Cosmetic Bariatric Surgery
Bariatric
or gastric bypass surgery has become the treatment for morbid
obesity. Body contouring after significant weight loss has become
very popular among patients after massive weight loss.
Using the latest techniques in body sculpting individualized to
each patient's specific needs and priorities, Dr. Shureih can
help you realize the real body shape beneath all the excess skin
folds that come as a result of massive weight loss.
Patients
experience significant weight loss over a relatively short period
of time (usually 12-18 months), after gastric bypass surgery.
The stretched skin has lost the elastic qualities necessary to
"shrink back" to your new body size. This often leaves patients
with excessive amounts of hanging skin that creates a multitude
of problems, most important of which the complaint that the patient
still feel fat.
A
comprehensive approach to the bariatric patient is necessary to
achieve the best results, and the body image they can have.
One
of the most important considerations for both plastic surgeon
and patient to realize is that a bariatric patient must be treated
differently from non-bariatric body contouring patients. What
has worked well for many years on other patients simply may not
provide adequate shaping and contouring for the bariatric patient.
The stretching forces resulting in excess skin is different than
what is usually seen in the non bariatric patient.
BPatients who have undergone gastric
bypass surgery have numerous areas of concern which may differ
from patient to another.
These
areas include a combination of the following:
-Breast
ptosis, or droopiness, with or without loss of breast volume
(Mastopexy is a procedure to lift the breasts and may be performed
with or without the addition of breast implants to improve shape,
fullness and cleavage.) Breast implants assure fullness in the
empty upper pole of the breast.
-Sagging
of the facial skin (Face lifting, forehead lifting and
eyelid surgery, along with neck contouring and neck definition,
may be necessary to achieve complete facial rejuvenation. The
face lift should be customized to the needs of the individual.
-Abdominal
skin laxity, laxity of the muscles of the abdominal wall.
Abdominoplasty or a lower body lift procedure can contour the
abdomen, hips and buttock. After massive weight loss, laxity can
be horizontal and vertical, as well as circumferential. Abdominal
laxity has to be studied very well so a plan of repair can be
formulated. Liposuction may still be needed for resistant areas.
-Hanging
skin of the arms (Brachioplasty is a technique to lift
the arms). Liposuction may be needed along with the removal of
excess skin.
-Wrinkling
and excessive skin folds of the thighs A medial thigh
lift can lift the inner thighs, with or without liposuction. The
lateral thigh and the buttock, posterior thigh is lifted through
a circumferential abdominal lift, or lower body lift.
Obviously
all of these concerns cannot be addressed simultaneously during
one operation. However, two procedures usually can be safely combined.
During your consultation, Dr. Shureih will assess your needs and
your priorities as well as your concerns to help you develop a
comprehensive plan for your body contouring.
The
cornerstone of a successful approach to body contouring is to
individualize treatment to your specific needs and goals and to
ensure that you have full understanding of the issues involved
so that you are able to make an intelligent decision.
If
you think you might be a good candidate for body contouring following
significant weight loss, call for your personalized consultation.
Consultation
During
your initial consultation, Dr. Shureih will inquire about your
medical history, prior procedures, medications, allergies, and
your motivations for seeking cosmetic surgery. It is very important
that you be thorough when providing your medical history, as this
information helps to prevent complications during your care. When
asked about medications, be sure to include any vitamin or herbal
preparations, as these can affect your blood pressure and clotting
ability and lead to major complications.
Smoking
and alcohol is also very important, as these may have a profound
impact on your recovery and your ability to heal following your
surgery. Remember that second hand smoke is as harmful.
Dr.
Shureih will discuss your concerns, priorities. After examining
you, he will be able to offer advice and options to help you achieve
the body you desire. He will explain the advantages and disadvantages
of the different options you have before you.
At
the completion of your consultation, you should be given a written
estimate of the cost of your procedure. At this time, you will
also have the option to schedule your procedure if you so choose.
The decision to undergo surgery is a very important one, and the
final decision should be given very careful consideration. You
are also encouraged to bring your spouse, family member, or a
friend to your consultation. Any body who has or will have an
opinion regarding the surgery or the results should be involved
in the consultation process.
Where Your Procedure Will
Be Performed
Most
patients undergoing body contouring following significant weight
loss choose to have their surgery performed in a full service
hospital, and many also choose to stay overnight following surgery.
Sometimes an overnight stay is required, depending on the procedure
you choose and your overall health status. Alternatively dividing
your surgeries into multiple smaller procedures allows us to perform
the procedure in our surgical facility. A private duty nurse can
care for you in the comfort and privacy of your own home, or your
family or friends may care for you during the early postoperative
period. You will need help in the first few days after surgery.
