Post-Bariatric Plastic Surgery

Significant weight loss achieved through bariatric surgery – i.e. the surgery used to treat obesity – can cause severe deformities such as severe lipodystrophies or dermatochalasis – i.e. excessive skin - in critical points such as the abdomen, back, thighs, buttocks, breast, face and neck. Post-bariatric plastic surgery solves these issues linked to weight loss.

During the specialist examination, the surgeon will go through the patient’s history, assess his/her health conditions and body characteristics, and then take some photos to add to their patient file. After having evaluated the patient’s expectations, the surgeon will explain the possible solutions, inform the patient of the advantages, risks and expected results. Since we are talking about different surgeries and a long path to reach the final goal, it is important to discuss with the patient the outcome, risks, results, and benefits of each procedure. Post-bariatric remodeling of the body is a long and difficult physical and psychological journey with possible complications that requires motivation and perseverance. According to international statistics, the incidence of post-surgery complications is up to 20% higher in former obese patients. Fortunately, these are minor complications, but they can prolong recovery and cause distress to patients.

Before undergoing post-bariatric plastic surgery, the patient’s Body Mass Index (BMI) should be below 30 and their weight stable for at least six months. It is generally necessary to perform some laboratory tests and it may be required to suspend or change the use of some drugs, such as aspirin, anti-inflammatory drugs or herb supplements that may increase the risk of bleeding. Ideal candidates are non-smokers with a strong motivation and a healthy lifestyle following a suitable diet and physical activity.

Post-bariatric plastic surgery is not just one single surgery, but many surgeries that allow for the remodelling of the silhouette after significant weight loss. The process may have more steps and require more surgeries over several years. Accurate planning is fundamental. Among the possible surgeries there are:
- brachioplasty to remove excessive skin in the upper part of the arms;
- mammoplasty (or mastopexy) to improve the aspect of the breasts;
- trunkoplasty to remove excessive skin in the abdomen, buttocks and thighs;
- crural lift to eliminate excessive tissue in the internal part of the thighs;
- abdominoplasty to remodel the abdomen;
- face lift to remodel the face, cheeks and neck.

The indications to follow after post-bariatric surgery vary depending on the procedures used.

Incisions are generally made in strategic areas to make the scars as least evident as possible. Nonetheless, it may take many months, if not years, for the scars to be less evident. No scar is invisible and some people may have better or worse healing capacities. However, refined surgery techniques and specific drugs – such as silicon gels to apply on the scars for a long period after surgery - can reduce scarring. Generally, the use of these drugs is justified by the great functional, psychological and aesthetic benefit they provide.

The outcome of each surgery is visible after a short time. Nonetheless, the redefinition of one’s silhouette after significant weight loss is a lengthy process and the time required to achieve the final result may be longer than that for losing weight.

The outcome of each surgery is visible after a short time. Nonetheless, the redefinition of one’s silhouette after significant weight loss is a lengthy process and the time required to achieve the final result may be longer than that for losing weight.

Possible risks associated with post-bariatric surgery include blood loss, infections, edemas, poor wound healing, skin loss, thrombus formation, deep venous thrombosis and pulmonary embolism, visible scars, numb skin or changes in skin sensitivity, residual skin laxity or silhouette irregularity. That is why post-bariatric plastic surgery should be performed only by plastic surgeons with experience in this extremely specialised field.