Body Contouring

Body Contouring At A Glance
Insurance Coverage
Overview of Body Contouring Surgery

by Peter T. Pacik, MD, FACS

The Cosmetic Surgery Times, Vol. 10, No. 8 Sept, 2007 published a series of articles on the massive weight loss patient. The following resource article is an overview of some of the more important concepts discussed in these articles:

The number of weight loss surgeries in the U.S. increased from 28,800 in 1999 to 171,000 in 2005, according to the American Society of Bariatric Surgeons, and, as a result, post-bariatric surgery has become one of the fastest evolving specialties in plastic surgery. Lower body lifts, for instance, soared from just 207 in 2000 to 10,323 in 2006 — a whopping 4,887 percent increase, and upper arm lifts jumped from 338 to 14,886 in the same period — a 4,204 percent increase, according to the American Society of Plastic Surgeons (ASPS). The total number of body contouring procedures performed specifically for massive weight loss patients exceeded 68,000 in 2005, the ASPS reports.

Unlike most other areas of aesthetic surgery, post-bariatric body contouring can be a truly life-changing event, with major physical, social and psychological impact. Most overweight people have struggled much of their lives with physical issues, other medical problems, self-esteem, body image problems and social discrimination. After the weight loss has been achieved, despite major improvements in health, they are disappointed to see a substantial disconnect between their new healthy lifestyle and their sagging physical appearance. They are unable to fit into proper-sized clothing or look as good as they feel. Old body image concerns resurface worse than ever. In short, many find they are not enjoying life the way they should be because of all of the excess skin and other deformities present after massive weight loss.

It is recommended that plastic surgery should not occur before a new and stable weight has been achieved for some months. Identifying malnutrition, which is quite common and often unrecognized, needs to be corrected. Protein-malnourished patients may have difficulty with wound healing. Psychosocial issues, including depression, other mood disorders, personality disorders and substance abuse, also need to be addressed before surgery is considered.  Although most patients find some support among their friends, spouses or family for undergoing bariatric surgery, the same support is often lacking once the weight is lost and the patient is seeking plastic surgery.

A new study, especially designed for massive weight loss (MWL) patients, shows improved quality of life and positive body image. These changes receive an added boost with body contouring. An interesting study finding was that when patients had improvement in certain areas of their body from body contouring surgery, it would sometimes draw their attention to other parts of their body that had not been surgically treated. For example, patients who came in with the primary complaint of dissatisfaction with the contour of their abdomen and breasts, who then had those areas treated with body contouring surgery and had good results, would then focus on other areas of their body that they have become dissatisfied with that hadn't been a priority for them in the past.

Insurance coverage for these procedures is limited and generally growing tighter — carriers typically might cover only post-bariatric abdominal panniculectomies — if any post-bariatric procedures at all. Insurers almost universally consider procedures for the arms, thighs, face and everything else cosmetic. And with the abdominal surgeries, their criteria, and how they enforce them, have gotten dramatically more rigid in the last two or three years.

We at the Plastic Surgery Professional Association are proud to have Dr. Daniel Sterling on staff working with the massive weight loss patient. This is an area of specific training that Dr. Sterling has achieved and we are delighted to see his results and the excellent feedback from his patients. He pays very close attention to nutritional, electrolyte, and hematocrit values and orders a full compliment of laboratory testing. The results are then discussed  with the patient. In this fashion, we have picked up several iron-deficiency anemias that were not being treated. Dr. Sterling has found body contouring surgery to be an especially rewarding part of the practice, helping people achieve their goals of looking and feeling better after they have made the major effort of major weight loss.

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