Ask the Doctor - Bariatrics

Q1 – I’ve been extremely overweight for most of my life and I this year I’m considering bariatric surgery. Can you please tell me if this is a good idea? 

Q2  - I received bariatric surgery not too long ago and have lost a lot of weight. Although I feel great and healthy again, I have a lot of loose skin leftover from when I was at my heaviest. I’m considering more surgeries. Is this a good idea?

A1 – This is a great question and a very important one as well. Bariatric surgery is a serious decision and should not be taken carelessly. Although the results can be wonderful, it is still a surgical procedure and certain criteria need to be met before even considering. 

The first thing each potential bariatric patient needs to realize is that the process of losing weight is a life-long commitment and will not be cured solely by a surgery. Although a bariatric procedure lends the way to faster and more efficient weight loss, it is a lot of work and dedication for the individual as well. This surgery entails a lifestyle change and many medical facilities that offer bariatric surgery involve a long list of requirements first because of this reason.
Other requirements often include a six month weight loss trial, supervised by a physician to see if the attempt is successful. Patients will also often meet with a nutritionist before and after the surgery to ensure they have the knowledge of how to take care of themselves. A physiological evaluation is also standard to make sure the patient meets the mental and emotional challenges of this life-changing surgery.
The physical requirements needed to qualify for a bariatric procedure are usually a BMI (body mass index) of 40 or above, or if you have a life-threatening problem related to your weight.
One of the newer bariatric surgeries is the gastric sleeve surgery. This procedure removes about 85 percent of the stomach. Because of the removal, the stomach isn’t able to hold as much food, and therefore aids in weight loss. The sleeve refers to the shape of the stomach after the procedure is completed.
In gastric sleeve surgery, the bariatric surgeon makes a few small incisions as opposed to the usual one large incision made with general bariatric surgery. This procedure also leaves the bowels and digestive system in-tact, rather than re-routing it as in gastric bypass surgery. Because of this, the gastric sleeve surgery has fewer complications.
Bariatric surgery also removes the part of the stomach that produces Gherlin, a hormone that stimulates appetite. The removal of this hormone doesn’t completely rid the person of his or her appetite, but instead lessens it dramatically.
Patients that have undergone gastric sleeve surgery have lost, on average, 55% of their excess weight within 18 months following their surgery and have gotten rid of health complications such as diabetes and high blood pressure. Relieving the body of excess weight will truly help it to regain its strength, stamina and overall performance.

I hope this helps you on your journey to health!

Nicolas Teleo, MD, heads the bariatric program at Pocono Medical Center with assistance from Gina Santiago, PA-C. Both are Board certified and specialize in bariatric and general surgery. They practice at PMC Physician Associates, General Surgery at Pocono Medical Center in East Stroudsburg, PA.

A2 – Congratulations, first and foremost, on your wonderful achievement. It is not easy losing weight but the weight loss will have many beneficial effects on your overall health.  Your question is a common one and a good one.

Body contouring surgery after major weight loss has increased in popularity as more patients are undergoing weight loss surgery.  Weight loss surgeries, including gastric bypass, gastric banding, and gastric sleeve, have become much safer in recent years. In my practice, it is not uncommon for patients to consult with me after weight loss of 100, 200 or even 300 pounds.

Weight loss itself, however, creates new problems that you may not have anticipated.  Areas of hanging skin can create cosmetic as well as functional issues.  Often, patients have regions of skin irritation and infection due to the folds of skin that can result from massive weight loss.

There are many different types of body contouring surgeries depending on the areas in which you lost weight and the severity of the sagging skin. Body contouring in the weight loss patient is not the same as surgery in the non-weight loss patient.  The surgeries themselves need to be tailored to the unique needs of the weight loss patient, as the laxity of the skin and support structures is usually more severe than in patients whom have not lost weight.  In addition, there are special nutritional and medical considerations that are important for the best outcome.  In fact, I have co edited an entire textbook* that covers surgery on almost all areas of the body, including:

  • Abdominoplasty – Also known as a tummy tuck. This procedure removes excess fat and skin and also restores weakened or separating muscles. In the weight loss patient, this surgery often needs to be an extended abdominoplasty or a lower body lift, where the scar is extended around the hips and, sometimes, onto the back
  • Brachioplasty – Also known as an arm lift, this procedure reshapes the under portion of the arm that many people call “bat wings.”
  • Mastopexy – Also known as a breast lift. This procedure raises and lifts the breasts by removing excess skin, creating tighter tissue and reshaping the area.  In many cases, we add a breast implant to the surgery to restore volume to the sagging breast
  • Thigh lift - This procedure removes excess skin and may include liposuction to create a more sculpted shape between the upper legs and along the outer thighs.
  • Facelift and necklift – Particularly in patients over the age of 40, the skin of the face and neck may sag after weight loss.  Surgery involves tightening not only the skin, but also the underlying support structures, including the muscle fascia

If you choose the option of body contouring surgery, you will meet with your surgeon to discuss your desires and expectations. Weight stability is necessary to begin the process and knowing the risks involved in any surgery will be addressed.  We usually recommend that your weight is stable for at least 6 months prior to considering body contouring.  Your surgeon will also discuss reasonable expectations for your result as well as the risks and benefits of each surgery.

Although cosmetic surgery is a wonderful way to restore your body’s appearance, it does not replace working out and eating right. Keeping in shape and continuing your new healthy habits are essential. Make your changes count, for good!

I hope this helped answer your question. Good luck moving forward and congratulations again!

Charles Herman, MD is the Chief Medical Executive and Chairman of Surgery at Pocono Medical Center. He is Board certified by the American Board of Plastic Surgery and specializes in plastic and reconstructive surgery. He is the editor of three major textbooks in plastic surgery and over 50 journal articles and book chapters.  Dr. Herman practices at PMC Associates, Plastic & Reconstructive Surgery in East Stroudsburg and has an office on Manhattan’s Fifth Avenue.

*Encyclopedia of Body Sculpting After Massive Weight Loss, that deals specifically with body contouring after weight loss.  Published in 2010 by Thieme Publishers (New York and Stuttgart, Germany)

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