Obesity is a pandemic, reaching millions of people worldwide. To combat it, in the last decades a great amount of treatments was proposed, varying from preventive measures - like physical activity and hypocaloric diets - passing through medications that interfere in the metabolism of sugars and fats, until bariatric surgery.
Of all the alternatives, the one that has brought the best result to the majority of the patients is the surgical option, which is divided into two large groups: restrictive procedures, such as an intragastric balloon or gastric ring and restrictive procedures, allied to a disabsorptive procedure absorption of fats), such as the Fobi-Capella and Scopinaro surgeries.
In the long term, the combined procedure (restrictive and disabsorptive) obtains better results, bringing great loss of weight together with a greater maintenance of the final weight of the patient, in the vast majority of cases. Varying from case to case, the average weight loss is 40% to 80% of the excess weight in 12 to 24 months, being able to reach higher values depending on each patient.
In the final stage of weight loss, when it stabilizes, the patient is more willing, with marked improvement of mood and self-esteem, but with a new problem to face: what to do with excess skin and fat generated by great weight loss? After all, what was once a large abdomen, today has become an excess of skin and fat that hang over the lower abdomen and genitalia, occurring a similar phenomenon in arms and legs (especially in the inner faces of thighs), in addition to pronounced fall in the breast and face, especially in the neck region.
For better contour control and body harmonization, Plastic Surgery has been improving with new and advanced techniques, with solutions specific to each sector of the body.
Abdomen: In addition to being a symbol of obesity alone, the excess skin and fat accumulated mainly on the lower abdomen and genital region is usually the first area to be addressed. Depending on body composition and weight loss, the technique can range from a conventional abdominoplasty to more complex procedures, such as an abdominoplasty.
a) Conventional abdominoplasty - An incision is made at pubis height, similar to that performed for cesarean section, but with lateral extension to the hip.
The tissue composed of skin and fat is peeled across the abdomen to the chest and its excess removed. Points are also given in the abdominal muscles to strengthen the abdominal wall and prevent further relaxation of the abdominal wall. A new navel is made, in smaller dimensions than the previous ones. A subcutaneous drain is left, which should be removed after five days on average.
The patient is discharged within one or two days, depending on the length of the surgery and individual recovery. A specific modeling brace is used by the patient for at least 2 months to optimize the outcome of the surgery.
b) Abdominoplasty anchorage - Another technique for abdominoplasty in patients with great weight loss is abdominoplasty at anchor.
Used to dry large amounts of tissue, this procedure is reserved for patients where only conventional abdominoplasty would not offer a good final aesthetic result.
The principles of technique and postoperative care are the same as those of conventional surgery, differing only in the type of incision applied, where a second incision is made in the medial part of the abdomen, from the incision of the pubis to the limit of the thorax, resecting the excess skin and fat of the medial region of the abdomen.
c) Liposuction - Whichever technique is chosen for the abdominoplasty, it may be necessary to perform a liposuction together with the procedure, to remove excess amount of excess fat, further contributing to a better aesthetic result.
Mamaplastia is the second most performed procedure by patients who presented great weight loss, losing only to Abdominoplasty.
Weight loss results in a marked decrease in breast tissue, requiring local repair. The difficulty found here is precisely the loss of breast content, since it is basically composed of breast tissue and fat.
Different techniques have been developed to resume breast shape and contents, bringing a more graceful end result to the breasts. They involve resection of excess skin and glandular tissue and vary in the use or not of silicone prostheses.
No drains are used in most cases and the patient is discharged the day after the procedure using a specific post-surgical bra, which should be maintained for the next 2 months.
In particular, I prefer the result of Mammaplasty with the use of silicone prostheses. The large variety in volumes and shapes that are currently on the market, such as high profile, super high, anatomic or conical prostheses, means that the breast content is adequately restored, giving more harmonic and long lasting results.
The surplus of skin and fat conferred on the arms and legs of patients who presented great weight loss is surgically corrected through simpler techniques.
a) Plastic surgery on arms: Brachioplasty or Brachial Lifting is performed through an incision in the inside of the arm, extending from the axilla to the elbow. All too much tissue is resected and the skin sutured. Local Liposuction may be required for the removal of all redundant fat. No drains are used, and the patient is discharged the next day using a specific compressive mesh within 2 months of the procedure.
b) Thigh plastic surgery: Coxaplastia, Crural Dermolipectomy or Lifting of Thighs is similar to brachioplasty in its principles. It may range from a simple local liposuction, to wider resections, located on the medial aspect of the thighs, and may extend to the inguinal region in more unique cases. Routine, local drains are not used, with the patient being released home the day after surgery, walking without major difficulties, also using a specific modeling belt for 2 months.
Ritidoplasty or Facial Lifting has been increasingly sought after in plastic surgery offices by patients who have achieved great weight loss. The main complaint focuses on the neck and eyelids, but the entire face tissue suffers a fall. Often liposuction of the neck region is required in conjunction with Facial Lifting, in order to achieve better results.
The scars are hidden as far as possible in the region of the scalp and behind the ears, leaving only a more apparent incision near the ears. A drain is used that is removed the day after the surgery, before discharge, and no tapes are routinely used. The postoperative period is not usually uncomfortable, with a return to routine activities earlier than other surgeries.
With weight loss, there is also a marked change in the gluteal region, and its remodeling is necessary. Gluteoplasty can be performed with or without the inclusion of specific silicone prostheses. In cases where an excess of fatty tissue predominates, resection of this tissue and remodeling of the gluteal region can be performed without prosthesis through an incision in the upper portion of the gluteus.
In those cases where there is only a drop of the local tissues, the inclusion of silicone prostheses should be the chosen option. In both cases, a liposuction can be performed to remove excess local fat, and postoperative recovery involves the use of modeling belts within 2 months after surgery.
It is worth remembering that, in Brazil, health plans are required by law to cover all expenses related to plastic surgery. In this context, the patients who underwent a great weight loss, by surgery or not, have the surgeries mentioned above covered in the majority, not having any cost on the part of the patient. They are the Abdominoplasty, the Brachial and Thigh Lift, and some cases of Mammaplasty. So, find a Plastic Surgeon who is in agreement with your health plan and ask your questions.
