Many body contouring surgery procedures have a significant impact and stress on your system. Extreme weight loss patients are more likely than normal weight patients to have some changes in their blood chemistries as well as heart and lung issues that may impede healing and place their general health at risk. For these reasons, all extreme weight loss patients will require medical clearance by their primary care physician before surgery. It is critically important that any medical condition be identified and treated beforehand.

Many extreme weight loss patients see their physicians routinuely and get regular laboratory studies. The important laboratory tests to get or to have are a complete blood count (CBC), metabolic panel, bleeding time, and electrocardiogram. (EKG) The CBC evaluates the health of your white blood cells (fights infection), hemoglobin (oxygen-carrying capacity) and platelets. (helps clotting) Changes in normal for any of these blood cells will delay surgery until the reasons are found and corrected. The metabolic panel tests more than a dozen functions of your organs, most pertinently the levels of electrolytes (which help your heart and body work) and your protein and albumin levels. (which are indicators of your nutritional status) The bleeding time tests how long it takes for your blood to clot. (a critical issue when large segments of skin are being removed) The well known EKG tests the electrical activity of the heart, ruling out heart rhythm problems and evidence of past heart attacks. Any abnormalities in any of these tests are likely to require further testing.

As long as these tests have been performed within six months of your scheduled surgery, and the results are normal, no additional presurgical testing will be needed. With normal laboratory studies, your physician should be able to provide written medical clearance for your bariatric plastic surgery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

What does body contouring surgery cost? Because surgical fees vary across the country and even within any given city, it is impossible to provide an accurate answer for any specific procedure on a general basis.

The first question most patients will ask, however, about body contouring surgery costs is whether their health insurance will pay for part or any of the surgical procedure. As a general rule, there are very few body contouring procedures that insurance will cover. This may seem unfair to many, but the reality is health insurances don’t consider most of the excess skin as causing any significant medical problems. Removal of the abdominal overhang, or pannus, may occasionally be covered due to skin rashes and its weight, but problems of the breast, arms, back, and thighs are almost always rejected.

Therefore, it is best to think of paying out of pocket for most or all of the body contouring procedures. The cost of a procedure is always a combination of three fees…use of the operating room, anesthesiologist’s charge, and the time of your plastic surgeon. Two of these costs are fixed, the operating room and anesthesiologist. They charge by time and at a fixed rate. The longer the operation is, the more their costs will be. Your plastic surgeon’s fee is variable…it is completely up to the plastic surgeon as to what they want to charge and whether they may offer discounts for multiple procedures. Additional charges may be incurred for overnight stays, postoperative garments, and any preoperative lab work. The good thing about elective surgery costs is that they are fully disclosed up front in their totality.

The issues surrounding elective surgery costs and payment are fairly universal across the country. After your consultation, you will receive a surgical quote at some point which will detail the costs. You will likely be required to place a deposit before booking your surgery. Full payment is usually required in many plastic surgery practices one or two weeks before your surgery. Make sure you read and understand the cancellation policy as unforeseen circumstances do occur to some patients and they have to reschedule or cancel their booked surgery.

Also, be aware and be clear on your plastic surgeon’s policy regarding revisional surgery. The need for revisional surgery due to complications or adverse results is not rare in major body contouring surgery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

In almost any geographic area with a significantly sized metropolitan city, there are dozens and maybe hundreds of plastic surgeons. But which one is right for your surgery? Like any specialized form of health care, you want someone who is both well qualified and has a fair amount of experience in body contouring surgery.

Sometimes it is easy…you know someone who has had the plastic surgery that you want and has had a good experience…so you go to their plastic surgeon for an initial evaluation. Word of mouth is almost always a good referral method. More often, however, you are not as fortunate and you have to start a search on your own. Here is how to do it.

First, only go to a board-certified plastic surgeon. This may sound territorial to some, but when it comes to major body contouring surgery it is not. For something like Botox or laser treatments or other minor cosmetic procedures, a host of so-called ‘cosmetic surgeons’ may suffice and the outcomes may be only marginally different. But body contouring surgery is not trivial and requires a lot of training and experience from doing reconstructive procedures of the body. There is a huge difference between managing not enough Botox and dealing with a postoperative wound separation of a thigh lift. Only someone trained in the full scope of plastic and reconstructive surgery has the knowledge to deal with major surgery….and their potential complications. Search for plastic surgeons in your area online at www.plasticsurgery.org, the official site of the American Society of Plastic Surgeons. Plastic surgeons listed there have to have the right training and board-certification to be a member.

