Obesity is one of the major health problems in the United States. It has increased dramatically over the last 40 years. Fast foods, lack of exercise, genetics, and poor diets have all contributed to the increase. It is estimated that 65% of American adults are overweight but it is not just a problem for adults. 30% of children between the ages of 6-19 are at risk for being overweight. In addition, one third of adults over the age of 60 are obese. Rates of obesity are higher in black and Hispanic women compared to their white counterparts. Obesity is associated with serious medical problems including hypertension, heart disease, diabetes, stroke, sleep apnea, and degenerative joint disease. Over the last 10 years, there has been a marked increase in operations to control weight gain. These bariatric surgeries are basically classified as restriction procedures such as gastric banding or malabsorption procedures such as gastric bypass. The number of bariatric procedures has increased from approximately 13,000 in 1998 to over 250,000 in 2008.
These procedures will result in dramatic weight loss, in some cases up to 250 pounds. It goes without saying, that once a patient loses that much weight, they have significant skin laxity. Procedures developed during the last decade, to remove excess skin, are probably the most exciting area of plastic surgery development. Most of the procedures concern removing skin and fatty tissue between the shoulders and the knees. Procedures with names such as extended abdominoplasties, lower body lifts, extended breast lifts, arm lifts (Brachioplasty), and thigh lifts have been developed and refined to the point that they are a reconstructive subspecialty within themselves. Because of the time it takes to perform these extensive procedures, as well as potential blood loss, these procedures are performed in stages, usually 3-6 months apart. The patient’s general health, including their nutrition, needs to be assessed. Bypass patients have more nutritional deficiencies, including anemia and these problems need to be addressed in order to ensure that the patient is in the best health they can be, prior to undergoing these procedures.