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Posts Tagged ‘bariatric plastic surgery’

Case Study – Arm Lifts in Bariatric Surgery Patients

Sunday, June 14th, 2015

 

Extreme arm sagging after weight lossBackground: Large amounts of weight loss, whether from bariatric surgery or from other non-surgical methods, creates a lot of secondary body issues. The loss of subcutaneous fat causes deflation of the overlying skin, resulting in skin sagging and often interference with numerous normal bodily functions. The arms are a classic example of this expected phenomenon with large amounts of loose skin hanging off of the back of the arm creating the classic ‘batwing’ appearance. Besides its unsightly appearance it often causes problems in fitting into shirts and other upper body wear.

Removal of excessive arm skin is done by the well known arm lift or brachioplasty procedure. This arm reshaping procedure has been around for a long time and not much has changed in how it has been performed. It involves removing the loose skin and fat that hangs below the arm when one has their arm extended out at 90 degrees from their body. There are no vital structures in this skin segment, not even any major artery or veins. An armlift does create a prominent scar but this is always a better aesthetic tradeoff in the extreme weight loss patient with true batwings.

The relevant issues about surgically planning an arm lift is the scar location and whether it should cross past the armpit into the side of the chest. The latter is simply decided by whether a web of skin extends between the arm and the chest wall. But the scar location has been a matter of surgical and patient discussion for years. The final arm lift scar can end up being placed on the inside (medial), the back side (posterior) and an intermediate location between the two. (posteromedial)  This is purely a function of how the excision of excessive arm tissue is oriented.

Case Study: This 42 year-old female had bariatric surgery three years previously with a stable weight loss of 110lbs. Her primary body shape concerns were her arms and stomach. Her breasts and thighs were less important and were planned for a second stage procedure

Left Armlift result front view Dr Barry Eppley IndianapolisLeft Armlift result back view Dr Barry Eppley IndianapolisUnder general anesthesia , she underwent a fleur-de-lis extended tummy tuck and armlifts. The armlifts were performed by a posterior excision of tissue that was marked upright before surgery. During surgery her arms were elevated, crossed and attached to a padded metal bar which allowed direct access to the arm excisions. The excess tissue was excised down to the deep arm fascia and just past the lower portion of the armpit. It was closed into two layers and no drain was used.

Right Armlift result front view Dr Barry Eppley IndianapolisRight Armlift results back view Dr Barry Eppley IndianapolisArmlift Scars Dr Barry Eppley IndianapolisHer postoperative arms showed a typical bariatric arm lift patient result with a dramatic improvement in the size of her arms and elimination of hanging skin. The back of the arm scars were only seen when the arms were raised and at certain angles from the back. There were typical arm lift scars, not great by plastic surgery standards, but would go in to fade considerably with further healing. (two month healing result)

The arm lift procedure is the single most satisfying of all the bariatric plastic surgery procedures. It is easy for patients to undergo, produces very satisfying results and is associated with few complications. It is an excellent body contouring procedure to do as part of a first stage bariatric plastic surgery program.

Highlights:

1) Arm lifts are an important part of bariatric plastic surgery after extreme weight loss and is often part of the first surgical stage of the body contouring procedures.

2) Of all the body contouring procedures after weight loss, arm lifts have the easiest and least painful recovery.

3) The excision of loose hanging arm skin can be done from multiple locations on the arm but the posterior approach offers the best arm lift scar location.

Dr. Barry Eppley

Indianapolis, Indiana

Body Contouring After Bariatric Surgery Maintains Weight Loss

Thursday, October 23rd, 2014

 

Body Contouring after Weight Loss Dr Barry Eppley IndianapolisThe benefits of bariatric surgery are well known and weight losses of 100lbs or more are not uncommon. While the weight loss has tremendous medical and functional benefits, patients often do not necessarily feel better about their body. Once deflated by the weight loss the excess skin results in extensive skin excesses and rolls. It can literally affect the whole body from the neck to the knees but always the stomach and waistline areas are the biggest concerns and the first for surgical removal.

