Plastic Surgery after bariatric surgery

Indications and contraindications

Excess skin can cause various complaints, including diametrically elaborations and infections of skin and navel folds, unpleasant odors, back and neck problems, pains and pain -related pains, exercise and intimacy, skin lesions due to concentration, difficulty finding matching clothes and inequality between appearance and age (5). Abdominal area causes most problems followed by chest and thighs (5, 6). Therefore, excessive skin can become a new source of stigma, social isolation and reduced quality of life for these patients (7, 21).

The risk of complications associated with body contour surgery after severe loss of meta-brimal weight varies depending on factors such as the size and range of the process, nutritional status, smoking and degree of overweight. Medical co -censorship are not a contraindication to plastic surgery, but limit the selection of procedures due to a higher risk of complications and underlying results (8).

Smoke smoking is linked to 2-3 times higher risk of postoperative complications of wounds, infections and delayed healing (22). Preoperative smoking cessation can be reduced by half to risk and the risk is lower after at least four weeks of abstaining from smoking (22). Smoking cessation is therefore an absolute requirement before any type of surgery of body contour surgery (22)–(24) .

Before plastic surgery, the patient should have good nutritional condition, hemoglobin levels> 10 g/100 ml (8, 23)and have a satisfactory level of physical ability (8, 24). Any gastrointestinal pain after weight loss surgery should be investigated and treated before the evaluation of plastic surgery, as it may otherwise be difficult to distinguish the subsequent acoustic pain in the digestive system. Patients with previous thrombosis of deep vein or lymphoedema on the risk of relapse should be informed and adequate thrombocytosis should be ensured (8, 25).

Plastic surgeons often regulate the upper BMI limit for body contour surgery at 30 kg/m² due to the fear of complications and because skin removal is easier if there is not much extra fat (9, 26). Some small retrospective observation studies support this view. Important evidence suggests that the incidence of serious and less serious complications is about twice in those with BMI ≥ 30 kg/m² compared to those with BMI <30 kg/m² (26)–(28).

The results of two important future registry studies have failed to confirm the preoperative BMI as an independent predictor of surgical complications (24, 29). However, the risk of complications increased with the growing BMI (OR 1.06, 95 % CI 1.0 – 1,1) (24). Overall, we do not believe that there are strong scientific reasons for the use of the BMI only as a tool for evaluating the indication for surgery. If BMI ≥ 30 kg/m² is used as an exclusion criterion for surgical removal of loose skin after weight loss, more than half of the patients needed such treatment could be excluded (17).