Dr. Joseph F. Capella Interview: Plastic Surgery After Weight Loss, Part 2

Patient Expert

Read part 1 of this Dr. Joseph F. Capella  Interview

**Dr. Capella abdominoplasty patient  **

Body contouring delivers dramatic improvement after bariatric surgery as seen in the before and after photos of a patient three months after abdominoplasty (tummy tuck).

The Need for Body Contouring Surgery After Weight Losy Bariatric Life: Dr. Capella, a survey conducted with members of the American Society for Metabolic and Bariatric Surgery (ASMBS) found that pre-bariatric surgery counseling regarding outcomes and discussions of body contouring procedures is deficient and that few bariatric surgeons refer their patients to plastic surgeons even when patients ask about these procedures.

So my question is what must be done to improve the comprehensive treatment of patients undergoing bariatric surgery to ensure they are fully informed of the functional and aesthetic consequences of bariatric surgery, and have information on and access to plastic surgery?

Dr. Capella: I think that the education should begin with the bariatric surgeon. And patients should be informed about the potential consequences of massive weight loss on their contours. When I worked with my father, who is now a retired bariatric surgeon, we spent a great deal of time educating our patients about that so they would not be surprised by it. I think these consequences are better received when people are aware of them before they actually happen.

So, I think education has to start with the bariatric surgeon. What some of my colleagues in the society [American Society of Plastic Surgeons] have done is made presentations at the bariatric surgical meetings. So that is one step in that direction. I just think that bariatric surgeons are very concerned with what they're doing. They may not be very familiar with the nuances of the plastic surgery. So, it might be easier for them just to avoid the topic.

MBL: As for me, I was not made aware of the functional and aesthetic consequences of bariatric surgery. I expected my flesh would shrink with the weight loss as it had done in the past. Why is weight loss after bariatric surgery different?

Dr. Capella: I think about this a lot.  And what I would say is that the excess tissue and when I say tissue I mean skin and the underlying structures that people have in excess after weight loss are correlated with a number of things. I think they're most correlated with the length of time the person was overweight, but also with their age, sex, and gender in terms of where the excess is but not with the speed with which they lose the weight.

I think it's a misconception that if you lose your weight very quickly you're going to have more excess skin. The damage is done by the extensive period of time that the skin is under tension. In women the skin's a little thinner, certainly lighter complexions tend to have more excess skin. Patients of darker complexion and men tend to have less excess skin and soft tissue.

MBL: So I'm getting a mental image of a balloon. When you blow it up, if you don't leave it inflated for a long time it pretty much returns to its pre-inflated state. Versus if you leave it inflated for a while, the shape is puckered when you deflate it.

Dr. Capella: Absolutely it's all shriveled up. That's exactly right.

MBL: It was not until I came through my abdominoplasty that I was struck with the awareness that body contouring is the final step in completing my weight-loss journey by removing the last traces of my former obesity. Please share your perspective on plastic surgery in the bariatric treatment plan and its role in improving the patient's quality of life.

Dr. Capella: There's no doubt that bariatric surgery has potential to improve people's health enormously, in a way that plastic surgery does not. However, I think despite the improvements people are often surprised by how their self-esteem and other daily activities are not improved without body contouring. And so issues having to do with rashes or what we call intertrigo or intertriginous dermatitis are often exacerbated by the weight loss. And people are encumbered by a large pannus [apron of belly fat]. So it's not like they're now then able to exercise like they thought they would by losing weight. And it's only body contouring that has a significant impact on that.

Now I would not want people to believe that plastic surgery, per se, improves their health by removing weight. There is weight loss but it's not the kind that would necessarily improve people's health conditions like diabetes and hypertension. And the reason being is the kind of fat that needs to go away to improve health is visceral fat, meaning the fat around the organs. The improvement in health really comes from increased functionality: They are able to be more active. But not because weight because it can be substantial is removed by the plastic surgery. So I think it plays a very important role in patients' recovery from a self-esteem point of view, emotionally and functionally.

Continue to part 3 of the Interview with Dr. Joseph F. Capella** Living life well-fed,**** My Bariatric Lifore shareposts from  MyBariatricLife on HealthCentral**** Follow  MyBariatricLife on Twitter**** Connect with  MyBariatricLife on StumbleUpon** ** View my  Grains Make Me Fat! recipe cards on Pinterest**** References**

PubMed.gov, American Association of Plastic Surgeons, http://www.ncbi.nlm.nih.gov/pubmed/19730313