Considering Plastic Surgery After Weight Loss?
There are many questions and considerations an individual may have as they consider moving forward with plastic surgery. After all, these are elective procedures which all inherently carry risk. These issues are all magnified in the setting of significant weight loss, no matter the means (gastric bypass surgery, sleeve surgery, diet and exercise, etc). Having a general framework to help navigate these complexities, even before having a formal consultation with a plastic surgeon, may help to demystify the process.First and foremost, if you are considering plastic surgery, it is critical to make sure your plastic surgeon is certified by the American Board of Plastic Surgery. Simply typing “is my plastic surgeon board certified?” in a Google search will direct you to the ABPS website where you can type in your surgeon’s name and get this information. While some plastic surgeons may be comfortable performing surgery on patients who have lost a significant amount of weight, there are others who may not. Therefore, secondary considerations such as “has my plastic surgeon done additional training in treating patients like me?” or “does my plastic surgeon have a history of treating many patients like me?” may be explored. This can be a little more difficult to figure out. Often times the website for a plastic surgeon will link to his/her CV, investigation of which can help answer those questions. Or simply calling the office and asking the receptionist those questions may give you insight. It may also save you the hassle of coming into an appointment (and potentially paying a cosmetic consultation charge) only to find out the surgeon is not comfortable doing these body lift procedures. Here at Charleston Plastic Surgery, I have both additional training in plastic surgery after weight loss (a 1 year fellowship at the University of Pittsburgh under the direction of the national expert in this field, Dr. J Peter Rubin) and a large experience treating patients who have lost a significant amount of weight (having served as Director of the Life After Weight Loss Program at the University of Rochester from 2012 – 2020).
Understanding the consultation process can help reduce stress if you are embarking on a plastic surgery journey, or even if just meeting with a plastic surgeon to get information. As surgeons, we will all have varying approaches to the consultation visit, but there are certain things that should be addressed. I have been asked to write articles about this process, the most valuable of which can be found through our major plastic surgery journal: Plastic and Reconstructive Surgery:
Bossert RP, Rubin JP. Evaluation of the weight loss patient presenting for plastic surgery consultation. Plast Reconstr Surg. 2012 Dec;130(6): 1361-1369.
Your plastic surgeon will need to understand your overall health history, including any history you may have of heart issues, lung problems, bleeding disorders, etc. He/She will also need to understand your weight loss history. How did you lose your weight? If you had bariatric surgery, how long ago was it? Are you still losing weight or has your weight loss stabilized? Are you at your goal weight? If you have previously undergone weight loss surgery, annual follow up with your bariatric surgeon is critical to ensure nutritional issues are managed appropriately.
Perhaps it does not need to be said, but your surgeon should be asking you what bothers you the most. I do not believe it is the plastic surgeon’s job to point out issues which patients do not find to be bothersome. I will routinely ask patients about which body areas they’d like to discuss. Often times, in the setting of weight loss, there are multiple areas of concern. I will ask my patients to prioritize those areas so I can address them in the order in which the patient finds them concerning. This involves not only a frank discussion, but also an examination.
From there I have an in depth discussion about how I may be able to help. I will have an open and honest discussion about what can be achieved with plastic surgery, and what cannot. It is critically important that every patient keep an open mind about this and it cannot be overstated. Skin damage following weight gain and subsequent weight loss is the norm rather than the exception. With that comes the fact that even after pulling tissue tight during an operation, there is ALWAYS post-operative skin relaxation which may result in some loosening of the skin. This is variable between patients. Given the large amount of skin removed, lifted, etc, there is obviously a big change following plastic surgery. But having realistic goals and expectations is critical for anyone exploring plastic surgery after weight loss.
Other questions may come up, ranging from “is this covered by my insurance carrier?” or “how many body areas can you take care of at one time?”. These are very complicated discussions which I would have at the time of consultation. However, I will dedicate future blog posts to these topics to help dispel myths or create some clarity before coming into the office for a consultation appointment.
Perhaps most important, I think it is critical you get a good sense of your plastic surgeon’s comfort with these operations, approach to medicine, and overall demeanor. Making surgical decisions is obviously a really big deal, and it is very important you feel comfortable with your doctor. If you have questions, ask them. Remember to keep an open mind. I am always happy to answer questions, and I will always do so in an honest fashion rooted in evidence and my personal experience.
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