Post WLS Plastic Surgery: Is It Mandatory?

(c)  Alma Orozco

Dramatic weight loss achieved as the result of bariatric
surgery, or from other forms of medical treatment, has
several benefits as far as the reduction in morbidities
associated with obesity is concerned. Patients who have
undergone bariatric surgery must accept a lifetime of
changes; eating habits, lifestyle adjustments, and
prolonged medical supervision. However, in spite of
reaching weight loss goals and a drastic lifestyle
modification, the patient may not achieve the desired
healthy body image.

Which brings us to the inevitable question: post WLS
plastic surgery: is it mandatory?

The answer is not as simplistic, and there are several
considerations, apart from aesthetics. Skin and
subcutaneous tissues cannot conform to the reduced body
size because of impaired elasticity, resulting in skin that
sags. The stretched and sagging skin is weak and
unattractive and often becomes macerated .This wet and
infected skin can pose a serious threat to the patients'
health, being a source of constant discomfort by causing
rashes and even serious infections.

Another important consideration is the psychological impact
of not achieving the desired body shape in spite of
stringent lifestyle changes and undergoing the morbidities
associated with bariatric surgery.

Plastic surgery for body contouring following weight loss
surgery not only improves the shape and tone of the body,
but also removes excess sagging fat and skin. The result is
a more normal appearance of the body, with smoother, more
harmonious contours. This results in a positive body image
commensurate with the initial expectations of the patient.

Aesthetic surgery following drastic weight loss includes
body contouring options as tummy tuck, liposuction, and
body lift. These procedures help patients to enjoy the
complete benefits of weight loss including cosmesis and the
positive psychological effect of having a refined body.

However, before a decision is made to undergo body
contouring following major weight loss, it is essential
that the weight loss be stable for a considerable duration
of time. Otherwise, continued loss of weight after body
contouring plastic surgery will result in redevelopment of
the sagging pockets. Similarly, regaining the weight can
stress the already weakened and thinned skin, resulting in
visible stretch marks and widened scars.

A consultation with the plastic surgeon and the bariatric
surgery team is imperative to learn understand how body
contouring following major weight loss can help the patient
achieve better health and an improved appearance. This
includes an evaluation of the individual case in terms of
the options available in body contouring surgery as well as
expectations of the patient .The patient must be informed
of the likely outcomes of plastic surgery following WLS and
associated risks.

Potential complications include bleeding, infection, fluid
accumulation, delayed or poor wound healing, and irregular
or asymmetric contours or scars, apart from the risks
associated with anesthesia due to repeated surgical
procedures.

It is therefore essential to evaluate the risk benefit
ratio on a case to case basis, in consultation with
experienced specialists in the field, before concluding
that post WLS plastic surgery is mandatory.