INNOVATIVE APPROACH TO BODY CONTOURING AFTER MASSIVE WEIGHT LOSS
November 6, 2002
With the growing popularity of gastric
bypass surgery to treat morbid obesity, body contouring after
massive weight loss has become a focus of the plastic surgery
community. An updated and innovative method that adjusts treatment
according to body type is creating improved results and enhancing
the shape of patients' bodies, according to a study presented
today at the ASPS/PSEF/ASMS 71st Annual Scientific Meeting.
With massive weight loss in a short
period of time, skin does not retain its shape, leaving the patient
with excess, baggy skin, according to ASPS Member Dennis Hurwitz,
MD, and author of the study. Also, patients lose different amounts
of body fat before the weight loss plateaus, leaving them either
thin, moderate or still heavy.
Although previous body contouring
techniques worked well on smaller patients who had gastric bypass
surgery, larger patients often had visible scars above and below
the underwear region after surgery as well as skin that did not
conform well to the body.
Building on current techniques from
colleagues at the University of Pittsburgh and other experts in
body contouring, Dr. Hurwitz found that effectively mapping incisions
before surgery as well as using a combination of new and current
cutting and shaping techniques led to the most successful surgeries
for moderate to larger body shapes.
"All the patients who participated
in the study are extremely pleased with the end result,"
said Dr. Hurwitz. "In fact, 39 of the 40 patients in this
study rated the outcome of their surgery very good or excellent."
With moderate to larger patients,
not only is it important to map the excess tissue to be removed
but to anticipate the movement of the skin left behind. This allows
the plastic surgeon to visualize where the scars will be after
the tissue is removed and place them where they will be hidden
by underwear or in a belt-like position. Ultimately, it allows
the patient to feel better about their body after the surgery.
The second step is use of particular
cutting and shaping techniques. For instance, when the patient
is a moderate to large size, Dr. Hurwitz feels surgeons should
use more liposuction than had been used during this procedure
previously to allow the skin to shift into place and reduce overall
bulk, giving a more pleasing volume and look to the body.
Other methods include using a scalpel
instead of electrocautery to minimize skin damage, placing the
patient in various positions to make it easier to stitch the skin
together, using permanent stitches rather than absorbable stitches
placed deeper in the tissue. Suturing deeper with permanent braided
stitches, which are significantly stronger than absorbable smooth
stitches, holds the skin better for moderate- and heavy patients,
making it less likely for the wound to open or slowly spread.
"The phenomenon of massive weight
loss is a new development in the medical community due to gastric
bypass surgery," said Dr. Hurwitz. "As a board-certified
plastic surgeon, I'm proud these updated methods allow patients
to look as good as they feel while addressing some very fundamental
issues that come with massive weight loss."
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