While the body contouring benefits from such large skin removals are obvious, a recent study suggested that there are other long term benefits as well. At the recent annual American Society of Plastic Surgeons meeting earlier this month, a presentation presented data that morbidly obese patients who have excess skin removed after bariatric surgery are more prone to keep the weight off than those who don’t. Out of Henry Ford Hospital in Detroit, plastic surgeons followed almost 100 patients who had bariatric surgery over a ten year period of which almost half had subsequent body recontouring plastic surgery procedures. The patients that had the plastic surgery had an average decrease in their BMI of just over 18 two and half years later. That compared to an average decrease in BMI of over 12 for those that did not have the body contouring surgery.

Body Lift after Gastric Bypass Dr Barry Eppley IndianapolisWhile bariatric surgery can have great short-term results, it is well know to have a relatively high rate of relapse with partial or full weight return in some patients. It is perhaps no surprise that those massive weight loss patients that feel the need and make the sacrifice to have body contouring have better long-term maintenance of their initial weight loss. There are numerous explanations as to why this is so but the most compelling would be their body image perception. Once you see yourself in a ‘new body’ that truly reflects what has been accomplished by weight measurements, you are more motivated to exercise and even lose more weight is some cases.

What this study shows is that many bariatric surgery patients who have excess skin should have body contouring surgery if they can. Economics is the ultimate barrier for many of these bariatric patients. While some insurance companies provide coverage for certain body contouring procedures (e.g., abdominal panniculectomy), the approval process can be arduous and often disheartening. The criteria for insurance coverage for such bariatric plastic surgeries are a large amount of weight loss (greater than 100lbs), a stable weight for six months and a documented history of chronic skin irritation or rashes. Even if approved it can be hard to find a plastic surgeon to do the procedure because of the very low insurance reimbursement rates given the amount of surgical work needed and the potential risk exposure.

But in almost any community plastic surgery care can be found to help get this reconstructive body contouring done. As this study shows, improved function and body image plays an important role in helping maintain the weight loss from bariatric surgery.

Dr. Barry Eppley

Indianapolis, Indiana

The Benefits of Body Contouring Surgery after Gastric Bypass

Sunday, October 6th, 2013

 

Gastric bypass surgery, or even persistent efforts at diet and exercise, can result in large amounts of weight loss. With this weight loss often comes a lot of loose skin over many parts of the body. This has resulted in a number of body contouring procedures that removes this excess skin. Such efforts at bariatric plastic surgery is not usually done for a year after gastric bypass to ensure that the weight loss is sustained and the patient’s metabolic state is stabilized.

A recent study in the October 2013 issue of the journal Plastic and Reconstructive Surgery reported that body contouring surgery to remove excess skin also improves long-term weight control. Since maintaining weight loss to reduce long-term health problems is the key goal of bariatric surgery, the researchers believe that body contouring should be considered reconstructive rather than cosmetic surgery for patients who have achieved massive weight loss.

In this study, the authors compared long-term weights from two groups of patients who had gastric bypass surgery. One group of 102 patients had gastric bypass surgery without any body contouring surgery which was compared to a group of 98 patients who had both gastric bypass and body contouring surgeries with excess skin removal. Gastric bypass patients who went on to have body contouring procedures regained less weight long-term. They averaged just over one pound per year which was substantially less than the four pounds per year for those patients who had gastric bypass alone.

Patients who underwent body contouring surgery after gastric bypass surgery achieved an average weight of 176 pounds seven years later. This is in contrast to the gastric bypass surgery only group which had an average weight of 200lbs. Patients who underwent body contouring had regained about four percent of their initial body weight, compared to 11 percent for those who had gastric bypass only. After accounting for the weight of excess skin removed, average weight regain was about 14 pounds in patients who had gastric bypass plus body contouring, compared to nearly 50 pounds with gastric bypass only.

It is well known that many gastric bypass patients can regain much of their body weight  back years after the procedure. This recently reported study shows that patients who have body contouring surgery are also more likely to keep weight off after gastric bypass. The interesting question is why? The study does not suggest a reason why this would be so. Perhaps it is only the most motivated gastric bypass patients go on to get body contouring procedures. It is also probable that once body contouring surgery is done there is high motivation to protect one’s new self-image and the surgical investment.

The authors point out that this study supports the notion that body contouring surgery should be considered part of the gastric bypass procedure and thus covered by insurance. The quality of life improvements seen (sustained weight loss) support that body contouring surgery is a reconstructive and not cosmetic surgery procedures.

