Showing posts with label bariatric surgery. Show all posts
Showing posts with label bariatric surgery. Show all posts

Friday, May 3, 2013

Brachioplasty - Upper Arm Lift

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Upper arm fat and skin removal to reduce hanging upper arm skin in obese women was first described in 1930. Cosmetic brachioplasty or upper arm lifts were first described by Argentinian surgeons in 1954 and subsequently became a well established procedure. However, due to the scarring, fluid collections under the skin, nerve damage and wound problems associated with the surgery it was not very popular. According to the American Society of Plastic Surgeons statistics as recently as the year 2000 more than 300 women got upper arm lift procedures in the US. Last year, 2012, the number increased to more than 15,000. 98% of these patients were women, 42% had undergone previous weight loss surgery, 63% were aged 40 to 54 and 33% were over age 55. The total spent on brachioplasties in 2012 was $61 million. What accounts for this 5 fold increase in the number of procedures over 12 years? Some of this is due to the increase in weight loss surgery. Over 200,000 Americans a year undergo some kind of weight-loss surgery, such as gastric bypass.

Thursday, February 21, 2013

Weight Loss After Tummy Tuck - Abdominoplasty

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Obesity is defined as a body mass index (BMI) of 30kg/m2 or greater. By this definition a third of men and a third of women in the US are obese. The prevalence of obesity in this country has doubled since 1980. This is a a major health concern because obestiy increases the risk of many diseases and health conditions, including but not limited to sleep apnea, diabetes mellitus, hypertension, osteoarthritis, dyslipidemia, certain types of cancers, gallbladder disease, stroke, and coronary heart disease. The associated health costs are quite high and have been estimated to be in the range of $75 billion per year. With more severity obesity of body mass indexes of 40kg/m2 or more the condition is considered morbid and weight loss surgery is usually recommended if dieting fails. Weight loss surgery has been proven to reduce the incidence and severity of medical conditions associated with morbid obesity.  The American National Institute of Health guidelines state that bariatric weight loss surgery should be offered to patients with a BMI of 35–40 kg/m2 who have obesity related conditions such as diabetes mellitus or obstructive sleep apnea, or in those with a BMI of 40 kg/m2 or greater regardless of weight related co-morbidity conditions.

A medical journal article just published revealed on retrospective review that patients maintained weight losses greater than the amount of tissue removed at abdominoplasty/tummy tuck more than a year after the surgery. This amount of maintained weight loss was greater in people who were heavier prior to surgery (24.5kg/m2 or more) and was proportional to the amount of tissue removed at surgery for 4.5 or more pounds of tissue removal. When asked why the weight was lost and the loss maintained these patients responded that they felt full after and between meals so they ate less. In my experience patients lose additional weight because they like and want to maintain their results. That involves lifestyle changes including exercise and eating a healthier diet. Abdominoplasty however should not be performed primarily to lose weight because the complication rates are quite high for patients with BMI over 40kg/m2 and the results are less than optimal with BMI of 35 to 40kg/m2. Nearly every patient I have ever seen who underwent abdominoplasty when morbidly obese (by surgeons other than myself) had complications including disruption of suture lines requiring months to heal. The best results and fewest complications are seen in patients who have stable weights, are not morbidly obese and have good quality skin without stretchmarks.

A Swiss study published in Oct 2012 showed that patients who have abdominoplasty to remove excess skin resulting from weight loss surgery are more likely to keep the weight off after the procedures. These patients regain about a pound a year vs. a 4 pound annual gain for patients who have weight loss surgery without body contouring surgery to remove excess skin. The contouring surgery produces a second wave of elation that helps patients stay on track to lose more weight. The timing is usually 12 to 18 months after the weight loss surgery as the complication rate at that time becomes the same as for those who have never had weight loss surgery.

There is clearly a benefit to abdominoplasty or tummy tuck that goes beyond the initial look achieved by removing excess skin and tightening abdominal muscles. The procedure has a long lasting effect which is different from a facelift whose affect diminishes with time due to the unstoppable aging process.

The obvious weight loss in this patient after abdominoplasty surgery should be maintained.

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Monday, March 2, 2009

Negative Pressure Wound Therapy

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Since the beginning of Plastic Surgery as a modern specialty, around World War I, Plastic Surgeons have been consulted to close wounds. In these cases the wound edges could not just be pulled together and sutured because of tissue deficiencies. At that time Plastic Surgeons would raise tubes of tissue (fat and skin) and slowly after multiple operations advance those tubes into the wounds in order to achieve closure.

Thursday, February 19, 2009

Abdominoplasty, thigh buttock lift and belt lipectomy

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Abdominoplasty - Tummy Tuck

Thigh Buttock Lift - Belt Lipectomy (mostly for patients after massive weight loss or bariatric surgery, gastric bypass etc.)

Abdominoplasty for excess skin and fat and loose muscle
Abdominoplasty for excess skin
Abdominoplasty after weight loss
Belt lipectomy 1
Belt lipectomy 2

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