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Comprehensive Body Contouring: Theory and Practice

Matarasso, Alan M.D.

Author Information
Plastic and Reconstructive Surgery: November 2016 - Volume 138 - Issue 5 - p 1137-1138
doi: 10.1097/PRS.0000000000002721
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Arun K. Gosain, M.D.

Review Editor

In less than a generation, plastic surgery after massive weight loss (i.e., bariatric plastic surgery) has emerged as a bona fide “subspecialty” of plastic surgery. Before the turn of the century, there was a paucity of literature and interest in the subject, perhaps because the massive weight loss population was limited to those few individuals who had succeeded in losing weight by diet and exercise. The explosion in the number of bariatric surgery procedures was the defining gateway to bariatric plastic surgery, and innovative plastic surgeons quickly mastered the unique needs of this population. Now, a plethora of articles, teaching symposia, societies, and dedicated training programs exist and attest to the specialized nature of this type of surgery, underscoring its niche in our specialty and the plastic surgeon’s role in completing the final transformation of massive weight loss patients in their journey to complete the process and shed their “second skin.”

Some textbooks exist on this subject, most of which have multiple authors and offer the advantage of diverse opinions and the disadvantages of being less cohesive in their thought and flow. Comprehensive Body Contouring: Theory and Practice is a single-author book, with an emphasis on his perspective regarding total face and body rehabilitation for skin laxity subsequent to massive weight loss. Hurwitz deviates from the typical surgical textbook’s format of addressing individual anatomical operations and moves to the impact that multiple simultaneous operations have on contiguous structures, and then further advances our knowledge by viewing them through the lens of gender-specific implications. Ancillary technology, such as VASER (Solta Medical, Inc., Hayward, Calif.) and Quill sutures (Surgical Specialties Corp., Wyomissing, Pa.), are highlighted because of his preference for using them. Despite the articles being single-authored, he appropriately describes collaborating and contrasting concepts that other surgeons have. The bibliographies that appear at the end of each chapter are comprehensive and span earlier and important historical contributions, accurately reflecting the evolutionary timeline to modern day surgery.

Comprehensive Body Contouring: Theory and Practice is a compact, hard-cover, 234-page instructional manual/atlas produced on high-quality paper, with excellent artwork from Brazilian illustrator Luis Concalves, that showcases excellent standardized patient-specific preoperative and postoperative examples. Ten region-specific, demonstrative videos accompany the textbook. Hurwitz’s preface, introductory comments, and second chapter (Aesthetics, Examination, and Care) establish the framework for his overall thought process. These are followed by chapters entitled Principles and Basic Techniques, Body Contouring Surgery for Women, Body Contouring Surgery for Men, and Facelift in the Body Contouring Surgery Patient. The book is written in a frank, conversational style that, in conjunction with text, artwork, examples, and video, endeavors to bring the reader into his operating room to observe and converse with the author in “real” time. Particularly noteworthy are his thoughts on which surgical procedures are appropriate to combine; reshaping the female breast; the boomerang pattern for gynecomastia; the L-shaped brachioplasty (or straight-line excision from elbow to infra-axillary region) and J-torsoplasty, and addressing muscular male patients. The author frankly comments on his early and long-term results.

A minor, albeit frustrating point is the periodic dislocation between the items listed in the index and their corresponding pages within the textbook, which ultimately is a minor distraction. Also, some selected ideas and concepts presume the reader’s preexisting knowledge, which may not necessarily be the case, so the text would benefit by additional explanation. Also, his thoughts on the role of pharmacologic deep venous thrombosis/pulmonary embolism prophylaxis, and any insight into his experience when these patients regain weight after surgery would be helpful. There is scant mention of remuneration for these multiple, costly procedures, which blurs the line between—depending on which side of the fence you happen to be on—self-pay or insurance reimbursable.

This textbook represents a compendium of the author’s practice and journal publications contributing to a subspecialty that he helped pioneer. Dr. Hurwitz has taken the arrows in that journey, which allows the reader to enjoy the fruits of his labor. This is a book that puts the entire process of surgery after massive weight loss together, and a volume that surgeons interested in this topic need to own.

Copyright © 2016 by the American Society of Plastic Surgeons