I would not dispute the argument that bariatric plastic surgery is reconstructive surgery that treats an induced medical problem. However the reality is that many insurances are going to continue to view body contouring after gastric bypass as unnecessary cosmetic procedures and will not provide coverage for most of the with the exception of an abdominal panniculectomy. As we proceed into this new era of ObamaCare under the Affordable Care Act, it is likely that even coverage for abdominal panniculectomies will go away or the reimbursements will be so low plastic surgeons will simply not do them.

Dr. Barry Eppley

Indianapolis, Indiana

Outpatient Body Contouring After Massive Weight Loss

Tuesday, May 29th, 2012

 

Unlike many plastic surgery procedures that are performed in outpatient centers (e.g., breast augmentation, facelifts etc), body contouring is more extensive and invasive surgery. Some bariatric surgery patients also have associated medical conditions which may lead to increased complications form surgery or anesthesia. The question then becomes as to the safety of extensive body contouring procedures in an outpatient setting.
In the April 2012 issue of Aesthetic Surgery Journal, a study was published entitled ‘Outpatient-Based Massive Weight Loss Body Contouring: A Review of 260 Consecutive Cases’. These patients came from a single plastic surgeon in private practice in the state of Washington. Over a six year period (2004 – 2011), 260 patients (93% women) who underwent a total of 544 body contouring procedures was evaluated. The average age of the patients was 42 years with an average weight loss of 130 lbs. The most common procedures performed were a lower body lift, liposuction and armlifts. Nearly 60% underwent more than one procedure with an average operating time of over 5 hours. (330 minutes) Nearly 90% of the patients went directly home after leaving the recovery room.
The most common complications were wound separation (17%) followed by seroma (5%) and urinary retention. (4%) There was one case each of the need for blood transfusion and a pulmonary embolism. No instances of infection, death or need for inpatient hospitalization occurred.
This study is impressive as 260 consecutive cases of any procedure is significant, let alone complex body contouring procedures. It demonstrates that good patient selection with an experienced plastic surgeon and anesthesiologist in an accredited surgery center can produce exceptional outcomes with a very low rate of complications. The lack of DVT and pulmonary embolism complications, albeit one patient, is noteworthy given the length of the surgeries and their extensive nature. Only one infection and such a low rate of seroma formation is also noteworthy given the hundreds of patients treated.
Wound complications are the norm in any form of body contouring whether it be the arms, breasts or lower body. I tell my patients to expect minor wound healing issues that will not be completely healed until six to eight weeks after surgery. It is never a question of if but where and how significant is the wound opening area.
This study clearly shows that many bariatric plastic surgery procedures can be safely performed as outpatient procedures. Combination procedures, which may take up to four to six hours of surgery, can be done and still send the patient home without increased risks of DVT or PE complications.
Dr. Barry Eppley
Indianapolis, Indiana


The Prevalence of Body Contouring After Weight Loss Surgery

Sunday, October 2nd, 2011

Weight loss surgery in the United States had grown considerably in the past decade. There are now over 200,000 bariatric surgeries performed each year consisting mainly of either a bypass or lapband procedure. Bariatric centers are located in every major city and I can count at least four major bariatric centers in Indianapolis alone. Despite this large number of bariatric procedures being done, only a fraction of this number actually go on to get plastic surgery for their loose skin that subsequently results from the weight loss.

According to a new study sponsored by the American Society of Plastic Surgeons, many bariatric patients are not aware of the after weight loss body contouring procedures they could have to remove loose skin. The study reports that up to 75% of bariatric patients don’t know about these body contouring procedures. Had they been more fully informed of their options, it is suggested that they might choose to partake of some of these bariatric plastic surgery treatments.

The study looked at nearly 300 patients who underwent bariatric surgery. They found that only 25% of the patients discussed the potential need for plastic surgery with their bariatric surgeon before or after their surgery. After their bariatric surgery, only about 15% were referred to a plastic surgeon for evaluation and just over 10% actually had plastic surgery to remove loose skin. Nearly 40% of the patients said they might have chosen to have the plastic surgery if they knew more about it or were better informed.

Why don’t more weighty loss patients go on to have plastic surgery? Certainly inadequate education before or after bariatric is one major cause. But this reason alone is not why so few pursue body contouring after weight loss. Not every bariatric patient actually needs plastic surgery or is concerned enough about whatever loose skin they have to consider a new set of procedures. There is also the realistic issue that many bariatric patients can only do what insurance may cover. Besides having considerable difficulty in even getting the most obvious sagging skin problems covered, paying out of pocket for many is simply too expensive. Many plastic surgeons today don’t participate or accept insurance for these procedures due to the abysmally low reimbursements.