Once you have found a handful of potential plastic surgeons to see, visit their websites and view what they have to say and show about bariatric plastic surgery procedures. Although not having any info or results to show does not mean they don’t have adequate experience, those plastic surgeons that do certainly have an interest in performing these types of plastic surgery. Cross check their names at the website of the American Society of Bariatric Plastic Surgery, www.asbps.com, an interest group of plastic surgeons who have or are sharing expertise in body contouring surgery. Today there are also a handful of young plastic surgeons that have received special training by completing a fellowship in bariatric plastic surgery beyond their basic plastic surgery residency.

Do as many consultations with different plastic surgeons as you feel necessary. Yes it will cost to have consultations but this is peanuts compared to the actual cost of surgery and the risks to which you will be exposed. The right plastic surgeon is often the one that makes you feel the most comfortable and takes the time and energy to spend time with you. Many patients are told to ask their prospective surgeon what their experience is and how many they do per month, year, etc. While there is nothing wrong with these questions, I don’t know how helpful these answers often are. How many operations do you have to do to be good at it? For some plastic surgeons it may be just a few every now and then, for others it many take many more. A more pertinent question is ask to see photos of results or talk to patients of the plastic surgeon who have had the procedure in the past several months. This is a more tangible question that can be very informative. Lack of photos or an unwillingness to share them or put you into contact with former patients is more revealing than a numbers question.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

It is understandable and natural for patients who have undergone large amounts of weight loss to want to complete their body contouring surgeries as soon as possible. Getting the exterior part of the body to reflect your weight loss accomplishments completes the final physical step in the journey. But the concept of staging is an essential consideration in anyone considering bariatric plastic surgery.

Staging is the separation of a large number of body contouring changes into a series of operations over a period of time. This is of great importance in most body contouring procedures due to the size of the operations and the physical stress that they place on one’s system during the procedure as well as in the recovery phase. While many weight loss patients will never complete total body contouring ( or the number of operations that can maximally improve their body), many will have at least two operations which are usually staged three to six months apart.

Because of the magnitude of major body changing surgeries, the realization of potential risks and the time needed for adequate recovery…..safety is absolutely paramount. Body contouring surgery is not just a technical exercise to see what can be done…but an operation planned that can be done with maximal safety and very visible results. For this reason, I will not do a body contouring procedure that exceeds five hours. This limits the exposure of the patient to general anesthesia and the chance for significant blood loss. In addition, I like to do a single operation in which the patient can still go home the same day. By keeping it to a five hour time limit, common combinations could be abdominoplasty/arm lifts, circumferential body lift (by itself), breast lifts/abdominoplasty, etc. Enough is done to make the surgery very worthwhile but still keeping safety as the utmost concern. And recovery is still a very manageable two to three weeks for all of the potential combinations that can be done in this time frame.

Doing body contouring surgery in stages is not only safer but usually leads to better results in my experience. I do not get too tired (plastic surgeons are just human) and attention to detail in a long operation is not lost. Furthermore, the amount of stretching and pulling on loose skin is not in too many directions at one time.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

With extreme weight loss (100 pounds or greater), the excess skin that results is usually everywhere. While it may be problematic at one body area more than another, the loose skin often poses an overall concern that literally may be from head to toe. Since most body contouring patients have needs that exceed just one corrective plastic surgery operation, it becomes important to establish an absolute needs list and a wish list. In essence, a list of the body areas that are most problematic to those of the least concern.

Over the years, I have seen hundreds of patients who have lost a lot of weight. (and some that really should lose some more) The bodies of extreme weight loss patients come in a wide variety of sizes and shapes,,,and many will differ by how much and where the excess skin is. However, in counsel with patients I find that there are almost always two body areas that are on the top of most patient’s concerns…. the stomach/waistline area (abdomen) and the arms. (women only, I have yet to have a male that wants to do an armlift) These top two concerns also make up the most common combination of bariatric plastic surgery procedures that I perform…abdominoplasty/circumferential body lift and brachioplasty. (arms) Sometimes they are done together and sometimes they are done separately but they are the most frequent initial requests of most weight loss patients.

For women, breast surgery (breast lift with or without implants) is at the second tier of concern while for men it is the sagging chest area. The thighs for both men and women, while a significant concern, are lower on most patient’s priority list. (I have yet to do thigh surgery first as the initial operation in any weight loss patient)

These priority lists are not set in stone but are what I have observed as general trends in extreme weight loss patients. I always recommend to patients that they choose as the first operation the most important concern…the one procedure that they are dying to do. Not necessarily the easiest or the simplest problem but the area they have dreamed about improving. For some patients, this may be the only surgery that they may ever do for any variety of reasons, mainly financial and medical concerns. So even if they do only one surgery, they will have addressed the most important concern. The point being….come into see your plastic surgeon with a list of body concerns based on what bothers you the most, what can wait until another day, and nice if we ever get to it but can live without it.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

While some patients may be anxious to get on with the ‘final’ stage of their weight loss journey, it is important to wait until at least several months after you have reached your weight loss goal. This allows your body a period to recover and adjust metabolically to the new weight, allows time for the skin to accomodate to your now smaller frame, and allows you to acquire new eating habits for long-term weight maintenance.

