008