While many massive weight loss patients do suffer a lot of loose sagging skin which causes rashes and other skin problems, the consideration of plastic surgery should be deferred for at least a year after their bariatric surgery. It is important to be sure that one’s weight is stable, one is healthy from a blood chemistry and electrolyte standpoint,and that whatever skin contraction can occur is given ample time to do so.

It is clear that insufficient counseling at the time of bariatric surgery can leave a patient unaware or surprised after their weight loss as to what their body will really look like. However, in today’s internet world and given the dirth of support groups and chat forums, it is hard to imagine one wouldn’t be aware that they would likely benefit by plastic surgery later. I think the real surprise is that most patients think that their plastic surgery, at least some of it, will be covered by insurance. That feeling is certainly understandable as the need to reshape the body is a direct result of the weight loss surgery. In the regard, however, patients can not be more misinformed.

Dr. Barry Eppley

Indianapolis, Indiana

The Need For Bariatric Plastic Surgery After Gastric Bypass

Thursday, July 14th, 2011

The growing popularity of bariatric surgery as naturally led to many patients considering or in need of major body contouring surgery after massive weight loss. Almost any plastic surgeon today can testify to the frequent requests for such procecures. Because most of the procedures performed on the massive weight loss patient are extensive and labor-intensive, certain practices make bariatric plastic surgery a focus and have the manpower and commitment to treat these patients.

Interestingly, it is not currently known how often the massive weight loss patient who has had gastric bypass or banding go on to undergo body contouring surgery. A recent issue of the journal Obesity Surgery reports on just that issue. Patients (250 in number) who had undergone gastric bypass surgery between 2003 and 200- returned a questionnaire which obtained information on body image satisfaction and frequency of body contouring surgery after massive weight loss. Perhaps surprising to some, the study found that the majority (75%) but not all desired body contouring after their surgery. Of this group, fifty-three patients (21%) had undergone a total of 61 body contouring procedures. The most common body contouring procedure was a tummy tuck/panniculectomy and lower body lifts.This study illustrates the significant disparity between the number of massive weight loss patients who want a body contouring surgery and those who actually received it. This small study showed that only about 20% of patients have some form of bariatric plastic surgery. No one will really ever know what the percentage is nationally, but it would not surprise me that this number is fairly accurate. The simple reason is economics. These extensive plastic surgeries are expensive and insurance does not cover many of them. While almost all massive weight loss patients expect insurance to cover the removal of their resultant hanging skin after their bariatric surgery, it is disappointing when they find out that it largely isn’t so.

Why doesn’t insurance cover many bariatric plastic surgeries? Because it has to have a proven medical benefit to do so. Just because there is too much skin and it hangs and doesn’t look good is not deemed medically necessary. The most common medical benefit to justify coverage of surgery is that it must improve dermatitis and skin infections. Generally only an abdominoplasty fulfills that medical criteria. This eliminates coverage for necklifts, armlifts, any form of breast reshaping, back lifts, and thigh lifts.

It is also no surprise that the most common body contouring procedure that is done is a tummy tuck or an abdominoplasty. This is largely driven by insurance coverage. Removal of a pannus or skin apron that hangs over the waistline is deemed medically beneficial in many cases. As a result, it is the one bariatric plastic surgery procedure that gets done first to those massive weight loss patients surgically inclined.  

Dr. Barry Eppley

Indianapolis, Indiana

Common Questions on Bariatric Plastic Surgery (Body Contouring after Massive Weight Loss)

Wednesday, January 13th, 2010

1.      How soon after my weight loss can I get plastic surgery done?

 

Large amounts of weight loss, generally 75 to 100 lbs or greater, will cause significant loose skin on multiple areas of the body. It does not matter whether that amount of weight loss is from dieting, gastric bypass, or lapband surgery, the skin can not shrink back done in most people.

 

Because body contouring surgery is about removing as much excess skin as possible, one should have maximized their weight loss and proven that this new weight is stable. For some patients, that may be 9 to 12 months. For others, it could be much longer than a year.

