I interviewed Dr. Joseph Capella (Capella Plastic Surgery), shortly after he did my tummy tuck, to gain his real-world perspective on body contouring after massive weight loss. Dr. Capella answers readers’ and my burning questions, bringing to light virtually everything we need to know when choosing plastic surgery after bariatric surgery. Go to part 1 of my Dr. Joseph Capella interview or read part 2 below.
Dr. Joseph Capella Discusses Skin Removal
My Bariatric Life: 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. Joseph 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.
My Bariatric Life: 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. Joseph Capella: Absolutely — it’s all shriveled up. That’s exactly right.
My Bariatric Life: Can you give us a profile of the typical patient who presents for body contouring following massive weight loss? Along that same line, who is the ideal candidate for post-bariatric plastic surgery?
Dr. Joseph Capella: I would say that the typical patient is really a cross-section of people, mostly in middle income levels whom have placed a great priority on getting the surgery. I’ve had patients in their teens and patients in their 70s. The patients who seek body contouring tend to be patients, among women especially, who have even as little weight loss as 50 or 60 lbs. Men — it tends to be men who’ve lost over 150 lbs. And this I think has to do with a couple of things: Maybe culturally it’s not as acceptable for them to consider body contouring, or, really, because men do not have the same amount of excess tissue as women and they don’t develop cellulite. So I would say that the concerns are less in men, in general.
As far as the procedures that they choose, I would say that younger women are concerned more with the lower body and breast. And as women get older, the arms start to become very important. I would say the arms can be important across the board, but it not uncommon for an older woman to say that’s the only thing that bothers her. Among men, I would say most specifically it would be the lower abdomen and hip regions that are a big concern, and sometimes the inner thighs. And the inner thighs are really a concern for both men and women.
The ideal patient is somebody who is recovering in an uncomplicated fashion from the bariatric surgery. Or, if weight loss was not from bariatric surgery, somebody who has a diet that is well-balanced. And for both groups of patients, whose weight has been stable and is not in any way creating any metabolic imbalances. Ideally, the patient has not been smoking.
There’s a lot of discussion about when do you operate on post-bariatric patients? Their weight should be stable but they also should be metabolically balanced as shown by their laboratory studies. You want their studies to be normal; otherwise, that would suggest that they’re not eating a balanced diet and they’re still wasting. Clearly, somebody who’s not vomiting if they’ve had a band or some bariatric procedure.
I’ve operated on people who are as little as 12 months out — that’s about the earliest. Take for example a gastric bypass for a woman who may be only 70 lbs overweight — she’ll lose that weight very quickly. And if she’s metabolically stable, there’s not really a problem operating on her. You obviously don’t want to operate on somebody who’s actively still in the weight-loss process because then she’d have more loose skin afterward than she would have otherwise.
Read part 3 of our Dr. Joseph Capella interview
Living larger than ever,
My Bariatric Life