Type(s) of Anesthesia
Anesthesia
is an essential part of any surgical procedure and must be performed
safely. General anesthesia or in some cases Local with Sedation
is preferred for most of these procedures. You are asleep, feel
no pain, and will not remember the procedure. Intravenous sedation,
called "twilight sleep," is a combination of local anesthetic
administered at the surgical site by the surgeon and intravenous
sedation administered by the anesthesiologist. You should feel
no pain, and you will not remember the procedure.
We
strive to make your experience as pleasant as possible.
Dr.
Shureih will discuss all of these options with you more thoroughly
at the time of your consultation; we encourage you to ask about
anything you do not understand. All your questions should be asked
prior to surgery.
Details of the Procedures
As
mentioned previously, it is important to develop a comprehensive
approach to your body contouring. This has evolved into several
specialized techniques meant to optimize your results. These include:
-Developing
a clear overall strategy during the consultation process and reviewing
this plan during the preoperative visit. This plan will be reviewed
thoroughly so that you have a full understanding of the procedures,
incisions, scars and results you can be achieved.
-Precise
preoperative skin marking prior to surgery. While you are standing,
Dr Shureih will make marks on the skin identifying certain landmarks
as well as the intended incisions. Not only does this provide
information necessary during the operation, but it also allows
you to review the operative plan one more time with before undergoing
the procedure.
-Careful
but considerable suture techniques to provide support to the incisions
during the healing process. By using multiple layers of strong
sutures beginning deep in the tissues and finishing superficially,
the resulting scar is optimized. Eventual scarring depends on
the surgical closure, the quality of the tissue being operated
on, the amount of stretch and your genetic factors.
Depending
on the combination of procedures you choose, surgery will probably
last between four and eight hours. After you are properly anesthetized,
Dr. Shureih will make the incisions necessary for removal of excess
skin and fat. For a tummy tuck, the muscles of the abdominal wall
are usually tightened using strong, permanent internal sutures.
Some patients have hernias in the abdominal wall, and these may
also be repaired during a tummy tuck. Hernia repair with a plastic
mesh may be necessary to reinforce the weakened abdominal wall.
Some patients may require liposuction of the upper abdomen at
the same time.
A
circumferential lift may be needed in some patients, this will
require extending the incision around the back to the buttock
crease.
At
the completion of the operation, a sterile dressing is applied
to the incisions, and a compression garment is applied to the
region of the body being treated. This compression garment helps
support your incisions during healing, decreases postoperative
swelling, and helps decrease any bruising that may occur.
After
Your Procedure
If
you are staying overnight in the hospital, you will be transported
from the recovery room to your own room. You will have a PCA pump
(Patient Controlled Analgesia) available so that you will only
need to push a button to self-administer pain medications when
needed. You will also be provided with thorough postoperative
instructions and a phone number so that you may reach your Dr.
Shureih directly at any time with any questions or concerns you
might have.
Alternatively,
if you decide to go home in the company of a private duty nurse,
you will be discharged after spending one to two hours in the
recovery room.
The
antibiotics that were prescribed during your preoperative visit
(usually Augmentin) should be taken twice daily beginning on the
evening prior to surgery. Continue this medication until it is
gone. The pain medication (usually percocet) should be taken fairly
regularly, every four to six hours, during the first twenty-four
hours (when you are not asleep, of course). Most patients find
that they are able to transition to Tylenol after four to five
days. It is not safe to drive a car within twenty-four hours of
surgery, or while taking pain medication, as your reflexes and
alertness may be altered.
You
should plan to take it easy following your surgery. No strenuous
activities, heavy lifting (over 10 pounds), exercises, swimming,
contact sports, should be planned for three to four weeks. As
Dr. Shureih monitors your recovery, he will advise you when it
is safe to resume specific activities. You should plan to wear
the compression garment for three weeks following surgery. Dr.
Shureih will remove the drainage tubes within several days following
surgery as the drainage decreases to an acceptable level.
The Results You Can Expect
You
will notice an improvement in your body contour immediately. However,
your shape will continue to improve in the following weeks as
the swelling subsides. You should be up and walking the day following
surgery, although you will be sore for several days. You should
be able to resume your normal daily activities within several
days following surgery, and you should be able to resume all of
your physical activities within three to four weeks of surgery.
Potential
risks
Surgery
carries a certain amount of risk, those include, infection, bleeding,
fluid collection skin loss, delayed wound healing, scarring, possible
wide thick scars. Blood clots, fat emboli, stretching of the scars
and resulting pull on the body parts.
As
a result of your body contouring, you should be able to look as
good as you feel and enjoy your new body.
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