From Our 2006 Archives

More Want Body Contour Surgery

As more patients undergo bariatric surgery to achieve a healthier weight, requests for body contour surgeries to remove excess skin and fat are rising, research shows.

ByKathleenDoheny
WebMD Health News

Reviewed ByLouiseChang,MD
on Friday, October 13, 2006

Oct. 13, 2006 -- As more patients undergo weight loss surgery to achieve a healthier weight, requests for body contour surgeries to remove excess skin and fat are rising, research shows.

The procedures used in body contouring are also becoming more refined and predictable, say researchers at the American Society of Plastic Surgeons Plastic Surgery 2006 meeting in San Francisco.

Demand Follows Rise in Bariatric Surgery

Weight loss surgery is known as bariatric surgery. With bariatric surgery procedures, the surgeon helps an obese patient lose weight by operating on the stomach or intestines, often creating a very small stomach pouch.

In 2004, 140,000 bariatric procedures were done in the United States, according to estimates from the American Society for Bariatric Surgery, and 56,000 body contouring procedures followed them, according to the American Society of Plastic Surgeons.

For 2005, these groups estimate about 171,000 bariatric procedures and more than 68,000 body contouring procedures were done.

Traditionally, about 25% to 35% of patents who have bariatric surgery go on to have the body contouring procedures.

"If you eliminate finances from the picture, that number would increase dramatically," says Al Aly, MD, an Iowa City, Iowa, plastic surgeon and expert in the field. Insurance typically covers only part of the procedures or none at all, doctors say. "The number would jump to 70% or 80% [if it was covered by insurance]."

Who Gets Body Contouring?

Younger patients and those who got closer to their ideal weight after the bariatric surgery are more likely to request the body contour procedures, finds Devinder Singh, MD, a researcher and resident in plastic surgery at Yale University in New Haven, Conn.

Singh's team compared 24 patients who underwent body contouring with 169 who did not, trying to find out which factors predict requests for the procedure.

Those who opted for the body contour procedures were, on average, 36 years old; those who declined the extra surgery were, on average, 41. Women greatly outnumbered the men; of the 24 patients, only four were men.

The body contour patients were also closer to their ideal weight than were those who declined it, she found. They had lost 70% of the excess weight they needed to lose, while those who declined had lost just 62% of their excess weight one year after bariatric surgery.

The study results make sense, says Robert Bell, MD, a bariatric surgeon at Yale University and one of Singh's co-researchers. "The more you lose, the more likely you are to need plastic surgery. Younger patients are often more motivated; older patients may accept a little sag."

"Those who lose weight rapidly after bariatric surgery may be more motivated to improve their appearance," says J. Grant Thomson, MD, associate professor of plastic surgery at Yale and another co-author. It's not just about appearance, he tells WebMD. Excess skin can make daily activities and moving around difficult.

The Natural Step 2

Body contouring is a natural second step to bariatric surgery, Aly says. Once the weight is lost, patients often still feel the stigma of obesity, he says.

"After losing, they still have bodies that might appear less than ideal [due to hanging skin and excess fat deposits, which are typical]," he says. "The body contouring surgery is really the final transformation into the normal world."

What It Involves

Body contouring refers to a number of procedures, says Robert F. Centeno, MD, MBA, a St. Louis plastic surgeon who led a presentation on surgical techniques at the meeting. "Probably the most common is a circumferential body lift," he says. An incision is made around the lower trunk, and the thighs and buttocks are lifted. The buttocks, which tend to flatten out with extreme weight loss, may be augmented, and a tummy tuck may be part of it.

Some patients go on to have an upper body lift, perhaps including breast augmentation to restore lost volume and an arm lift to remove droopy skin there.

Costs of body contouring vary widely, Aly and Centeno agree. A patient who has multiple contouring procedures probably pays about $25,000 to $60,000, Aly estimates. The range is extreme because the type of procedure needed varies from patient to patient and surgeons' fees vary by region.

The process is lengthy. "Figure about a year to have the whole body contoured," Aly says. It's often done in two or three stages with intervals to aid healing.

Complications can occur, with fluid collection under the tissues, called a seroma, being one of the most common, Aly says. They're treated in the office by aspirating the fluid. Some skin areas may not heal as well as they should.

1 Woman's Story

After Sheila Emley, 49, of Eureka, Mo., lost 117 pounds from bariatric surgery, she was down to a much healthier 106 on her 5-foot-1-inch frame. She felt better, but the excess drooping skin was a problem. "I was carrying around a lot of extra flesh that just didn't look good," she says. "I thought, 'Why stop there?'"

She underwent a series of body contouring procedures and says it was well worth the $23,000 price tag, even though insurance did not cover it. "My clothes fit better; there is no chafing [from excess skin]. I weigh the same, but I went down a size and a half in clothing. I can't believe how much more energy I have and how much more self-confident I am."


SOURCES: American Society of Plastic Surgeons Plastic Surgery 2006, San Francisco, Oct. 6-11, 2006. Al Aly, MD, plastic surgeon, Iowa City, Iowa. Robert F. Centeno, MD, MPA, plastic surgeon, St. Louis. Robert Bell, MD, director, bariatric surgery, Yale University, New Haven, Conn. Sharon Emley, body contouring patient, Eureka, Mo. J. Grant Thomson, MD, associate professor of plastic surgery, Yale University, New Haven, Conn.

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