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Life After Massive Weight Loss

Article courtesy of Tom Pousti, M.D.
August 17, 2011

In order to attain a more healthy body weight for obese individuals who have been unable to achieve significant weight loss through diet modifications and exercise programs alone, bariatic surgery is a consideration. Bariatic surgery, also known as weight loss surgery, encompasses all surgical treatments to treat morbid obesity by modification of the gastrointestinal tract to reduce nutrient intake and/or absorption. However, this does not include procedures for surgical removal of body fat, such as liposuction and abdominoplasty. This treatment option is highly recommended for patients with a body mass index of 40 kg/m2 or greater who presently suffer from obesity–related co-morbid conditions, such as hypertension and diabetes mellitus.

There are a number of surgical options available to treat obesity, each with their advantages and pitfalls. The procedures may be classified into three main categories: predominately malabsorptive, predominately restrictive, and mixed procedures.
 
Predominately malabsorptive procedures reduce stomach size, but mainly create malabsorption. Biliopancreatic diversion (BPD) or the Duodenal switch (DS) involve procedures where part of the stomach is resected, creating a smaller stomach. The distal part of the small intestine is then connected to the pouch, bypassing the duodenum and jejunum. Fewer surgeons perform BPD/DS compared to other weight loss operations due to the complications in nutritional deficiencies and long–term monitoring of patients.

Predominately restrictive procedures mainly involve the reduction of the stomach size. In vertical banded gastroplasty, also called the Mason procedure, a part of the stomach is permanently stapled, creating a smaller pouch, which serves as the new stomach. The same effect can be created using a procedure known as Lap Band surgery. During this operation, surgeons place a band around the top part of the stomach, restricting the amount of food the stomach can hold, so patients feel full faster, it can also be adjusted as time goes on, depending on how the patient is losing weight. Gastric band placement, unlike malabsorptive weight loss surgery, does not cut of remove any part of the digestive system. Unlike the individuals who undergo, BPD or DS, it is unlikely that gastric band patients will experience any nutritional deficiencies or malabsorption of mutirents.

Mixed procedures involves the application of both techniques in unison. Gastric bypass surgery is the most popular performed operation for weight loss in the United States. This procedure makes the stomach smaller and allows food to bypass part of the small intestine. The patient will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed, leading to weight loss. The most common gastric bypass surgery is a Roux-en-Y gastric bypass. In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).

Following bariatic surgery, or any substantial amount of weight loss, the skin and tissues often lack elasticity and cannot conform to the reduced body size. As a result, the severely stretched skin is unsupported, causing sagging. With the help of a plastic surgeon, surgical body contouring after a weight loss procedure improves the shape and tone of the underlying tissue that supports fat and skin, removing excess sagging fat and skin. There are several areas of the body in need of improvement include the face, neck, arms, abdomen, back, and thighs.

Due to the growing popularity of weight reduction surgery, many patients experience a variety of difficulties in different areas of the body. A variety of surgical procedures are performed at different times. Depending on which area bothers you the most, the surgery is tailored to fit your needs, starting with the area of greatest concern. Most massive weight loss patients prefer to start with abdominoplasty, which is also known as a tummy tuck.

Abdominoplasty involves the removal of excess fatty tissue and skin folds in the mid and lower abdominal region. Tightening of the abdominal wall and repair of the lower and upper abdominal rectus muscles, may also be improved.
Breast lifting surgery, arm lifts, face lifts and neck lifts are all additional procedures that can be done at different times.
Massive weight loss patients are told to make sure that their weight has stabilized before proceeding with and plastic surgery procedure. If a skin tightening procedure is performed before their weight is stable, they may need to undergo more plastic surgery to improve results from the initial surgery.

Plastic Surgery procedures following massive weight loss are usually extremely gratifying for both the patient and surgeon. The results are usually dramatic and provide a significant functional and aesthetic benefit to the patient.

 


This is a 21 year old patient from El Cajon California, interested in having breast augmentation / lift and  lower body lift. She was referred to double board certified plastic surgeon Dr. Tom Pousti from Kaiser Plastic Surgery.  This patient had significant weight loss after having gastric bypass surgery and was left with excess skin. She is 3 weeks post op tummy tuck (abdominoplasty) and breast lift (mastopexy) / breast augmentation with 550cc smooth round moderate profile silicone gel implants made by the Mentor Corporation. She is extemely happy with her results even at this stage.



 
This 43 year old patient from Riverside County was referred to Dr. Pousti. She was interested in finding the best plastic surgeon in Southern California to help her achieve her results. In 2006, she had gastric bypass surgery and lost 170 pounds. She was very happy with the loss of her weight but was not happy with the hanging skin and hanging breasts. She wanted her breasts lifted and a lot fuller, she wanted an arm lift and an entire upper body lift. She felt very comfortable with Dr. Pousti's bed-side manner and extremely comfortable with his surgical experience.


 
This 43-year-old patient from Oceanside California was interested in having an arm lift. After having gastric bypass surgery,  this patient  lost a substantial amount of weight and wanted to tighten up her arms. This patient is 1-month post-op arm lifting surgery.

 

This 41 year old patient from El Cajon, CA and had gastric bypass surgery in 2003 and lost 135 pounds. She was extremely unhappy with her "saggy skin" and wanted it taken care of all over her body. She decided to undergo tummy tuck, belt lipectomy, thigh lifting, arm lifting and breast augmentation and breast lifting surgeries in different stages to achieve her result.
 


She is 1 year post op surgery and very happy with her new look.



 
Testimonial

Welcome to all of Dr. Pousti’s new patients who are thinking of cosmetic surgery. I have the BEST cosmetic surgeon. He’s wonderful with a big heart. His name is Dr. Tom Pousti. Dr. Pousti has been my cosmetic surgeon since November of 2003. I had Gastric Bypass I lost 150 lbs. I needed a lot of help with the excess skin. I feel beautiful. I would not have this much self-confidence with out the help of Dr. Pousti. I have had 6 cosmetic procedures with Dr. Pousti. I have had tummy tuck, belt lipectomy, upper body lift and arm lift, breast augmentation-breast lift, and also tattoo removal. Lets not forget his beautiful wife and his STAFF they are wonderful and professional who make Dr. Pousti even Better. Thanks Girls! Thank you Dr. Tom Pousti for all you have done for me, I feel beautiful! Your patient for life!
 


 
 


 
 

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