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Body Contouring Doc

Body Contouring Doc
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Janet K. Turkle, M.D.
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Carmel, IN 46032
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More high profile personalities like NBC newsman Al Roker, singer Carnie Wilson, actress Queen Latifah and others are losing half or more of their body weight through several types of bariatric surgeries. Surgeons create a drastically reduced pouch in the stomach that holds no more than half a cup of food. Nearly 141,000 Americans underwent the procedure in 2004.

But for these patients - whose average weight loss runs from 100 to 250 pounds -- the battle is only half over. Because they have been so overweight for so long, their skin is stretched out and hangs loose on the body like a huge suit three or four times too large.

"I recently saw one patient whose loose stomach skin hung down to her ankles," says Dr. Turkle.

Consequently, more people are asking plastic surgeons about body contouring, or body lifting, surgery that removes the extra skin.

"People considering the operation should have lost at least 100 pounds, maintained a stable weight for 12 to 16 months after the bariatric surgery, be in good health and are not planning on becoming pregnant," says Dr. Turkle.

The condition is more than unsightly - not only does all the extra skin get in the way of free movement, it chafes, causes the skin to break down in places and creates hygienic problems. Moreover, it's hard for such a person to fit into clothing.

In the initial consultation, surgeons explain the downside of a total body lift is long scars on the arms, legs and across the stomach. Many massive weight loss patients also opt to have a breast lift while a few request a facelift due to significant skin looseness in the neck and jawline. Where possible, surgeons try to hide the thin scars - which are only one-half the width of a pencil line -- in natural creases in the skin. Scars can take a year to completely heal and usually fade after about three years. Nonetheless, most patients accept the tradeoff for losing the bothersome extra skin.

In a typical full body lift, the surgeon removes excess skin from the chest to the upper thighs. It starts by taking off the excess skin hanging from the patient's upper arms in a procedure known as a "brachioplasty." Incisions are made that run from the armpit to the elbow. On the lower abdomen, another incision running from hip to hip allows the large, hanging paunch that surgeons know as a "pannus" to be removed from the abdomen, while the upper thighs are opened from the crotch to the knee. A total body lift requires a "belt lipectomy," an incision that runs all the way around the body.

Possible complications include problem wound healing, temporary discomfort, blood loss, infections and blood clots in the lungs. However, surgeons do all they can to help lessen these slight risks by getting the patient up and moving after the surgery and showing them how to best care for surgical wounds. With a 150 pound loss, it is not unusual to remove between ten and thirty pounds of skin on a large patient. The largest amount I've seen was from the patient whose excess skin hung down to her ankles. The oversupply of skin from her stomach alone weighed 60 pounds.

The procedure is usually done in more than one session if the patient wants multiple areas removed. The generally accepted safe time for a healthy person to stay under general anesthesia is five or six hours or less. Thus, the excess skin of the breasts and trunk can often be removed in one surgical session while the redundant skin from the arms and thighs are removed in yet another.

Most procedures that are completed in two to four hours are done on an outpatient basis. In four to six weeks, the patient can return to work, with other normal activities being resumed at about eight weeks.

Some surgical centers use the skin and fatty excess in stem cell research or for burn research with the patient's permission. Otherwise, the tissues are discarded.

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