Post-Bariatric Weight Loss Surgery


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Post-Bariatric Surgery

Member - American Society of Plastic Surgeons

Post-Bariatric Weight Loss Surgery

Are You A Good Candidate?
Meeting With The Doctor
How The Procedure Is Performed
What To Expect After Surgery
Possible Side Effects And Risks
How Long Will The Results Last
Questions You May Have

Post-Bariatric Weight Loss Surgery
After the extreme weight loss that follows bariatric surgery, 100 pounds or more in many cases, the skin is left loose and saggy and hanging from many areas of the body, especially the abdomen below the belt line. For many patients, the hope of being able to finally feel comfortable in "normal" clothes is postponed by hanging flesh that just doesn't seem to fit on their much slimmer frame. Increasingly, post-bariatric weight loss patients are turning to body contouring surgery to help give shape to their new slimmer form.

For patients who have recently lost a large amount of weight, hanging skin does not just accumulate in one area of the body. Your entire body, from the face and neck down to the legs, may have sagging skin and tissue left over from your larger shape. The surgeons at The Metropolitan Institute for Plastic Surgery understand that a comprehensive approach must be taken to post-bariatric weight loss surgery. For example, if skin and tissue are removed from only certain areas of the body, it will result in an asymmetrical appearance of the body. The staff and doctors of the Institute will meet with you at length to discuss the goals you want to achieve from post-bariatric surgery and to work with you to develop a surgical plan that helps you achieve these goals in the safest and most effective manner possible.

Are You A Good Candidate for Post-Bariatric Weight Loss Surgery?
If you recently underwent bariatric weight loss surgery or self-motivated weight loss that resulted in large amounts of loose and sagging skin throughout your body and you are now in generally good health, you may be suited for body-contouring surgery. Typically, body-contouring surgery is performed once you have achieved your weight loss goal and have adequately recovered from your bariatric surgery. It generally takes a year or more to recover from bariatric weight loss surgery. The staff and doctors of The Metropolitan Institute for Plastic Surgery will work with you to determine the best time to perform your body contouring surgery.

Meeting With the Doctor
Prior to moving forward with your massive weight loss surgery, you will have an extensive and comprehensive consultation with the staff and doctors at The Metropolitan Institute for Plastic Surgery. The purpose of the visit will be to evaluate your physical health, to discuss your specific goals for your post-weight loss procedures, and to ensure that you have a realistic view of the results that can be achieved with post-bariatric weight loss surgery. The doctors at the Institute will explain in detail the type of procedures that are available to meet your goals and outline how each procedure is performed, the risks associated with each procedure, and the recovery time that will be required. Working as a team, you and the staff and doctors of The Metropolitan Institute for Plastic Surgery will come up with a surgical plan that will result in a safe and pleasing outcome.

The Metropolitan Institute for Plastic Surgery doctors and staff will:
� Review the various body contouring procedures with you
� Clearly discuss the potential risks of each procedure
� Outline in detail how each procedure is performed and what you can expect before, during, and after the procedure
� Outline in detail the type of procedures recommended and the most appropriate surgical plan for you
� Provide detailed cost, insurance (if applicable), and payment information
� Clearly answer all your questions

You will be asked to provide:
� Details about your medical history
� A list of all medications you currently take including over the counter medications such as aspirin, vitamins, and herbal supplements
� Information regarding your tobacco and alcohol use

How The Procedure Is Performed
For most post-bariatric patients, body-contouring procedures are performed in stages. The doctors of The Metropolitan Institute for Plastic Surgery will develop a surgical plan that addresses all areas of concern in a safe and phased approach.

Your post-bariatric weight loss procedures will most likely be performed at the hospital; the length of your hospital stay will depend on the procedures you are having performed and the wishes of you and the doctor. Procedures are performed using general anesthesia and can take from a few to several hours to complete depending on the extent of work being done.

Surgery is performed by removing excess skin and tissue and pulling the remaining skin tight against the body. The nature of the surgery requires the doctor to make long incisions; the length of the incisions depends on the amount of excess skin being removed. Depending on the extent of the procedure and your individual anatomy, the doctor may be able to hide the majority of the scars along the bikini line, under the armpit, or underneath the breasts to minimize visibility. Placement of scars will be discussed with your during your initial consultation.

Once the doctor makes the incisions, large crescent shaped segments of skin and tissue are removed. The remaining skin and tissue are lifted and pulled close to the body to achieve a tighter and smoother affect. The doctor then stitches the incisions closed and gauze dressings are placed over them. Temporary drains are put in place to help drain excess fluid from the area of the surgery. A firm fitting body garment is placed over the surgery site to provide support to the area.

What To Expect After Your Surgery
Your recovery time will vary depending on the type and extent of the procedure or procedures you have performed. The following is a general guideline of when you can resume activities after each body contouring procedure. Remember, these are just general guidelines; each patient and each procedure is different. Specific details about your recovery will be explained to you during your initial consultation.
Activity When

Shower Two to Three Days After Surgery

Back to Work Two to Four Weeks After Surgery

Driving Two to Three Weeks After Surgery

Strenuous Activity Six to Eight Weeks After Surgery

Fading of Scars Several Months to One Year

Immediately After Your Surgery
Depending on the procedure or procedures you have performed, you will spend one to several nights in the hospital. It is important that you have someone to drive you home and to stay with you for the first few days you are at home. There may be moderate pain during the first few weeks after your surgery. Pain medication will be prescribed to alleviate as much post-surgery pain as possible. Though you may not be able to stand up completely straight for at least a week after surgery, it is important to start moving and walking within a day of surgery.

