Skin Removal Surgery After Bariatric SurgeryAugust 21, 2019
The amount of weight loss after bariatric surgery, the age of the patient, their genetic makeup as well as skin type will determine if skin removal surgery is a reasonable option after large amounts of weight loss. The patient's body makeup along with the amount of deflation will help predict the outcome.
Goal Weight and Skin Removal Surgery
Typically after a bariatric procedure, from what I have seen in my own practice, the majority of patients get significant weight loss, but most patients do not generally hit their goal weight. I am often asked by patients if they need to get to their goal weight prior to skin removal surgery. My personal approach to these patients is to advise them to get to a stable weight that they can maintain for three months and then skin removal surgery is a good option.
I found from doing skin removal surgery for over 15 years that many patients do get frustrated when they do not hit their goal weight, but every individual is different. At some point, the patient needs to accept that the weight they are at, typically at 12-18 months is the weight that they are likely to remain at because that is where the body has achieved homeostasis.
I always encourage patients to continue to go to their support groups as that seems to be a motivating factor to keep the weight off and provide checks and balances with other individuals who can be supportive to the patient.
When it comes down to skin removal surgery, the area that seems to be most commonly affected is the abdominal wall along with the breast or chest wall followed by the arms and the legs. The one caveat in all of this is that most patients also appear older than their stated age due to the loss of fatty volume in the face. For many patients, this ends up being the area that bothers them the most as this is how they feel the public perceives them as everything else can be covered with clothing.
Required Preparatory Time
Once a decision has been made to undergo plastic surgery for skin removal, the patient requires at least four to six weeks of preparatory time to make sure that they are up-to-date with their protein intake, all of the supplements that may be required, and we will typically get a blood count and EKG. Most patients after massive weight loss are much healthier than they were when they were obese and this bodes well for their postoperative recovery.
I encourage patients to exercise frequently as they will need to get up and move around after surgery to prevent things such as blood clots in the legs or pneumonia from being in bed postoperatively.
The amount of skin removed can be massive, but this does not necessarily translate into weight loss. Most patients overestimate the amount of skin thinking that it can weigh 25-30 pounds and it is rare that the amount of weight is removed. Also, I ask patients to keep in mind that if we take off that amount of tissue that they are likely to lose some blood volume in that tissue, so we have to be prepared preoperatively when there is actually going to be a massive resection of 20-30 pounds of tissue that they donate two units of blood to be transfused postoperatively.
The GBRx Procedure
The GBRx Procedure is one that I have come up with approximately 15 years earlier to allow a patient to have multiple procedures, but not go beyond a period of six hours in the operating room, as this can lead to postoperative complications like nerve compression injuries or blood clots.
Within a six-hour time frame, I can typically do a body lift, a breast lift with augmentation, and sometimes a bilateral arm lift. While this seems like a lot of surgery, if it is mainly skin that is removed then I am not as concerned about the amount of blood loss. But if the patient does still have a fair amount of fatty tissue, then I will limit the procedures to just a body lift and an arm lift or a breast lift with augmentation. The patient is usually discharged the same day with a pain pump in place and drains to be managed postoperatively.
It is routine in my practice to do one or two of these major body contouring procedures a week. Due to this, we have protocols in place that we have set forth for the safety of the patient and to allow for postoperative recovery. This allows us to address other areas such as the thighs, or the face, or the back within two to three months after their blood count recovers. The order that procedures are performed is done with the patient's goals and for their safety.
These procedures are generally done in my practice in an outpatient surgical center, which is well-equipped for these types of procedures. I have had patients that like to see the amount of skin removed and weighed, which we do routinely. Pictures were given to the patient postoperatively.
In addition, I have many patients that come in from out of town from places all over the US for these procedures. I require them to stay for two weeks after surgery in order to make sure the drainage has minimized and they can leave without their drains in place.
Generally, the recovery after significant skin removal is anywhere from six to eight weeks until the patient feels fairly normal. At that point, a second procedure can be considered. The foremost goal is to make this a safe procedure and oftentimes the patients will refer to this as “rewards” surgery.
ABOUT THE AUTHORDr. Munish K. Batra has over 20 years of experience and known for taking on complex surgical cases. The San Diego County Medical Society awarded him twice with the honor of Top Plastic Surgeon in San Diego. He has been featured in the LA Times, People Magazine, and the Oprah Winfrey Show for his outstanding work. Recognized for his bedside manner, humanitarian work, honesty & superb technical skills, Dr. Batra has built a world-renown cosmetic surgery practice called Coastal Plastic Surgeons in San Diego, CA.