In this Q&A session, Detlev Erdmann, MD, PhD, MHSc, of  Duke Plastic Surgery, discusses recent trends and procedures in metabolic surgery.Detlev Erdmann, MD, PhD, MHSc

What do you offer in the way of metabolic surgery?

With the growing popularity of gastric bypass surgery and similar procedures to treat morbid obesity, plastic surgeons nationwide noticed an increase of patients seeking plastic surgery procedures to contour their body after massive weight loss. Plastic surgeons expect the trend to continue in the future.

Body contouring includes a variety of procedures, such as panniculectomy, abdominoplasty, lower body lift, arm lift (brachioplasty), thigh lift, and others.

Procedures are usually staged, meaning several trips to the operating room (OR) over a time period of one to two years are required.

Body contouring has recently been associated with a quality of life improvement and improved body image in patients after massive weight loss. In addition, these procedures seem to support to a long-term stable weight.

What are the salient trends you see in your practice?

I have seen a steady trend of increasing numbers of patients seeking various body contouring procedures after surgical-induced or diet- or fitness-induced weight loss.

These patients frequently complain about their appearance. They may present with chronic (therapy-resistant) skin rashes, lower back pain, and an inability to wear regular clothes.

What kinds of patients are you looking for?

Patients should be metabolically stable. Therefore, body contouring should not be performed before one year after weight loss surgery, but they, of course, can be evaluated and informed about potential future procedures at any time.

Female patients should have their family planning completed.

Do you feel patients have realistic expectations about outcomes?

A patient-physician agreement is important regarding realistic expectations. Procedures may have to be staged, and complications may occur, such as seromas or hematomas, infections, and others.

These complications can usually be managed in-clinic, but may be time consuming.  Overall, I feel that the patient satisfaction is high and the majority of patients are grateful.

What are some of the issues that need to be resolved before this field can move forward?

Insurance coverage is inconsistent and many procedures are labeled as cosmetic surgery. In fact, body contouring surgery is much more than cosmetic surgery, as it is medically necessary in many patients with symptoms as mentioned above.

However, no clear guidelines exist amongst insurance carriers, and patients may not accept that their gastric bypass surgery was approved but subsequent plastic surgical procedures are not. As a consequence, gastric bypass surgery is increasing, but related plastic surgical procedures are somewhat stagnant.

Source: American Society of Plastic Surgeons (ASPS)