Preparation for Plastic Surgery After Massive Weight Loss

Timing for Plastic Surgery

On average, gastric bypass patients lose 60% to 70% of their excess weight within the first 12 months after surgery in Los Angeles. Many patients regain some of the was able to drop weight during the ensuing years and on average regain about 25 pounds by their fifth post-operative year. From a plastic surgery standpoint, the best time for Plastic Surgery is probably between 18 to 24 months after weight loss. This is the time that patients have been able to drop most of their excess weight and have significant excess tissue and laxity. This is also the time that most patients have minimal nutritional reserves following months of reduced food and calorie intake and continued malabsorption of fat, carbohydrates, proteins, vitamins, and minerals. With up to 50% of reported nutritional deficiencies occurring within the first year of weight loss surgery, it is crucial to pay serious attention to the patient’s nutritional status prior to any body lift procedures. Dr. Siamak Agha considers Plastic Surgery only when your weight has reached a plateau for several months. He considers this period critical for replenishing your nutritional reserves. It is also important to realize that 3-5% of post-bariatric patients lose more than 100% of their excess weight. This group of patients have often had a complicated post-bariatric recovery and may be clinically malnourished. Many of the patients who reach normal weight and/or become malnourished tend to start with a BMI of less than 40 kg/m2 before surgery in Los Angeles. Again, it is imperative to recognize this group of patients before surgery since performing Plastic Surgery on a malnourished patient can potentially lead to more severe complications.

Where Will Your Surgery Be Performed?

Dr. Siamak Agha has been granted staff privileges at several local hospitals and outpatient surgery centers. In the interest of the safety of his patients, he only performs surgery in fully accredited facilities with the proper services and staff. Your anesthesia will always be administered under the care of a Board Certified M.D. anesthesiologist. General anesthesia is the deepest form of anesthesia, and many consider it to be the safest. You are asleep, feel no pain, and will not remember the procedure. This is the most common type of anesthesia used for post-bariatric body lift because these procedures tend to be lengthy and require full muscle relaxation for maximum tightening.

Surgical Marking and Planning

Whether you have decided to have your upper body and breasts corrected or start with your lower body, your procedure will begin the night before your surgery in Los Angeles. After taking a final shower, Dr. Siamak Agha will see you in his office to rediscuss the surgery, answer any remaining questions, review potential complications, and finally to mark you in preparation for surgery the next day. The process can take an hour or more as the marking requires precise planning. After you have changed into a gown the next morning before surgery, the anesthesiologist will see you. An intravenous line will then be established, and you will be given a dose of antibiotics as a precautionary measure.

Insurance Coverage

Insurance carriers generally do not cover Plastic Surgery after significant weight loss. These procedures are considered elective and cosmetic in nature. Your carrier may cover a certain percentage of your surgeries if you have an abdominal wall hernia that will be corrected through the procedure or a very large abdominal pannus that meets certain criteria (see below). It’s extremely important that you begin communicating early with us about your insurance concerns. Dr. Siamak Agha will write a letter to your insurance carrier, making the case for medical necessity if that diagnosis applies to you. It’s also very important to realize that insurance may only cover certain portions of the surgery, and you will be responsible for the remainder. Insurance plans may also exclude coverage of any complications that may occur as a result of surgery. A large abdominal pannus may accompany significant overstretching of the lax anterior abdominal wall and often occurs in morbidly obese individuals or following extensive weight loss. The severity of abdominal deformities is graded as follows (American Society of Plastic Surgeons).

  • Grade 1: panniculus covers hairline and mons pubis but not the genitals
  • Grade 2: panniculus covers genitals and upper thigh crease
  • Grade 3: panniculus covers upper thigh
  • Grade 4: panniculus covers mid-thigh
  • Grade 5: panniculus covers knees and below

The presence of a massive overhanging pannus may result in chronic and persistent local skin irratations in the abdominal folds. These conditions may include intertrigo, intertriginous dermatitis, cellulitis, ulcerations, or tissue necrosis. These conditions may also lead to painful inflammation of the subcutaneous adipose tissue (panniculitis). When panniculitis is severe, it may interfere with the activities of daily living, such as personal hygiene and ambulation. In addition to excellent personal hygiene practices, treatment of these skin conditions generally involves topical or systemic corticosteroids, topical antifungals, and topical or systemic antibiotics. In these situations, a panniculectomy is indicated. The panniculectomy is an effective procedure that removes the redundant pannus of skin and subcutaneous fat located in the lower abdominal area. Although the incision resembles that of a tummy tuck approach, there is no correction of the abdominal muscle laxity or removal of excess upper abdominal tissue. Panniculectomy is a functional procedure rather than a cosmetic correction. Insurance coverage for a panniculectomy may be provided for the following criteria:

  • The pannus hangs to or below the level of the pubis, as demonstrated in pre-operative photographs.
  • The individual’s medical record documents that the hanging panniculus causes skin irritation and/or infection that results in pain, ulceration, supapubic intertrigo, monilial infestation, and/or panniculitis that is chronic, persistent, and refractory to medical treatment for at least six months. In addition to good hygiene practices, treatment should include topical antifungals, topical and/or systemic corticosteroids, and/or local or systemic antibiotics.
  • The pannus interferes with activities of daily living.

Most insurance companies will request:

  • Dated photographs of the pannus hanging over the pubis and of the pannus elevated to expose the chronic, persistent, and refractory skin infection or irritation.
  • Office notes from the treating primary care physician that reflect the chronic, persistent, and refractory skin infection or irritation that persists despite optimal medical care over a six-month period.
  • A list of the medications that were prescribed during a six-month period and the length of time the agents were used.

Costs

The cost of Plastic Surgery is highly dependent on the surgeon selected, the number of procedures planned, and the amount of work needed. Some patients elect to pay for everything up front. Meanwhile, others opt to finance their body lift procedures. Medical loans and second mortgages are common ways that people pay for Plastic Surgery. Although the cost of body lift is a major factor to consider, it is yet another reason not to take body lift options lightly and to seek a plastic surgeon who specializes and is experienced in this field.