Can you really fix it all at once? Post weight loss surgery truths [Bob Basu, MD, Houston]

Eva Sheie (00:00):
You're listening to Where Before Meets After. When someone's lost a lot of weight, let's say we're in the 50, 100, 100 plus range, what's the first thing that they want to get done? Everything has loose skin and you can't do it all at once.

Dr. Basu (00:16):
Sure, sure. So it's a great question. Every week I see patients with lost weight who come in wanting everything transformed head to toe. They want to face a neck lift. They want to address their breasts. They want to address their tummy, back, arms, legs. And what I ask the patients, and I look, we live in an instant world. We want everything done right away. We want no recovery, and that's just not reality. So what I always ask my post weight loss body contouring patients is, what is your number one area of concern? What is your number two area of concern? And then what is your number three and four? So I basically have patients triage their priorities essentially. What's your one, two area of concerns? I don't ask them to tell me which procedures they want. I simply want them to focus on the areas that bother them.

(01:02):
And then together we come up with a comprehensive plan that we can maximally treat the number of areas safely. A couple things that I look at, patient's health status, their age, their fitness level, other medical issues that I kind of evaluate to determine how much surgery that we can do safely in one setting. And I always tell patients, "Don't feel pressured you need to do everything at once." Sometimes it's better and safer to do less and less is more. Sometimes it's better to do a smaller procedure and come back and fight another day. So I know a lot of people want to get everything one and done. I get it, but sometimes it's better to do less and that's often more.

Eva Sheie (01:41):
Can you share some example plans and timelines and maybe some scenarios for what it would look like for your typical weight loss patient?

Dr. Basu (01:49):
Sure. So if they want me to create a plan from the collarbone down to the buttock area, one way, again, this is not right for everybody, but one way is to divide the body into two zones. And when I say the body, we're talking about from the shoulders down to just below the buttocks. And one way to divide up the body is basically drawing an imaginary horizontal line from your rib cage across. So we're kind of dividing the upper trunk and the upper trunk means your arms, your sides and your breasts. And it might also include your back. The lower trunk, meaning everything below that horizontal line, that's the lower body. And where oftentimes we can do what's called a circumferential body lift, which is basically a 360 tummy tuck, that's another term for it, or a belt lipectomy. But a circumferential body lift includes multiple procedures in one.

(02:40):
Number one, it includes the tummy tuck in the front of your tummy. It also includes an anterior and lateral thigh lift with a waist reduction. As we continue the incision to the backside, that includes a lower backlift and a buttock lift. And very common for patients who've lost weight because they're concerned about volume loss. They've lost all the volume in their buttock. We can often do some other procedures to help enhance the buttock, whether it be through fat transfer or some advanced techniques called auto augmentation techniques or a combination of those two. Typically on a circumferential body lift, I'm removing about four to 10 pounds of tissue circumferentially. So when patients say, "Well, I want to lose five or 10 more pounds." The circumferential body lift, although it's not a weight loss procedure, removing that loose skin and fat will remove those pounds. So I tell patients, "As long as your weight loss is stabilized, you're in a healthy place, then we can consider a potential procedure for you".

Eva Sheie (03:38):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wearbeforemeetsafter.com. Where Before Meets After is a production of The Axis.