Plastic and Cosmetic Surgery - Reconstruction Surgery

• Aesthetic Surgery
  • Facioplasty
  • Blefaroplasty
  • Rhinoplasty
  • Secondary Rhinoplasty
  • Lasers in Aesthetic Surgery
  • Botox and Fillers
  • Otoplasty
  • Breast Augmentation
  • Breast Reduction - Breast Uplifting
  • Gynaekomastia
  • Abdominalplasty
  • Liposuction
  • Arm Plastic Surgery
  • Legs Surgery
  • Buttock Lift - New Method
  • Combination of Aesthetical Operations
• Reparative Surgery
  • Burns
  • Arms and Legs Traumas
  • Chronic Osteomyelitis, Pseudarthrosis
  • Chronic Ulcus
  • Repairs
  • Scar Repair
  • Breast Repair
• Obese Surgery
• Pre-Surgery Instructions
• New Techniques and Methods
  • Buttock Lift - New Method
  • Blefaroplasty Expansion - Mid Face Lift
  • Breast Reduction/Uplifting
  • The role of stem cells in plastic surgery
• What must not be operated

Treatment of Obese Patients Program by the Plastic Surgeon

90% of the obese patients present aesthetical problems that need to be addressed. Usually, these problems are not only aesthetical, but also functional. For example, a hanging abdomen creates problems of cleanness and intertrigos, while the spine is strained. Gigantomasty creates furrows on the shoulders, pain at the back, intertrigos and difficulties in moving and getting dressed in general.

The patient’s first contact with the obesity group is with the obesity surgeon. Having in mind the patient’s background, his diet habits, his age, height and activities, the doctor will have to present three alternative options:

1. The patient has very high chance to lose the excess weight with an adjustable gastric banding (lap-band).

2. The patient has some chance to lose his excess weight with a lap-band, but there are cases that a supplementary gastric bypass may be necessary.

3. The patient, according to his background is advised to undergo a gastric bypass combined with the lap-band method.

Our lengthy experience with such cases lead us creating a program of obesity treatment, which, when it is followed, promises excellent results.

Abdominoplasty is the operation which must be made simultaneously with the aforementioned obesity treatment methods, except that of case 2, whereas the lap-band may not be enough for the desired weight loss. If such a case, the abdominoplasty operation is adjourned for a semester, so as the gastrical bypass operation is to be decided or not. The result of the abdominoplasty is preserved after the weight loss. Based on our observations, if the abdominoplasty operation is immediate, a better result will be achieved in the end of the program than when postponing it.

The reduction or lifting of the breasts is an operation that often needs an obese patient. This operation is always adjourned towards the end of the program. After the weight loss the breasts get in a state of atrophy and excess relaxation is noticed. If the surgeon decides to make this operation before the weight loss, he may have his patient undergo a breast augmentation operation at the end of the obesity program.

The treatment of the arm relaxation is left for the end and may be dealt at the same surgical time with the breast augmentation or reduction. The arm relaxation does not always happen when someone loses weight so, the often patient check-up from the plastic surgeon during the weight loss program is important.

The treatment of the relaxation of the thighs and buttocks is also left for the end of the treatment. This relaxation also does not always happen and many could be done to prevent this or at least to lessen the degree of relaxation, in a state bearable to the patient.

A special scientific physiotherapy program has been developed and incorporated to the whole weight loss program. The program includes:

a) Special training in a vibration machine, with a program that is gradually changing under the observation of trained personel.

b) A special massage program in a LPG (Endodermologie) machine, whereas each program is selected from the plastic surgeon specifically for his patient and his needs. The program is applied from the very first post-operational visit of the patient to his doctor.

c) A passive training program involving muscle contractions, inflicted with the use of direct current.

Only a few patients after these programs do end up in a surgical operation of buttock or thigh surgery. If so, however, this operation is not as vast as the regular one. A breakthrough special grid method developed for the buttock and thigh relaxation has more stable results with very small incisions.

Gynaekomastia in obese patients is almost always the rule. The weight loss brings about a great degree of relaxation and a certainly not pleasant aesthetic result. Its treatment in the male breast is only surgical, as our physiotherapy programs do not have any effects. The breast lifting in man leaves scars, which are not so pleasant, since they could not be hidden as those of a woman. They are inevitable though. Based on our observation and experience, there is a significantly smaller degree of relaxation after the weight loss, when the patient has undergone a liposuction in the breast area simultaneously with the application of the obesity technique. At least 60% of such cases will avoid eventually a breast lifting surgical operation.

Liposuction in obesity operations is very important. The plastic surgeon cannot guess how the patient’s body like before his gaining weight was. The patient’s information and background help the plastic surgeon suggesting where he would have the liposuction on the patient. We advise our patients to have a liposuction simultaneously with the obesity treatment techniques, because, based on our experience, the relaxation is lesser in these points, should the liposuction is preceded. The post-operational physiotherapy program aids to the desired result.

Among all problems regarding relaxation, the least affected area is the face. Only a small percentage of the patients will need a face lift, mainly the elderly patients. We were given the impression that those who asked for a face lift due to facial relaxation problems would eventually have asked for a face lift anyway.

Physiotherapy

Physiotherapy and physical exercise is of great importance when treating the ramifications of weight loss and aging. The physiotherapy programs that have been developed and applied globally should be selected each time by a specialized doctor (plastic surgeon, etc.). There is a different treatment for different skin types and for different aesthetic problems. Another program is to treat a certain area and a different one to treat another. The main goals for physiotherapy would be the muscle mass and tone increase, a better blood supply at the tissues and a better lymphatic flow. Soon enough someone can notice the reduction of cellulitis and the relaxation, and the better quality of the skin texture. The program lasts for 6 weeks, twice a week, and is repeated once in a month. It comprises of a 10 minute active exercise on a vibrating surface of a machine, afterwards a special massage with programs selected from the doctor for each patient, which the operator sets for 35 minutes, and lastly, passive exercise with direct current.

If these programs are applied almost immediately after the operation, the consequences of the weight loss in the skin are minimized. At least a 40% of these patients, regardless of skin type and body type, will not have any need of supplementary aesthetical operation. Another 40% of the patients will have an acceptable degree of relaxation and cellulitis, and if an aesthetical operation is requested, it would be limited. The remaining 20% of the patients would need an operation, of a certainly less degree, for the aesthetical and functional, in most cases, rehabilitation.