Marina del Rey
Dr. David Stoker
4640 Admiralty Way #1000
Marina del Rey, CA 90292
Many patients are winning the struggle against obesity by losing large amounts of weight. Some change their lifestyles and lose the weight through diet and exercise. Weight loss surgery works for many Los Angeles residents, where gastric bypass or banding procedures help them lose the extra pounds. No matter the method, patients feel much better after the weight comes off. In addition, many serious medical conditions resolve completely.
While there are innumerable benefits of losing weight, there's also a significant problem: patients are often left with a large amount of loose skin that inhibits them from fully enjoying their lean physiques. Fortunately, there are effective surgical options for removing the unwanted skin.
Surgical treatment of patients following bariatric surgery and massive weight loss is an area of specialization for me. I perform a high volume of these procedures and have published extensively on my experience with combined surgical procedures. Surgeon experience is infinitely important with these major body transformations. Using state-of-the-art techniques, I'm able to create dramatic improvements for these patients.
Well over 30% of Americans are now obese, and the rate of obesity is increasing. The vast majority of Americans are overweight. The three main factors responsible for weight gain are:
Cultural influences and high calorie food options are also big contributors to the problem. One thing that's certain is that it's difficult to lose the weight once a person puts it on.
Diet is the most important contributor to an effective weight loss program. Extreme diets tend not to work long-term. Medications are also not an effective solution for most people. Lifestyle changes are needed to decrease caloric intake day after day so the cumulative effect is to shed weight over time. For most people to lose weight, the calories they consume must not exceed the calories they burn through exercise.
Exercise is important for cardiovascular health as well as for losing weight. By adding muscle mass, patients can increase their basal metabolic rate. That means the person will continue to burn calories at a higher rate even when they're sedentary. Aerobic exercise helps to burn calories at a faster rate so the benefits of dieting will be seen more quickly.
In Los Angeles, bariatric surgery is the last hope for many patients who are losing the battle against obesity. Gastric bypass and banding surgery are extremely effective at helping patients to lose weight. Although bariatric surgery is much safer now than it was over a decade ago, there are still substantial risks from the procedures as compared to losing weight through diet and exercise.
When patients succeed at losing large amounts of weight, they often feel as though they have a second chance at enjoying a full life. They feel much better, and many of their medical problems resolve as well. But most are left with bulky, loose skin that can be physically uncomfortable, as well as a constant reminder of their former obesity. Removing the loose skin is an important finishing step to usher in this new stage of life.
Most patients have a wish list of body areas to improve after their skin loosens with weight loss. In my consultations, I help patients understand the best options for improving their appearance. Whether it's through plastic surgery or exercise, I create an individualized plan that will allow the patient to achieve their goals.
In my Los Angeles practice, I've found that plastic surgery after weight loss is a powerful incentive for patients to keep the weight off. Patients invest time and money for a plastic surgery transformation, and they're rewarded with huge improvements in their appearance. When the patient looks better and feels better, they can't help wanting to stay that way. Plastic surgery provides positive reinforcement for patients to keep the extra weight off.
These are the most common procedures for me to perform in patients who have lost large amounts of weight.
The best candidates for surgery after weight loss are healthy non-smokers who have large amounts of excess skin.
Patients with a history of obesity have a higher rate of complications than patients who have never been overweight. However, they also tend to benefit even more from plastic surgery because of their large amounts of extra skin.
To prepare for surgery, patients should exercise and avoid smoking. Patients tend to recover more quickly when they are in good physical shape before surgery. Patients should also make sure they are nutritionally balanced. It's common for bariatric patients to have vitamin or iron deficiencies, and dietary supplements are usually appropriate for them to take.
It's never a good idea to gain the weight back. Usually patients will still look better than they would have without the surgery, but obviously they're not making the most of their opportunity.
Most of my weight loss patients have more than one procedure with each trip to the operating room. I have published multiple clinical studies on the safety and efficacy of my techniques for these combined surgeries. Breast and abdominal surgery, or multiple facial procedures would be common examples of procedures to perform at the same time.
Planning the stages of plastic surgery for weight loss patients is highly individualized in my practice. It's common for my patients to have 2 or 3 different days of surgery, with multiple procedures done at each stage. The age and health of the patient, as well as the scope of the procedures, are key considerations for planning the stages of surgery.
Medical insurance frequently covers lower abdominal skin removal (panniculectomy or abdominoplasty) when the patient's excessive skin is so severe that it creates medical problems requiring treatment. Examples include rashes, sores, or infections in the folds of skin. However, patient eligibility and benefits vary greatly between policies.
In a perfect world, it would be nice for all patients to be at their ideal weight and to remain at their ideal weight. That's not realistic for many patients. Carefully chosen procedures may improve a patient's ability to continue to lose weight and enjoy their lives even before they reach their goal weight. Examples include removing large amounts of hanging skin from the abdomen or fat from the inner thighs if it inhibits the patient's ability to exercise. Plastic surgery is definitely not a substitute for weight loss, but it may be a powerful tool to help patients achieve their goals.
For patients following bariatric surgery, I typically allow for their weight loss to plateau for several months before scheduling plastic surgery. For patients who are losing weight through diet and exercise, I will sometimes operate earlier if the patient's need and desire for surgery is great. Selected plastic surgery procedures may act as a powerful catalyst for the patient to continue to work hard to achieve their weight goals.
The female body changes quite a bit following pregnancy. It's reasonable for most weight loss patients to wait until after pregnancy for procedures such as a tummy tuck or breast lift. If the weight loss is substantial, however, the loose skin may be a much bigger problem for the patient. In these cases plastic surgery may help a patient's self-esteem in a way that is beneficial to them before having children. In abdominoplasty cases before pregnancy, the abdominal muscles are usually flat enough that they do not require tightening. This speeds the recovery from the surgery.
Some of the more common risks of plastic surgery following weight loss include bleeding, seromas (fluid collections) and delayed wound healing. Patients with complications require more care and recovery time, but they still benefit tremendously from the surgery. Venous blood clots in the legs are also possible. They are reduced in frequency with early ambulation following surgery.