Shortly after my tummy tuck, I did an interview with Dr. Joseph F. Capella (Capella Plastic Surgery) to gain his real-world perspective on body contouring plastic surgery after bariatric surgery, answer some of readers’ and my burning questions, as well as bring study findings to light.
Dr. Joseph F. Capella, M.D., F.A.C.S.
Dr. Joseph F. Capella has performed more than 10,000 body contouring surgical procedures on weight loss patients — representing one of the largest experiences in the world. He also has assisted in more than 1,000 bariatric procedures. Dr. Capella is certified by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgeons and the American College of Surgeons. He is the Chief of Post-Bariatric surgery at Hackensack University Medical Center and has a private plastic surgery practice, Capella Plastic Surgery, with offices in New Jersey and New York.
Plastic Surgery after Bariatric Surgery: Completing Your Journey
Paralleling the increasing use of bariatric surgery, there is a high demand for body contouring through plastic surgery. Following massive weight loss, patients are left with substantial folds of redundant skin that cause significant functional and aesthetic impairments on the trunk, buttocks, breast, upper arms, thighs and face. These disfigurements cannot be resolved by diet and exercise. Rather, body contouring procedures such as the abdominoplasty (tummy tuck) and body lift, provide dramatic results and restore the body’s natural contour.
A recent study published in Obesity Surgery measured the impact on health quality of life (HRQoL) of body contouring plastic surgery after bariatric surgery versus bariatric surgery alone. The study showed that body contouring procedures significantly improved patients’ HRQoL, in comparison to those who had only gastric bypass.
Researchers concluded that the treatment of morbid obesity should not be deemed achieved unless plastic surgery has been considered.
By reshaping the body into its ideal proportions, the true success of the bariatric surgery is fully realized. Yet a dichotomy exists: According to research widely published in medical journals — Obesity Surgery, Journal of Plastic, Reconstructive, & Aesthetic Surgery, and North American Journal of Medical Science — a global disparity exists between the number of patients who desire body contouring plastic surgery after bariatric surgery and those who actually receive it.
A Need for Plastic Surgery after Bariatric Surgery
My 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. Joseph F. 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.
My Bariatric Life: 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. Joseph F. 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.
Read part 2 of our Dr. Joseph F. Capella interview, “Skin Removal after Bariatric Surgery.”
Living larger than ever,
My Bariatric Life