Post Bariatric Surgery
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- When can skin reduction surgery be performed?
- Does everybody undergoing bariatric surgery need to undergo skin reduction surgery?
- Do patients need to be monitored by a nurse overnight following post bariatric surgery?
- Does the skin redundancy come back?
- Is there a limit to the number of areas that can be treated?
When can skin reduction surgery be performed?
Patients undergoing bariatric surgery will have to attain their ideal or near ideal weight and demonstrate a stable weight for at least 6 months prior to being considered for post-bariatric surgery.
Does everybody undergoing bariatric surgery need to undergo skin reduction surgery?
Patients who lose extensive weight will notice deflation of their skin due to the loss of fat cell volume. The redundant skin can be quite extensive and may be aesthetically unsightly. This redundant skin may have the capacity to resorb itself if it still maintains a recoil protein called elastin. Unfortunately, after the age of 40 years of age, the elastin protein is lost from the skin resulting in non-elastic and non-absorbable skin. For those under 40 years of age and those who are patient, the redundant skin will tighten back down over several years. For those patients older than 40 years of age, skin reduction surgery is the only option for eliminating the unsightly redundant skin.
Do patients need to be monitored by a nurse overnight following post bariatric surgery?
Patients undergoing post bariatric surgery are evaluated much in the same manner as other surgical patients. If patients have medical illnesses, other than the redundant skin they are trying to eliminate, they will require an overnight stay at one of the local overnight care facilities near our office. In addition to identifying medical illness, patients are evaluated with respect to their body mass index. The body mass index (BMI) is a parameter that measures the degree of obesity in the patient. When the BMI is greater than 30 and even despite a 100 to 200 pound weight loss, the patient is considered a high-risk candidate and recommended to spend the night with one of our registered nurses.
Does the skin redundancy come back?
The redundant skin will not return unless the patient relapses from his/her bariatric surgery and regains the extra weight and then looses the weight again. There is an early postoperative complication called Recurrent Skin Laxity Syndrome which is associated with early return of apparent skin redundancy that appears within 1 month of surgery. This complication is related to the fact that post bariatric patients, in contrast to routine cosmetic patients desiring skin tucking, must undergo a more aggressive excision of redundant skin as their skin has lost its elasticity and thus will give following surgery. For example, during tummy tuck surgery; the routine cosmetic patient is flexed to approximately 20 to 25 degrees when trying to trim out the extra skin whereas the typical post bariatric patient is flexed between 35 to 45 degrees.
Is there a limit to the number of areas that can be treated?
For patients undergoing post bariatric surgery, there is a safety time limit of 6 to 8 hours duration within which surgeries should be completed. As such, it is important to prioritize the regions such that problem areas may be treated in an optimal and expedited manner without going over the safe time allotted parameters. Most patients are able to combine two problem regions during each surgery. Most patients complete a series of surgeries as below: 1st) tummy tuck and breast lift with or without an implant; 2nd) medial thigh tuck and upper arm tuck; 3rd) buttocks lift with or without an implant; 4th) face and neck lift. This order of surgical management may be altered depending on the patient’s problem areas. Some patients may also elect to perform the tummy tuck with the buttocks lift, which is completed as a total body-lift procedure. This procedure cannot be combined with other regions.
