Plastic Surgery and Obesity: What’s the Connection?February 19, 2020
There continues to be more attention directed to the care and treatment of the obese patient. One of these reasons is the increasing incidence of obesity worldwide. The prevalence of obesity was 39.8% and affected about 93.3 million US adults in 2015-2016, according to the National Center for Health Statistics.
According to the World Health Organization (WHO), worldwide obesity has nearly tripled since 1975. In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these, over 650 million were obese - 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
Most of the world's population live in countries where being overweight and obesity kills more people than underweight. 41 million children under the age of 5 were overweight or obese in 2016. Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016. Obesity-related conditions include heart disease, stroke, type 2 diabetes, and certain types of cancer that are some of the leading causes of preventable, premature death.
These statistics have resulted in a tremendous focus and increase in the treatment of obesity through various means, non-surgical, but primarily surgical, through bariatric surgery. Before 2011, the numbers of restrictive gastric operations were so few as to not even be officially recorded. Even today, the actual number performed is just a guess based on the number of operations by surgeons, mainly general surgeons, that are members of the American Society of Metabolic and Bariatric Surgeons (ASMBS). They report a 45% increase over a six-year period ending in 2017.
The statistics worldwide have also shown an increase of about 350,000 gastric bypass surgeries performed to date.
They have increased not only because more people find themselves suitable candidates, but also because the procedures themselves have become less invasive and safer, and thus more appealing alternatives. This has become possible as a result of newer and simpler techniques, helped in large part by specialized equipment and instrumentation. Other factors include the metabolic preparation of patients and nutritional guidance post-bariatric surgery.
In the not so distant past, the mortality rate from these operations was approaching 10%. Other complications such as infection, prolonged recovery, or annoyances like persistent diarrhea further scared potential patients even though the health benefits were well-known.
Dieting was still the mainstay of weight reduction, but this proved futile in most cases. Only now have clinical studies shown that just a very small percentage of patients can achieve their objectives, i.e., permanent loss of their unwanted weight through dieting. This has further increased the numbers of these bariatric procedures which have evolved from gastric banding to some form of gastric bypass.
There is no question that bariatric surgery is the most effective and long-lasting treatment for obesity.
The Connection Between Plastic Surgery and Obesity
How are plastic surgery and obesity connected? Most of the patients that have lost massive amounts of weight through restrictive gastric procedures are ill-prepared for the physical and cosmetic changes that occur to their bodies as a result of their significant weight loss.
They have morphed from immeasurable sizes to acceptable ones but with hanging skin everywhere. Even though they are healthier with the absence of diabetes, cardiovascular disease, high blood pressure, and metabolically in excellent condition, psychologically, they are still suffering and even sometimes regret their weight loss procedure!
Fortunately, through body and facial contouring, or bariatric plastic surgery, much can and is done to help these patients regain their self-esteem and a positive body image.
Lori (my plastic surgery patient, but not her real name) began gaining weight as a teenager, eventually ballooning to 270 pounds when she underwent her gastric bypass procedure. She subsequently lost 170 pounds over a two-year period. “Even though I felt better,” says Lori,” I was horrified to see myself in the mirror.” Her abdominal skin apron was removed via an abdominoplasty, and a brachioplasty and mastopexy were added. Now, Lori feels much better about herself. “I am finally ready to begin dating again and even look forward to marriage and having a family,” Lori said.
Plastic Surgery Procedures Evolving
Body-contouring patients are becoming an increased focus of plastic surgeons’ practices and led me to establish the American Society of Bariatric Plastic Surgeons (ASBPS) as well as the International Society of Bariatric Plastic Surgeons (ISBPS). They are challenging cases because they involve extensive surgery and skin resection from every part of the body. These procedures have also evolved. Long and bad scars may still result, but operations can be safely combined and performed even on an outpatient basis with decreased morbidity.
I treated my first patients for more than 20 years ago. Over a period of two years and innumerable operations and hospitalizations. His skin was tailored to his new frame! This is in sharp contrast to Lori, who had her make-over performed as an outpatient in one operation with a relatively uncomplicated recovery.
The number of bariatric plastic surgeries has increased exponentially. Between 2000 and 2018, the number of lower body lifts, where the tissue and loose skin is removed in a circumferential way around the torso, has increased by 4295% and the number of brachioplasty or arm reduction surgeries has increased by 5030% in the same period, according to statistics compiled by the American Society of Plastic Surgeons (ASPS).
Since 2013 when the American Medical Association classified obesity as a disease, most insurance companies will cover the restrictive gastric procedures. However, very few reimburse for these giant nips and tucks because they view them as purely cosmetic. Hopefully, with further understanding of the actual functional improvement of dermatological problems, difficulty with ambulation that these patients experience, more of these post-gastric bypass radical body-contouring procedures will be covered.
Plastic surgeons, especially those focusing on these special needs of patients and their surgeries will continue to strive to help them rehabilitate themselves fully and complete their long journey. I hope the increasing obesity trend is reversed, but if it continues, bariatric plastic surgeons are ready, willing, and able to lend their helping hand.
ABOUT THE AUTHORDr. Edward J. Domanskis is certified by the American Board of Plastic Surgery. He's a member of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, President & Founder of the American Society of Bariatric Plastic Surgeons. His primary office of Body Contouring International is in Newport Beach, CA with satellite offices in San Francisco, Miami, EU, Anguilla.
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