While there is no magic waiting period, most plastic surgeons would like their patients to have a stable weight for close to six months before considering elective body contouring surgery. A stable weight means minimal fluctuations of only a few pounds. Patients who have had gastric bypass, due to intestinal absorption changes, aren’t usually ready for body contouring surgery for a year or longer after the surgery. Patients who have had the lapband procedure lose weight at a much slower rate and it may be much longer than a year after their procedure. Extreme weight loss patients who have done it on their own without surgery can be done within six months after they have hit a stable weight.

The most important reason to wait is to allow your body time to recover. Wound healing for almost every body contouring procedure requires a lot of nutrients and energy to heal properly. You want your energy stores and your immune function to be in the best shape possible. In short, you don’t want to be malnourished going into major surgery. (particularly when it is ‘elective’) Many extreme weight loss patients have some metabolic deficiency. In a recent article published in the August 2008 issue of Plastic and Reconstructive Surgery by Agha-Mohammadi et al, they state that many post-bariatric surgery patients have protein-calorie malnutrition as well as various vitamins and mineral deficiencies that may limit optimal health and healing. With the stress of major body contouring surgery, even a mild nutritional problem may become apparent in the postoperative period as evidenced by wound healing problems.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Body contouring surgery can be technically performed on any massive weight loss patient. The important question, however, is whether you can go through the operation safely and heal after surgery with a reasonably low risk of potential complications. (there is no such thing as zero risk of complications in any surgery)

Any patient’s candidacy for body contouring surgery consists of three important issues, your general health, your BMI (body mass index), and your financial preparedness. The first and most important issue is your general health. Do you feel good overall? Are you active and in good nutritional health? Do you have any post-bariatric surgery symptoms such as nausea and vomiting, GI bleeding, or stomach ulcers? Many patients are not truly ready for a major surgery until well after they have achieved their optimal weight gain. Most body contouring surgeries (arms, breasts and neck excluded) should be considered as major and put a lot of stress on your body to not only go through but to heal properly. You must be in a positive nutritional balance to undertake such a task. You will need clearance from your weight loss doctor and blood laboratory studies that look at your blood counts, electrolytes, and protein levels.

The Body Mass Index (BMI) is a good way to determine how effective body contouring surgery will be. Removing loose or excess skin will not be maximally effective if you are still obese. A thick fat layer still persistent under the skin will not allow body contouring surgery to show a good effect. BMI is a number calculated from a person’s weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.The mathematical formulation is difficult to do and one can see their BMI by googling BMI on the internet and using one of the easy calculators which appears on many websites. (for example, http://www.cdc.gov website) BMIs of 30 or lower are most ideal for body contouring surgery. I wouldn’t say that there is an absolute BMI cutoff, but anything over 35 is not ready for those body contouring surgeries that involve the abdomen and thighs unless it is a simple abdominal panniculectomy procedure.

Fiscal preparedness is also an important issue. Most body contouring surgeries are not going to be covered by insurance. Understandably, most patients think that is unfair but there must be a documented medical reason for your insurance carrier to even consider it. (and even then it will be a battle)

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

The development of loose floppy skin after large amounts of weight loss (greater than 75 or 100 pounds) is a well recognized problem that occurs frequently. While it can be a surprise to some weight loss patients, it should not be.

Whether the weight loss is from heroic dieting efforts or bariatric surgery, the damage that has been inflicted on the skin is irreversible. Once the skin appears taut when fully inflated (high weight), the loss of the underlying fat support causes a deflation of the skin cover much like the deflation of a balloon. The skin does not ’snap back’ for two reasons which is identical to what can occur from pregnancy. First, the slow (or rapid) expansion of fat and weight stretches the skin and, in fact, actually makes more skin as it expands. This is well known in plastic surgery as an older, but still useful, surgical technique known as tissue expansion. (commonly used today in breast reconstruction after cancer) The slow stretching of skin, while causing it to thin somewhat, actually makes more surface area of skin. Secondly, stretching beyond a certain point causes the elastic fibers in the skin to become permanently deformed. The elastic fibers (and collagen) are responsible for skin’s elasticity. Like overstretching a spring, the fibers are pushed beyond their tensile limits and they are no longer able to return to their original coiled shape. The combination of more skin that is no longer elastic results in hanging sagging skin.

There are other factors which can make the loose skin condition better or worse. How much weight is lost, how rapid the weight loss has been, your type of skin (thinner more fair skin stretches more), your age (older patients develop more loose skin), and smoking (smoking breaks down elastic fibers faster) are all contributing factors as well. Clearly, large amounts of weight loss over a short period of time in an older patient with fair skin who smokes does not bode well for skin readaptation.

