Post-Bariatric Body Contouring

The reader should enjoy this timely issue of Seminars in Plastic Surgery for it contains original clinical experience and research from plastic surgeons committed to post-bariatric reconstructive surgery. I have enjoyed recruiting these experts (and friends) and reviewing their contributions for this issue. They have labored hard to present interesting and relevant information, for which we are indebted. Some of the material is straightforward or historical and needs no clarification. Some of the work is being presented for the first time.

This Seminars begins with a succinctly progressive history of body contouring surgery as it applies to the weight loss patient by Drs. O'Toole, Song, and Rubin. Many novel and aggressive skin excision approaches have already been performed, and you should read this review before submitting your “original” work.

This is followed by an excellent review from Drs. Sacks and Mattar on contemporary bariatric surgery. As subsequently treating physicians, plastic surgeons need to be aware of the altered physiology and complications related to bariatric surgery. Excess food restrictions with nutritional deficiencies can be subtle and are determined by a nutritionist. The article by Dr. Jacobs and coauthors also examines the problem of obesity and progress in gastric bypass surgery. Their approach to abdominoplasty is straightforward and should be followed. They describe the problems of residual obesity and abdominal surgical scars. They artfully use a pedicled groin flap to circumvent precarious abdominal skin.

Although there are various presentations of the massive weight loss deformity, Song and coworkers from the University of Pittsburgh have shown that the deformity for reconstruction can be ranked by degree of severity. Improvement is noted by a reduction of the rating scale after corrective operations. This registry permits application of the scientific method to clinical research.

Increasingly, surgeons are adopting techniques to improve sensuous contours, and there is no better example than the autogenous fat flap augmentation of the buttocks reported by Gerut. I find that the lateral flap extensions over the hips have precarious blood supply. I also wish to emphasize that the L thighplasty is often complicated by scattered areas of delayed healing. Severely oversized legs do poorly. For the right patient, the satisfaction is high. In fact, as a group, patients with massive weight loss are extremely appreciative of well-performed reconstructive aesthetic surgery.