 

The other benefit to waiting until your weight loss is stable is to make sure you are in  a good nutritional state. Weight loss, no matter how it is done, depletes one’s body of vital nutrients and other stores that are needed for the healing of long surgical incisions and extensive wounded tissues.

 

2.      At what weight should I before I can have body contouring surgery?

 

Many extreme weight loss patients have a specific target weight in mind. Whether they make it or not depends on a lot of factors and one of those is certainly time. Whether any patient will hit their weight target is unknown. But at some point one will realize a point when their weight will not get any lower. Once one has bounced around at a low weight for awhile, then you can be certain this is where your body will live. Once you are comfortable that you have found this weight, and can keep it, then you are ready for surgery.

 

3.      What’s the difference between a tummy tuck and a circumferential body lift?

 

The one body area that bothers all extreme weight loss patients is the abdomen or waistline area. Loose skin is always present in front of, over, and behind the hips. For some patients, a skin overhang is only present in the front. For many others, the skin excess extends around the waistline and across the back, resulting in sagging of the buttocks and posterior thighs as well. These concerns are almost always addressed first in most bariatric plastic surgery treatment plans.

 

When the excess skin overhang is primarily in the abdominal area, a tummy tuck or abdominoplasty is all that is needed. While it can be a conventional horizontal elliptical excisional pattern, the amount and stretched out quality of the skin may need  a modified pattern to provide optimal tightening. This may require the horizontal cutout to go further back along the waistline or to include a vertical skin wedge resulting in an invert T or anchor closure pattern. (fleur-de-lis tummy ruck)

 

When the loose skin incorporates the entire waistline, a circumferential or 360 degree cutout is needed. This is known as a circumferential body lift. It is a lot like ‘pulling up your pants’. The scar will run completely around your waistline. In some cases, the front side of the circumferential body lift may include the fleur-de-lis cutout pattern as well.

 

4.      How can I reshape my saggy breasts…or my manboobs?

 

One of the most challenging of all body parts to reshape after extreme weight loss is the female breast and the male chest. The female becomes essentially a deflated bag of skin with severe sagging and the nipple often pointed downwards. The male chest also loses volume, although less so than the female, but the chest skin shifts and sags downward with a lower than normal  nipple position.

 

 The breast often requires a combination of an implant, for volume replacement, and a lift (mastopexy)to reduce the amount of sagging skin and bring the nipple back up to a more central position of the breast mound. This is a difficult operation, from an artistic standpoint, and it often requires two separate surgeries to get the best result.

 

The sagging chest in the male, while not trying to make a mound like in the female, is complicated by trying to limit scarring. There are no natural creases or folds to hide scars in the flat male chest. Getting the nipple back up on the chest and tightening the skin requires a compromise between the result and the amount of scarring. The chest lift in a man is done differently than a breast lift in a woman.

 

5.      I hate my ‘batwing’ arms, what can I do about them?

 

Loose skin in the arms is another common extreme weight loss problem. In the back of the upper arms (triceps area), loose skin and fat hang off and below the humerus bone. This creates a large fold of hanging skin. It often extends into and past the armpit and down into the side of the chest. In some cases, I have seen the skin excess goes past the elbow into the forearm.

 

The good news is that arm recontouring, known as brachioplasty, is the ‘simplest’ of all body contouring procedures. The arm’s circumferential measurement can be measurably reduced.  Skin and fat is removed longitudinally along the arm and the cut out often takes a right turn into and past the armpit. The bad news is that it does result in a long scar in an unnatural area on the inside of the arm. Scar healing problems are not uncommon in the moist and moveable armpit area.

    

6.      How bad are the scars from bariatric plastic surgery?

 

Body contouring after extreme weight loss is about making a trade-off…scars for improved contours. Depending upon the body area, scars tend to turn out somewhat different. Breast and abdominal scars generally look best while arm and thigh scars tend to become wider. Most of these scars are more than just fine or pencil-line in width and some of them will end up becoming hypertrophic or wide due to the tension placed on the wound closure.

 

Regardless of how the scars may look, there can be a lot of them if multiple body areas are treated. Despite the plethora of this new skin ‘problem’, weight loss patients universally prefer them to their prior ‘sharpee’ body look.

