Post Massive Weight Loss Body Contouring - Dr. Peter Fisher, M.D.


Over the past ten years, the body contouring procedures following massive weight loss have increased more than ten-fold. Primarily performed by plastic surgeons, this area of surgery has essentially become a subspecialty of plastic surgery, making up to 80% of my practice. Like many regular cosmetic procedures, there is a definite learning curve as well as a higher complication rate to body contouring surgery. Although essentially cosmetic, a considerable amount of our reconstructive background has been used to develop some of the surgical techniques that we use.

Most of the patients that we see are those that have lost weight following bariatric weight loss surgery. These patients have their own special problems that we try to address, ranging from nutritional to the quality of their tissues.

One of the problems following bariatric weight loss surgery is the patient’s nutritional status, because of changes in their absorption pattern, worse in bypass patients, better in gastric sleeve patients, and best in gastric bands.
The reverse is true for the amount and rapidity of the weight loss. Typically the greater and more rapid the weight loss, the worse the subsequent condition of the skin, - resulting in thinning and loss of elasticity. With the loss of fat volume and subsequent gravitational pull, not only do we have to remove excess tissue and lift the remainder, but also add volume.

This can be done by flaps of tissue and fat injections.

Who are candidates for post bariatric body contouring, when is the ideal time to perform these, and how many procedures can be safely performed at one surgical setting?

Depending on which surgeon you choose, these answers may differ considerably.

I will operate on patients up to 75 years of age if they are healthy enough. The closer you get to your goal weight the better your results will be. The less fat on your body, the fewer complications you will have. Having said that, most patients that I operate on are still above what we would call their goal weight. I would like my patients to be at a stable weight for at least three months. If I feel they are still heavier than I would like, we discuss the possibility of changing their diet and exercise program to try drop a little more weight if possible. If not I will still usually operate with the understanding that these patients post surgical complication rates will be higher. I will also be less aggressive with my techniques to try to reduce the complication rate.

I try to encourage patients to do as many procedures in one surgical setting. This gets them closer to the end of their surgical journey sooner, allowing them to concentrate on moving forward with their lives. It also means fewer anesthetics and less time off work recovering from what would be multiple operations. In order to do multiple procedures in one surgical setting the surgeon needs a well trained staff that are used to these big procedures. I also use a second plastic surgeon to reduce the time under anesthesia.

Next time, I will discuss the procedures themselves.

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San Antonio Plastic Surgeon