Post Bariatric Surgery in San Francisco Bay Area, Oakland, and Walnut Creek

While one third of the American population are obese, just five percent are in fact candidates for bariatric surgery. According to the American Society of Bariatric Surgery (ASBS), 200,000 Americans will undergo massive weight loss surgery this year, and 75% of them will later seek a plastic surgeon for body contouring.

Roux-en-Y Procedure

The most common technique used in Bariatric Surgery involves a partial division of the stomach, diverting the smaller remaining stomach to the small bowel, the stomach below this division is in turn again diverted to a more distant small bowel, this is called a Roux-en-Y Procedure.

San Francisco Bay Area Post Bariatric Surgery

Following Bariatric Surgery, modern insurance inclusion criteria for a ‘covered benefit’ for plastic surgery includes: greater than one year after Bariatric Surgery, greater than 90 pound weight loss, and a symptomatic pannus of the lower abdomen which extends beneath the lowest pubic hair line. Most insurance carriers will authorize a surgery called a ‘panniculectomy’ (the resection of a pannus). Typically this does not involve preservation of the umbilicus if included in the pannus. Many patients request a more cosmetic result and opt for an abdominoplasty with panniculectomy. There is an additional cost associated with the abdominoplasty. The abdominoplasty is usually combined with an extension to the posterolateral flank to avoid an unsitely so called ‘dog –ear’ deformities in the flanks after the surgery. This extended abdominoplasty is combined with liposuction in the flank region, which helps with the overall contour.

Some surgeons prefer to perform a circumferential resection of skin and fat. I have found that this limits the amount of resection from either side. Most my patients loose about 15-20 pounds after the abdominoplasty. This weight lose is related to a sense of satiety which may last over 6 months. The sense of satiety I believe is a result of the internal corsette like effect of suturing the rectus muscles together in the midline. The ability to sit the patient forward during surgery allows for a greater skin resection, a lower less visible bikini line scar and a more dramatic flattening of the abdomen. Performing circumferential resection would limit the amount of flexion possible and for this reason I prefer to stage the procedures.

About 3 months after the abdominoplasty a near – circumferential thigh and buttock lift is performed. This is the ideal time, at maximal weight loss following abdominoplasty. First the thigh lift is performed face up and then the buttock lift is performed in the face down position and in relative back extension. Back extension, the opposite of that for abdominoplasty, allows for a maximum thigh and buttock lift. If there is considerable buttock flattening, the skin and subcutaneous fat above the buttock is folded downward into the buttock to give it volume and shape.

Body Contouring, Post Gastric Bypass, Morbid Obesity, Gastric Band Surgery, Body Lift and More

Following the thigh and buttock lift, most patients then undergo less extensive procedures such as removal the underarm pannus: brachyplasty and often this is combined with a breast lift with sub-muscular breast augmentation. The final procedure is the rejuvenation of the face with face-lift and eyelid surgery.