Unfortunately, no amount of dieting, exercise, or topical creams will restore the elasticity of skin. Simply put, excess skin must be cut out and the skin left behind tightened. This often leaves remaining stretch marks (if present before surgery) and, with time after surgery, there will be some relaxation of the remaining skin which has been tightened. But this small amount of relapse is trivial compared to the size of the original problem.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

In large weight loss patients, through bariatric surgery or from their own dieting program, excess skin is almost always left behind. If the excess skin is considerable, this results in a ‘new’ problem. The body may be smaller, but the large folds of skin cause problems of personal embarrassment, the need to still buy larger clothing, and the potential for problems of skin irritation, rashes, or infections from the overhanging heavy skin. Unfortunately, the very process that got you to this point will not get rid of loose skin. No amount of dieting, exercise, or wishful thinking will make the skin snap back into place or make it go away. This is a surgical problem that is best addressed with body contouring surgery.

Reshaping the body after weight loss are plastic surgery procedures that are specifically designed to remove excess skin and fat and reshape specific body areas. Body contouring surgery can remove large amounts of sagging skin and fat that are often dramatic in size. While the removed pieces may look large, they often weigh a lot less than you would think. Think of body contouring surgery as restoring shape and contour to certain areas of the body rather than any more significant weight loss. These surgical procedures will not only remove excess skin but will tighten areas as well. Almost every body contouring surgery is about the actual excision (cutting out) of loose tissue, liposuction (fat removal only) actually plays a very minor role in this type of plastic surgery although it is occasionally used.

While body contouring surgery can produce some dramatic changes that can improve your physical and psychological health, there is a trade-off. That being of scars. Every body contouring surgery results in significant scarring…that is the long-term price that you must pay. I have yet to find a large weight loss patient who balks at that trade-off but remember you are trading off one problem for another…..excess skin and fat for scars. So be certain that this trade-off is a good one. If one is highly concerned about a lot of scarring, then body contouring surgery may not be for you. Body contouring surgery is unique from pure cosmetic body contouring in that the goals are to make you look good in clothes…not to be critically judged out of them.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Body lifts are almost exclusively done in the bariatric surgery patient who has undergone massive weight loss. (> 100 lbs) A body lift is a combined frontal tummy tuck and a posterior buttock lift with a resultant 360 degree (circumferential) scar. While good care after a body lift is not hard, the need for management of several drains can be challenging.

 
1. Body lifts usually have only a moderate amount of postoperative discomfort as
only skin and fat have been removed and no muscle work has been done. In addition
to taking your pain medication, keeping yourself in a partially flexed position (knees
slightly bent toward your chest) when resting in either a chair or bed is very helpful
during the first week after surgery.

 
2. You will have as many as four (4) drains coming out of the pubic and back area after
surgery. They will be removed when the drainage is sufficiently low. As most drains
don’t come out before 10 to 14 days after surgery, it is not important to start
recording their output until after the tenth (10th) postoperative day.

 
3. Get up and walk periodically even in the first few days after surgery. This will help
you breathe deeper and ultimately feel better. Judge your activity level on how you
are feeling. You will tire more easily than expected, even up to one month after
surgery.

 
4. You may shower on the 2ndd day after surgery. Do not submerge your incision in a bath
tub or hot tub/jacuzzi until 1 month after surgery. By this time, your drains will have
been removed and the incision healed adequately to prevent internal contamination.

 
5. Tapes are usually placed across the abdominal and back incisions. They should be
left in place and do not require any care. They will be removed within the
first two weeks after surgery.

 
6. You are to continue wearing your circumferential binder for 2 weeks or more after surgery.
As these binders have a tendency to ride up, it is important to keep them repositioned
low over the hips so some pressure can be maintained over the incision site.

 
7. Numbness of the abdominal and back skin is to be expected and complete return of
feeling may take up to 6 months after surgery. During this period, exposure to heat
(e.g., hot tubs, heating pads) should be done with this consideration in mind to avoid
potential burn injuries.

 
8. Avoid exercise and heavy lifting for 6 weeks after surgery. Abdominal stress and
abdominal specific exercises can be resumed 8 weeks after surgery.

 
9. You may drive when you feel comfortable and can react normally and are off pain
medication. Driving is all about whether you are safe to yourself and others on the road.

 
10. It is not rare to have some small openings along your extensive incision line which
develops several weeks after surgery. This is either sutures which are coming to the surface
or small areas that have slightly separated due to tension and movement on the wound.
Simply keep them covered with antibiotic ointment and a dressing and they will go on to
heal on their own. It is ok to get them wet in the shower.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis