Obesity is today affecting 30% of the population and, 15 percent are children or teenagers.
Obesity is today a social decease and leads not only to psychological problems such as depression, melancholia, low self-esteem, loss of energy, but also physiological problems like: difficulty to find clothes in the right size, to go swimming, to tie shoelaces, sports activities and having sex.
Obesity is also associated with several medical complications like diabetes, high cholesterol, cardiac diseases, vascular diseases such as thromboses and varicose veins, an increased risk for pulmonary embolus and intracerebral bleeding.
Loosing weight is essential. Not only to avoid severe complications and possible early death, but also to feel better with oneself.
To lose weight it is necessary to have a good nutritionist, who can help by putting together a balanced diet, without causing malnutrition. However this is frequently not sufficient, especially with severe obesity. These patients can only be helped with what we call, bariatric surgery. The focus of this kind of surgery is to make change to the intestines so less food is absorbed or can be eaten in one meal. The most common procedure today is to reduce the stomach size and it can be done with endoscopic surgery, which carry less risk of complications then other kinds of surgery. With the help of this surgery it is not unusual to lose 30 to 50 kg in one year.
When the normal weight has been established, it is a very common that the skin size is five times too big for the new body. The patient has a feeling of floating around inside his/her skin.
This is where the plastic surgeon can help performing a so-called bodylift, together with other liftings procedures on different parts of the body, like brachioplasty for the upper arms, and a breast lifting (for both men and women).
A bodylift is basically an abdominoplasty(tummy tuck ) which is extended on both sides until the two incisions meet each other in the midline of the back. With this surgery, one can correct the surplus of skin, over the abdomen, outside of the thighs, as well as lifting the buttocks.
And the results of a body lift is very fullfilling for both the doctor and the patient. A bodylift is frequently done for women after multiple pregnancies. The situation after multiple pregnancies can be quite similar to an obese person who has succeeded to loose a significant amount of weight, with a too big skin costume as part of the result. In both cases it is very common to have stretch marks, following the earlier growth. This skin has lost the elastic capacity and can not retract on its own.
The body lifting should only be done in the best possible conditions, that means when a sufficient weight loss is achieved and the weight is also stabilized. An early consultation with a plastic surgeon, even before the weight loss has taken place, can sometimes be of great help, to plan a strategy for the weight loss, to find a nutritionist, a psychologist and eventually a bariatric surgeon.
As I mentioned earlier, different liftings of the body techniques are required depending on the need of the patient. The most common however, is an abdominoplasty.
The goal here is to reduce excess of skin and fat and shorten the abdominal muscles which have been overstretched either due to obesity or multiple pregnancies. This has been described under the headline of abdominoplasty. In short, one is making an incision just above the pubes horizontally, out into the flanks. It is frequently combined with a liposuction of the abdomen area and out into the flanks. The skin and fat is undermined over the whole abdomen. The stretched muscles are repaired and brought into the midline. The excess of skin and fat is excised and the umbilicus is re-positioned into its new position.
Many patients are afraid of the scar, but even if it’s long, it is healing well and is well hidden even inside a bikini.
An abdominoplasty will give you a flat abdomen, beautiful, and functional, and in many cases also will solve the problem of constipation and backpain due to bad posture .
The repair of the abdomen is crucial for both men and women. It gives a better look as well as a better quality of life. More details are given about the surgery under headline of abdominoplasty.
The body lifting
This is a different surgical technique, which will improve the abdomen, outside area of the thighs and lift the buttocks. The bodylift is also sometimes called a circular lipoectomy.
The body lifting is necessary to do in 2 positions on the operating table, and the mapping is done with great care beforehhand with the patient in a standing position. This surgery starts with normal abdominoplasty, and then the incisions are carried out into the flanks. The excess of skin and fat is taken away and the places of incisions are closed, the patient is then turned on to the stomach and the incisions in the flanks are now continued on to the midline of the back. Excess of skin isreduced. When closing the skin, the lateral thighs and the buttocks will be lifted. The whole process, in simple words, can be viewed as pulling on a pair of pants.
The bodylift is an excellent operation that gives the middle part of the body , a whole new appearance. It is however as I earlier emphasized, necessary that the patient loses excess of weight to get the best possible result. To women after multiple pregnancies, who often have a normal weight, but their skin has been overstretched and destroyed with multiple stretch marks especially over to abdomen, the bodylift, as well as an abdominoplasty alone, can give back a youthful body and they can start a new life.
The recovery period for the body lifting is the same as for an abdominoplasty, if the patient has succeeded with the weightloss and the weight now is stable.
Complications are unusual and mostly local, like insufficient wound healing, a small skin necrosis, most common with smokers, or a wound infection due to contamination from the closeness of the perineum. To avoid this, it is necessary to follow all postoperative instructions and take the medications as prescribed. Among the instructions is important to mention the use of stockings for the first two weeks to avoid thromboses and an eventual pulmonary embolus.
Special boots with intermittent pressure are used during surgery to drain the blood of the legs, and prevent a thrombosis . Heparin is also given after surgery for the same reason. An antibiotic treatment is given during and after surgery to prevent possible infections.
Before leaving the operating room, I put on anelastic garment around the stomach and body to hold the skin in place and it give more comfort to the patient.
Other body lifting procedures
Together with the bodylift, we often also performe lifting of the inside of the thigh. If the skin excess is not too big, I use a short horizontal incision that can be hidden beside the pubes. With large amount of extra skin the thigh, it is necessary to use a vertical incision on the inside of the thigh all the way down to the knee.
Brachioplasty, the tightening of the skin of the arm, can be done either with a short incision in the armpit, or along the inside of the upper arm. With the latter incision it is important to show the patient the resulting scar ,which is difficult to hide with bare arms. It is also therefore important that theneed for this kind of surgery is very well established.
Lifting of the breasts is very often necessary with our weight loss patients. Look under the headline of breast surgery for more precise details.
One can foresee three different cases:
The breasts are still very large and hanging, and then a classic breast reduction is done.
The breasts are normal in volume, but hanging. A breast lifting is done.
The breasts are empty and lacking normal volume, as well as being hanging,with loose skin. They look like two empty sacs. The volume is substituted with an implant, or if the patient have enough fat and is in need of a liposuction, one can use the fat to do a reinjection to replace volume in the breasts, this is called a lipofilling. With the volume replaced a lifting is proceeded to reduce the excess of skin.
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