Bariatric surgery, while successful in treating obesity, takes a large toll on a patient’s body. To compensate for this, it’s essential to prepare the patient for the procedure by ensuring optimal health prior to any body contouring surgery, such as body lift. This ties into the pre-operative evaluation, a crucial step toward ensuring a safe and efficacious treatment.
During the consultation stage, patients must be prepared to share their weight loss history in full detail. Prior surgeries can have an impact on contouring treatment and their timeline may also help surgeons to understand whether or not weight loss has stabilized. Surgery should only be performed once you have finished shedding body mass and begun following a proper exercise and diet regimen. Without a normal body mass index (BMI) that has remained stable for at least three months (gaining or losing no more than 1-2 pounds/month), body contouring results may not be long-lasting or effective. Once bariatric surgery has been performed, individuals typically settle into a regulated weight within a period of 18 to 24 months. If surgery is performed before a patient’s weight has fully stabilized, factors such as continued weight loss can lead to recurring skin laxity.
This information also allows plastic surgeons to determine whether or not the patient has been receiving proper nutrition. Massive weight loss (MWL) is often accompanied by a substantial reduction in calorie intake and, because of this, can lead to deficient protein, mineral and vitamin levels. These deficiencies can adversely affect results or, worse, increase the risk of surgical complications.
By the time most MWL patients have come to a plastic surgeon for body contouring treatment, they’re no longer within the care of their bariatric surgery team. This means that they may not be actively monitored for the development of MWL related medical conditions. Lab tests work to safeguard against this by checking patients for vitamin, folic acid, iron, potassium and copper deficiencies. Without sufficient amounts of these elements, patients may experience or develop irregular metabolisms, trouble forming blood clots and other significant problems that can lead to improper healing and serious complications.
Once a patient’s physical health has been established it’s important to evaluate their mental well being, too. Body contouring procedures can greatly improve an individual’s self-esteem, but, as with all aesthetic surgery, realistic expectations have to be set in order to provide these benefits. To complicate matters, many MWL patients have poor self-image, often experience weight loss alongside a stressful life event (like divorce) or suffer from body dysmorphic disorder.
Anyone who is currently troubled by psychological issues such as those listed above may not be a suitable candidate for body contouring surgery. With reasonable expectations and an optimistic outlook, however, the procedure can lead to complete satisfaction.
The Pittsburgh Rating Scale has been developed in order to best assess and quantify massive weight loss related problems. The scale works by measuring the level of deformity in ten different areas of the body (arms, breasts, abdomen, flanks, mons, back, buttocks, medial thigh, hips/lateral thighs and lower thighs/knees) with a four point grading system. The grading scale runs from normal range (grade zero) to mild (grade one), moderate (grade two) and severe deformity (grade three).
Using this scale, we can determine which level of correction is most appropriate for you. Severe deformities often require combination lift/excision surgeries while mild issues can be treated through minimally invasive procedures. The Pittsburgh Rating Scale allows for greater surgical predictability and is a valuable tool for preoperative patient assessment.
Your surgeon will also discuss the degree, location and length of scarring in order to help you form realistic expectations regarding their eventual appearance.