For patients suffering from morbid obesity, bariatric surgery (also called gastric bypass surgery) has become a viable alternative. It offers them an end to years of humiliation and suffering, and lets them enjoy the rest of their lives inside healthy, comfortable bodies.

Once their body weight has stabilized after gastric bypass surgery, however, these patients need multiple body contouring surgeries to help their loose, sagging skin fit onto their new forms.

Body Contouring

That’s where Annapolis Plastic Surgery comes in. One of Dr. James Chappell’s specialties is body contouring. He has undergone extensive training to deal with the particular issues involved in contouring the bodies of the previously obese. Dr. Chappell finds this part of his work to be among the most satisfying aspects of his career.

When Is It Done?
Body contouring can be undertaken a year to a year and a half after bariatric surgery, or when weight loss has reached a plateau and remained stable for three months to six months. Because most patients require a succession of procedures, it will go on for quite some time. Typically, a procedure will be undertaken every three months to six months, depending on how quickly patients heal. Since many patients need work on the abdomen, back, legs, arms, breasts and other areas, this can add up to a few years of surgery.

How Long Does Each Surgery Take?
As a general rule, six hours of surgery is enough at one time. You will prioritize the areas that bother you most, and we will focus on these first before moving to other areas of the body.

Is Liposuction Involved?
For some patients, liposuction is used to reduce overall bulk before skin reduction surgery. This is a science unto itself for massive weight loss patients, whose loss of skin elasticity demands more use of tumescent fluids than we employ with conventional patients.

Scarring
Body-shaping creates long scars down the arms, up the legs, across the lower stomach, sometimes at the waist. By mapping the tissue to be removed, Dr. Chappell can place these scars where they will be hidden by underwear or in a belt-like position. For arms and legs, he hide the scars where clothing seams would be.

Skin Elasticity
Many post-bariatric surgery patients experience an extreme loss in skin elasticity, their tissue permanently damaged from being stretched to such an extreme. Since it won’t contract, the loose excess skin must be removed.

We used to dispose of this skin – often many pounds of it. But recently a “skin bank” was created to make use of discarded skin from body contouring patients. The harvested skin is implanted in burn patients, accident victims and others in need of skin grafts. The Boston Globe recently ran an article describing the technology that’s allowing body contouring patients to become donors to those in need.

Am I a Candidate?
The best candidates for this type of body contouring are healthy individuals who’ve stabilized their body weight. People with co-existing conditions such as diabetes or heart problems may not be eligible for body contouring surgery. We judge each case individually, taking a variety of important health-related factors into account.

Will insurance pay for it?
Unlikely. In general, these cases are regarded as cosmetic and are not covered.

Risks
Massive weight loss body contouring is riskier than other types of body contouring. Fluid shifts occur after large amounts of skin and fat are removed. Swelling is common, and in certain areas of the body (the abdomen and back) it can take months to subside.

Nutrient Deficiency
Patients may be deficient in key nutrients as a by-product of their massive weight loss surgery – most often iron, calcium and potassium. We check lab values at least a week before these surgeries. Checking early allows time to correct deficiencies.

Losing the Navel

Many bariatric surgery patients have a large incisional hernia. Repair of this, especially when combined with abdominoplasty, may result in removing the navel. We warn patients of the risk of this loss before undertaking the procedure.

A Blessing for the Chronically Overweight

Dr. Chappell believes that bariatric surgery is a Godsend for people afflicted with morbid obesity. With surgical methods improving constantly, what used to be an unusual and extreme solution is now a realistic alternative. Although uncomfortable to undergo, it is worth it, because it can create lifelong wellness. He thoroughly enjoys his role in restoring normality to people who have suffered from excess weight. It’s the finishing touch to their long and arduous journeys.

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