After Massive Weight Loss Mobile
Obesity is a major health crisis with 32% of Americans classified as obese and 5 % as morbidly obese. Weight loss surgery is the most effective long-term treatment for obesity and approximately 200,000 procedures are performed annually. Unfortunately, the surgery does not take care of all of the problems since markedly stretched skin loses its ability to contract completely. Multiple plastic surgery procedures are necessary to improve hygiene and cosmesis after weight is stable at its new low. The most common procedures include a lower body lift, abdominoplasty, thigh lift, breast surgery, upper arm lift (Brachioplasty), blepharoplasty (eyelids), facelift, and neck lift. A thorough consultation with Dr. Park is necessary to determine the staging of the needed surgeries based on patient desires and safety. With most health insurance plans, these are cosmetic surgeries not covered by insurance. Certain procedures combined with reconstructive procedures such as hernia repair may allow for partial coverage but clear communication is necessary to avoid confusion.
Preoperative evaluation of weight, nutritional, physical, and psychiatric status is necessary prior to surgery to maximize safety. These can be evaluated with a history, physical exam, lab tests, and occasionally radiographs. It is important for patients to have proven stability near their goal weight before proceeding with body recontouring, as further significant weight loss or weight gain could negate the effects of otherwise successful plastic surgery. The major weight loss types of surgeries are restrictive, malabsorptive, and a combination of the two. Restrictive procedures reduce the size of the stomach and malabsorptive procedures bypass portions of the gastrointestinal tract to reduce the absorption of what is eaten. Malabsorptive procedures have significant risk for nutritional deficiencies and anemia since nutrients and vitamins are also absorbed in the gastrointestinal tract. Commonly checked labs are Albumin and Prealbumin (measurement of protein levels in blood), Hemoglobin and Hematocrit (blood counts), coagulation times (clotting ability), electrolytes, and vitamin levels (A, B complex including folate and B12, and C).
The surgical plan can be complicated since many massive weight loss patients have numerous needs of varying severity – facial / neck laxity, eyelid bags, sagging of breasts, abdomen, buttock, back, chest, thighs, arms, legs, or genitalia, and deflation of breasts or buttock. Pairing of procedures to minimize the total number of operations needed while maintaining safety is critical. Each operative plan is tailored to the patient but common combinations include:
- Abdomen and Buttock (Abdominoplasty, Panniculectomy, or Lower Body Lift)
- Breast (Gynecomastia, Mastopexy, or Augmentation) and Arms (Brachioplasty)
- Face and Neck (Rhytidectomy), Eyes (Blepharoplasty), and Chin
- Thighs and Legs
- Hands, Genitalia, and Other
Suspension of layers stronger and deeper than skin is critical in maximizing lift and minimizing scar. Due to the large size of the areas treated and the potential malnutrition, complications such as fluid collections (seromas and hematomas), wound healing problems, infection, scarring, and deep vein thrombosis (DVT/PE) are more common and must be given maximum attention and may require additional prophylactic measures such as prolonged drainage and blood thinner injections at home.
with Dr. Park or Dr. Rebowe
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Due to COVID-19, MPRSD and the Med Spa will be closed indefinitely beginning March 30th, 2020. Both Dr. Park and Dr. Rebowe will only be seeing post-operative patients, patients with pressing issues, and will continue working hospital consults and ER coverage. However, during this time we will not be seeing new elective patients. Staff will reach out to cancel appointments and notify patients, and will be reaching out to reschedule when we are back in the office.
We always do our best to stay available to our patients. If the normal communication systems break down during this crisis, Dr. Park should be reachable at firstname.lastname@example.org and Dr. Rebowe at email@example.com. Immediate availability cannot be assumed during these unpredictable times so do not email with urgent issues. Urgent issues need direct communication with a provider either through the office or if necessary, your nearest emergency room.
Email firstname.lastname@example.org to setup a virtual consultation with Dr. Park or Dr. Rebowe