Obesity is today affecting 30% of the population and , 15 percent are children or teenagers.
Obesity is today a social decease and gives course to psychological problems: like depression melancholia, low self-esteem, loss of energy, but also physiological problems like: difficulty to find clothes in the right size, to go swimming, to tie shoelaces, sports activities and having sex.
Obesity brings also along medical complications like diabetes ,high cholesterol, cardiac diseases, vascular diseases like thromboses and varicose veins, an increased risk for pulmonary embolus and intracerebral bleeding.
To avoid all these things it is necessary to loose weight not only to avoid severe complications and possibly death, but also to feel better with oneself.
To lose weight it is necessary to have a good nutritionist, who can help with putting together balanced diet, without causing a malnutrition. However this is frequently not sufficient, especially with severe obesity. These patients can only be helped with what we call ,bariatric surgery. The principle of this kind of surgery is to change the intestines so less food is absorbed or can be eaten in one meal. The most common procedure today is to diminish the stomach and can be done with endoscopic surgery, which carry less risk of complications then other kinds of surgery. With the help of this surgery it is not unusual to lose 30 to 50 kg in one year.
When the normal weight has been established, it is a very common that the skin costume is five number too big for the new body. The patient has a feeling of floating around inside his/her skin envelope.
This is where the plastic surgeon can help with a so-called bodylift, together with other designed liftings of different parts of the body, like brachioplasty of the upper arms, and a breast lifting (of both men and women).
A bodylift is basically an abdominoplasty (tummy tuck ) which is extended on both sides until the two incisions meet each other in the midline of the back. With this surgery, one can correct the surplus of skin, over the abdomen, outside of the thighs, as well as lifting the buttocks.
An the results of a body lift is very gratifying for both the doctor and the patient a bodylift is frequently done for women after multiple pregnancies. This situation after multiple pregnancies is many times very similar to an obese person who has succeeded to loose a significant amount of weight, with a too big skin costume as part of the result. In both cases it is very common with stretch marks ,following the earlier distention. This skin has lost the elastic capacity and can not retract.
The body lifting should only be done in the best possible conditions, that means when a sufficient weight loss is achieved and the weight is also stabilized. An early consultation with a plastic surgeon, even before the weight loss has taken place, can sometimes be of great help, to make a strategy for the weight loss, to find a nutritionist, a psychologist and eventually a bariatric surgeon.
As I mentioned earlier, different liftings of the body is designed depending on the need of the patient. The most common however, is an abdominoplasty.
The goal here is to reduce surplus of skin and fat and shorten the abdominal muscles which have been distended either from overweight or multiple pregnancies. This has been described under the headline of abdominoplasty. In short, one is making an incision just above the pubes horizontally, out into the flanks. It is frequently combined with a liposuction of the abdomen and out into the flanks. The skin and fat is undermined over the whole abdomen. The distended muscles are repaired and brought into the midline. The excess of skin and fat is excised and the umbilicus is cut out and re-implanted into its new position.
Many patients are afraid of the scar, but even if it’s long, it is healing well and placed well inside a minimal bikini.
An abdominoplasty will give you a flat abdomen, beautiful, and functional, and in many cases also solves the problem of constipation and backpain due to bad posture .
The repair of the abdomen is crucial for both men and women. It gives a better hygiene, as well as a better quality of life. More details are given about the surgery under headline of abdominoplasty.
The body lifting
This is a different surgical technique, which will improve the abdomen, as well as the outside of the thighs and will lift the buttocks. The bodylift is also sometimes called a circular lipoectomy.
The body lifting is necessary to do in 2 positions on the operating table, and the design is done with great care with the patient in a standing position before surgery. This surgery starts with doing a normal abdominoplasty, and then the incisions is carried out into the flanks. The excess of skin and fat is excised and the incisions are closed, the patient is then turned on to the stomach and the incisions in the flanks are now continued on to the midline of the back. Excess of skin is excised. When closing the skin, the lateral thighs and the buttocks will be lifted. The total length of the incision and the procedure , can be viewed as pulling on a pair of pants.
The bodylift is an excellent operation that gives the middle part of the body , a whole new appearance. It is however as I earlier emphasized, necessary that the patient has lost the overweight to get the best possible result. For women after multiple pregnancies, who often has a normal weight, but this skin has been distended and destroyed with multiple stretch marks especially over to abdomen, the bodylift as well as an abdominoplasty alone, can give them back a youthful body and they can start a new life.
The convalescence of the body lifting is the same as for an abdominoplasty, if the patient has succeeded with the weightloss and the weight now is stable.
Complications are unusual and then mostly local, like insufficient wound healing, a small skin necrosis, most common with smokers, or a wound infection due to contamination from the closeness of the perineum. To avoid this, it is necessary to follow all postoperative instructions and take the medications as prescribed. Among the instructions is important to mention the use of stockings for the first two weeks to avoid thromboses and an eventual pulmonary embolus.
Special boots with intermittent pressure is used during surgery to drain the legs of blood, and prevent a thrombosis . Heparin is also given after surgery for the same reason. A cover of antibiotics is given during and after surgery to prevent possible infections.
Before leaving the operating room, I put on an elastic garment around the stomach and body, this to hold the skin in place and it gives also a better comfort for the patient.
Other lifting procedures of the body
With the bodylift ,we often also performed a lifting of the inside of the thigh. If the skin excess is reasonable, I use a short horizontal incision that can be hidden beside the pubes. With larger amounts of skin excess on the thigh, it is necessary to use a vertical incision on the inside of the thigh all the way down to the knee.
Brachioplasty, the tightening of the skin of the arm, can be done either with a short incision in the axilla, or along the inside of the upper arm. With the latter incision it is important to show the patient the resulting scar ,which is difficult to hide with bare arms. It is also therefore important that the indication for this kind of surgery is very well established.
Lifting of the breasts is very often necessary with our weight loss patients. Look under the headline of breast surgery for more precise details.
One can foresee three different cases.
The breasts are still very large and hanging, and a classic breast reduction is done.
The breasts are normal in volume, but hanging. A breast lifting is done.
The breasts are empty and lacking normal volume, as well as being hanging,with loose skin. They look like two empty sacs. The volume is substituted with an implant, or if the patient have enough fat and is in need of a liposuction, one can use the fat to do a reinjection to replace volume in the breasts, this is called a lipofilling. With the volume replaced a lifting is proceeded to reduce the excess of skin.
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