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