 

7.      Will insurance cover my skin removal surgeries?

 

While third-party payors often pay for surgical and non-surgical weight loss treatments, such widespread coverage for body contouring is not so generous. The line between cosmetic and reconstructive procedures for removal of excess skin is a judgment call that does vary amongst different insurers. Ultimately they are looking for functional problems that this skin causes, such as infections, to determine medical necessity for the operation. In general, the most commonly covered procedure is the abdominal panniculectomy or frontal abdominoplasty. The procedures never covered are breast and chest reshaping.

Dr. Barry Eppley

Indianapolis, Indiana

Body Contouring after Weight Loss on Indianapolis Doc Chat Radio Show

Monday, December 21st, 2009

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis fromnoon – 1:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the topic of body contouring after extreme weight loss (Bariatric Plastic Surgery) was presented. This is an encore show that was replayed due to popular demand.

After massive weight loss (MWL) which is usually done through bariatric surgery (lapband and bypass procedures),  many patients suffer with a lot of excess and hanging skin. What to do with all the excess skin has led to the development of specialized plastic surgery procedures for these patients.

Todays’ guest was a world’s authority on bariatric plastic surgery, he discussed a variety of important topics for patients considering these procedures. Important issues are when such procedures should be considered in the massive weight loss patient, whether medical insurance will provide coverage for them, the differences between a tummy tuck and a lower body lift, breast and chest reshaping, arm lifts, and thigh and buttock lifts. Numerous body contouring after weight loss procedures can be combined in a single operation but overall body recontouring requires several stages to complete. These operations are complex and one must be nutritionally sound to go through them to prevent wound healing problems from the long incisions that are required. Another important issue is the timing of such surgery and how long after the bariatric surgery should such procedures be considered.

Free Body Contouring and Bariatric Plastic Surgery consultations with Dr. Eppley can be arranged by calling his Indianapolis suburban area facilities at IU Health North or IU Health West Hospitals at 317-706-4444 or sending an email inquiry to: info@eppleyplasticsurgery.com.

Body Contouring after Massive Weight Loss on Indianapolis Doc Chat Radio Show

Saturday, October 10th, 2009

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 1:00 – 2:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the topic of Bariatric Plastic Surgery was discussed. After massive weight loss (MWL) which is usually done through bariatric surgery (lapband and bypass procedures),  many patients suffer with a lot of excess and hanging skin. What to do with all the excess skin has led to the development of specialized plastic surgery procedures for these patients.

Todays’ guest was one of the world’s authorities on bariatric plastic surgery. He discussed when such procedures should be considered in the MWL patient, whether medical insurance will provide coverage for them, the differences between a tummy tuck and a lower body lift, breast and chest reshaping, arm lifts, and thigh and buttock lifts. Numerous body contouring after weight loss procedures can be combined in a single operation but overall body recontouring requires several stages to complete. These operations are complex and one must be nutritionally sound to go through them to prevent wound healing problems from the long incisions that are required.

Free Body Contouring and Bariatric Plastic Surgery consultations with Dr. Eppley can be arranged by calling his Indianapolis suburban area locati0ns at IU Health North or IU Health West Hospitals at 317-706-4444 or sending an e-mail inquiry to: info@eppleyplasticsurgery.com.

Bariatric Plastic Surgery on Indianapolis Doc Chat Radio Show

Saturday, August 1st, 2009

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 1:00 – 2:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the topic of Bariatric Plastic Surgery was discussed. After massive weight loss (MWL) which is usually done through bariatric surgery (lapband and bypass procedures),  many patients suffer with a lot of excess and hanging skin. What to do with all the excess skin has led to the development of specialized plastic surgery procedures for these patients. Todays guest was plastic surgeon Dr. Peter Rubin from the University of Pittsburgh. As one of the world’s authorities on bariatric plastic surgery, he discussed when such procedures should be considered in the MWL patient, whether medical insurance will provide coverage for them, the differences between a tummy tuck and a lower body lift, breast and chest reshaping, arm lifts, and thigh and buttock lifts. Numerous body contouring after weight loss procedures can be combined in a single operation but overall body recontouring requires several stages to complete. These operations are complex and one must be nutritionally sound to go through them to prevent wound healing problems from the long incisions that are required.

Free Body Contouring and Bariatric Plastic Surgery consultations with Dr. Eppley can be arranged by calling his Indianapolis suburban area facilities at IU Health North or IU Health West Hospitals at 317-706-4444 or sending an inquiry by e-mail to: info@eppleyplasticsurgery.com.


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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