The First 24 to 48 Hours After Your Surgery
During the first 24 to 48 hours after your procedure, you will feel tired from the anesthesia and will experience discomfort in the area of the surgery. Pain medication will alleviate much of the discomfort. There will be visible bruising in the area of the surgery and swelling may be severe; the bruising and swelling may take three to four months to completely disappear. Your discomfort level will improve rapidly after the first two days.

To facilitate the healing process, it is important to start moving and walking within a day of your surgery. You will wear an elastic body garment for four to six weeks after your surgery to provide gentle, healing pressure, to provide stability, and to help reduce the risk of blood clots.

The First Two Weeks After Surgery
You will notice a marked improvement in your discomfort level during the first few weeks after your surgery.

The drains that were inserted into the surgical area will be removed within five to ten days of your surgery. Upon release from the hospital, you will be instructed on how to take care of the drains, which are used to allow fluid to drain from the surgical area. Most of the stitches used are dissolving; any non-dissolving sutures used will be removed within five to ten days after surgery.

Small amounts of bleeding and oozing are normal in the first few days after surgery. If you see more than just a slow staining of the gauze dressing, apply pressure to the area with your hand for 20 to 30 minutes to stop the bleeding. If this does not stop the bleeding, call The Metropolitan Institute for Plastic Surgery. Heavy bleeding is rare; however, if it does happen, call the Institute right away.

Resuming Your Normal Routine
Everyone heals at different rates and you are the best judge of when you are ready for certain activities, but the following are general guidelines. The staff and doctors of The Metropolitan Institute for Plastic Surgery will work closely with you as you recover and resume your normal routine.

� Swelling and bruising gradually disappear within three to four months of surgery.

� You can most likely return to work or school within two to three weeks after your procedure. If your work is strenuous, plan to stay home from work for four to eight weeks, depending on how you heal and the type of work you do.

� You can most likely return to your physical exercise program within six to eight weeks of your lower body lift. Our patients are encouraged to plan an exercise program and discuss it with the staff prior to resuming.

� The scars caused by the incision should be protected from sunlight for at least a year after surgery.

Things To Be Aware Of After Your Surgery

� Because patients can have as much as 20 to 30 pounds of skin and tissue removed during surgery and incisions are sometimes deeper than with traditional surgery, more pressure can be put on sutures holding skin together. It is crucial that you strictly follow all post-surgical instructions, especially those relating to caring for your incisions.

� Your scars may actually appear to worsen during the first three to six months after surgery; this is a normal part of the healing process. Within about nine months of your surgery, your scars will flatten and lighten in color.

� Healing does not always occur evenly from side to side and areas of your body may heal at different rates and in different ways.

� You may experience a loss of sensation or numbness in the area of your surgery. This is entirely normal and may take several months to return to normal.

� The skin in the area of your surgery may appear shiny due to swelling. Within a few weeks, the swelling will disappear and the skin will return to a normal appearance.

� You may notice a tingling sensation in the surgical area. This feeling is a result of the healing of the nerves in the area and will go away within several months of your procedure.

What Are Possible Side Effects or Risks? Like all surgical procedures, there are risks associated with any body contouring procedure. During your initial consultation with the doctors and staff of The Metropolitan Institute for Plastic Surgery, your individual risks will be assessed and discussed. As with any surgery, you can help reduce the risks by closely following the pre and post-surgery instructions provided to you. And the doctors and staff of the Institute will be with you every step of the way to ensure a safe procedure and a smooth recovery.

Most likely risks include the following:
� Infection
� Seroma or excess fluid trapped in the surgical sites
� Hematoma or blood collection in the surgical site
� Loss of sensation
� Damage to sensory nerves
� Areas of wrinkling or slight depression in the skin
� Increased risk of hernia
� Changes in the asymmetry of the body
� Scarring

How Long Will the Results of Your Lower Body Lift Last? Post-bariatric weight loss surgery can dramatically improve the appearance of loose and sagging skin throughout the body. While excess skin and tissue removal is permanent, you should keep in mind that the laxity of the skin will still be there, and the tissue will give over time, but not to the same degree as experienced previously. The amount of future skin and tissue sagging is affected by aging, heredity, anatomy, and subsequent weight gain. It is impossible to predict future skin and tissue sagging.

Questions You May Have

� Will my insurance coverage pay for my post-bariatric weight loss surgery or surgeries?
In cases where post-bariatric weight loss surgery is considered essential to future health, insurance may cover all or part of your treatment plan. The staff of The Metropolitan Institute for Plastic Surgery will work with your insurance carrier to determine which parts of your treatment plan will be covered by your insurance. You are responsible for the full payment of those portions of your treatment plan not covered by insurance. Cost and payment information will be fully discussed with you during your initial consultation.