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Cosmetic Surgery after Massive Weight Loss

Korman, Josh M.D.

Plastic and Reconstructive Surgery: January 2014 - Volume 133 - Issue 1 - p 200
doi: 10.1097/PRS.0000000000000001
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Ronald P. Gruber, M.D.

Review Editor


Once bariatric procedures became safer and insurance companies discovered that covering the cost of these operations was in their best interest, thousands of patients lost a lot of weight fast. As a result, the plastic surgery community has responded with an array of procedures to treat the tissues that had no time to recover as the fat vanished. Countless articles and many books have been written to assist the plastic surgeon with these challenging patients. Cosmetic Surgery after Massive Weight Loss, edited by Seth Thaller, M.D., and Mimis Cohen, M.D., is a welcome addition to this growing library. The relatively small overlap of authors of books writing on the topic attests to the large number of surgeons who have developed an interest in the massive weight loss patient.

The book begins with chapters on patient selection, including medical and psychological screening. Preoperative evaluation is especially important in these postbariatric patients, as it relates to nutritional deficiencies and the potential for postoperative anemia. Knowing when to operate on these patients is as important as knowing who are good candidates. Of course, some patients lose significant amounts of weight with diet and exercise, and they do not have the same nutritional needs. The book follows with anesthetic considerations, and the sequencing and timing of surgery (including outpatient lower body lift). Then, with very clear photographs and diagrams, each relevant anatomical section is addressed (i.e., trunk, breast, extremities, and face). Some additional important areas covered include the gluteal area and the mons pubis. Many of these patients have a relative deficiency in the buttock area and significant ptosis and redundancy of the mons pubis. How to treat these areas is a necessary consideration, as so many of these patients are anxious to achieve the best aesthetic result in as few procedures as possible. These anatomical areas are among the most challenging in producing consistently excellent results. Another important chapter includes the treatment and avoidance of unfavorable results. The final chapter on medicolegal issues offers an excellent summary of medical malpractice considerations in all plastic surgery patients.

For any practitioner who embarks on treating this challenging group of patients, Thaller and Cohen’s book will be a useful guide to preoperative issues, including timing and safety considerations. When it comes to performing the operation, plastic surgeons with little experience in dealing with massive weight loss patients may initially find it hard to appreciate the nuances that exist in three dimensions. This skill will come after performing these operations over and over again. For those experienced with these procedures, this book also addresses thought-provoking alternatives. Clinicians need to literally tailor their techniques to each individual, and this book should prove helpful in successfully treating these challenging patients.

©2014American Society of Plastic Surgeons