Which Oprah will do best with surgery? Probably the one in the red dress!
I get this question a lot from patients who are thinking about having breast and/or body contouring. It’s an important question and I am always glad to hear it because it tells me that the patient understands that weight fluctuations can make a difference in surgical outcome. Take Oprah for example. There have been times in her life where her weight has yo-yoed all over the place. Operating on her during these times would be like operating on a moving target. A great result seen two weeks after surgery could turn into a lousy or even bizarre result a few months hence if her weight went up or down 30 – 40 pounds.
Sooo……patients should be at a stable and sustainable and healthy weight prior to surgery. Did you notice that I did not say ideal?Ideal weight may be achievable for some patients but unless it is sustainable, I would rather operate on a patient who is a little bit or even quite a bit over their ideal as long as they are healthy.
Healthy is the key word here. If a patient is carrying a lot of excess weight and has type 2 diabetes, high blood pressure and has trouble walking up a flight of stairs, that person is not healthy and should not be having elective surgery. That is the type of patient I will refer to a weight loss specialist. If on the other hand, the patient is carrying extra weight and does not have diabetes, high blood pressure and plays an hour of pickle ball every day, I have no problem doing elective surgery on them. And at the other end of the weight spectrum there are issues with being too thin. I screen carefully for patients with eating disorders such as anorexia nervosa or bulimia. Those conditions are serious illnesses and patients need evaluation, care and support – not plastic surgery. Thin patients who are well nourished and weight stable usually make excellent surgical candidates.
So as you can see, it’s not about the number on the scale or the BMI or the dress size. It’s about being healthy.
Seattle Plastic surgeon shows why belly fat cannot be treated with liposuction (with a little help from Oprah and Dr. Oz).
This, folks, is belly fat. It is inside the abdomen, deep to the abdominal muscles. It cannot be removed with liposuction or tummy tuck (abdominoplasty). Losing weight will make it shrink.
I saw a patient a couple of years ago who was requesting abdominal liposuction. I did my usual body contouring evaluation and had the unenviable task of informing him that he was a really lousy candidate for liposuction or an abdominoplasty (tummy tuck). His abdominal girth was caused by belly fat a.k.a. intrabdominal fat a.k.a. visceral fat a.k.a. beer belly fat. The way I could determine this was to have him lay down on the exam table. His belly did not flatten out. See photo on the right.
The omentum from a deceased obese person vs. the omentum from a deceased slender person.
Belly fat collects in the mesentary, which is the structure that carries blood vessels to the abdominal organs, and the omentum, which is an apron like structure that hangs off the stomach. In an obese person, they are very, very thick. In a lean person, the mesentary and omentum are very thin and translucent. Here is Dr. Oz holding the omentum of a fat person and Oprah holding the omentum of lean person. There is NO WAY a fat omentum can be sucked down to a thin omentum. The only way to reduce an omentum is to lose weight. I referred the patient to Dr. Richard Lindquist at Swedish Medical Center Weight Loss Services.
I asked him to follow-up with me but I haven’t heard from him. And he never went to Dr. Lindquist. I hope he did not find a surgeon ignorant or desperate enough to do surgery on him. If he did, my guess is that he is sorely disappointed with his result.
Seattle Plastic Surgeon discusses the importance of “translation of pull” in body lifting after massive weight loss.
Try this at home! If you get a lot of lift and smoothing of the skin by pulling, you will likely do well with a body lift.
I have seen quite a few massive weight loss patients interested in body lifts in the past several weeks. The fall and winter months are the best time to have this type of surgery and these patients are wanting to sort out their options so they can take advantage of cool and dismal months and be fully recovered by the time spring rolls around again.
Body lift is a really big procedure and should only be considered if the patient has a really good chance of getting a lot of improvement. The requirments for this procedure include excellent health, a stable and healthy weight, a good support system, the ability to take enough time off of work for healing, and good translation of pull.Translation of pullrefers to how much the skin reacts to traction.
Many massive weight loss patients are like this lady where the skin can be yanked up almost like a pair of panty hose. In this case, she is likely to have great result.
Some patients, however, either because of residual fat or thick and tethered skin, hardy budge with this manuver. Sometimes additional weight loss helps but sometimes it does not. Those patients with lousy translation of pull will not see much improvement with a body lift. And a body lift would be a very, very long run for a very, very short slide for these patients.
Seattle Plastic Surgeon riffs on how those Downton Abbey women stay so slim and what it all has to do with the modern day tummy tuck.
A tummy tuck is a little like having an internal corset.
The ladies of Downton Abbey spend a lot of time having their corsets laced up by their maids – and it’s always right before they go down for dinner. No wonder they all stay so slim. Who can overeat when laced up tight?
And this brings me to a recent study about weight loss in ladies who have had a tummy tuck. This is a common observation in my practice but I had never before seen it reported in the plastic surgery literature. It seems that the internal corset that is part of most tummy tuck operations results in automatic portion control just like an old fashioned corset does.
Just another great thing about tummy tuck. You get to wear your corset 24/7 and you don’t even need a maid!
Seattle Plastic Surgeon’s hunch confirmed by recent report – body lifting is in demand.
I really, really like doing body contouring procedures on patients after massive weight loss. There are many, many types of lifts that are done below the neck. They include: lower body lift, flank lift, mons lift, brachioplasty (upper arm lift), thigh lift, breast lift, buttock lift and tummy tuck which is sorta kinda a lift.
These procedures make such a huge difference in both how the patients look and feel. Many of these patients, despite being at or close to their ideal weight, still feel obese because of all of the excess skin and sags and bags.
It’s a good thing I like doing these procedures because according to the American Society of Plastic Surgeons, these sorts of lifts have increased 600% over the past 10 years. The reason, of course, is the obesity rates have gone up as thus the incidence of formerly obese patients has gone up.
About 1/2 of my massive weight loss patients have had weight loss surgery. The other half have accomplished their weight loss through huge and profound permanent lifestyle changes usually with the help of a peer support group such as Weight Watchers or Overeaters Anonymous.
I feel very, very privileged to help these patients finally achieve their personal best after they have suffered so much from their obesity and have worked so very, very hard to improve their health and their appearance. I say, keep ’em coming!
Permanent weight loss – here’s what I’ve learned from my patients
How to lose weight for good according to Dr. Lisa Lynn Sowder’s weight loss patients.
I am a bit of an expert on weight loss, not because I have ever had major weight loss, but because I know so many patients who have and have been able to maintain their weight loss. These are patients who come to me for body contouring procedures such as abdominoplasty, breast lift, upper arm lift, thigh lift, flank lift, lower body lift and so forth.
I always ask them how they managed to finally lose the weight and keep it off. I ask them to go into some detail. This is not because because I want to write the next “diet bestseller” and buy a small island in Greece (although that would be nice) but because I want to pass on their secrets of success to other patients who struggle.
About 40% of my weight loss patients have undergone weight loss surgery. That’s another blog. The other 60% have done it through life style changes. Here is what that 60% have told me:
Without exception, they have all sworn off sweets and refined carbohydrates.
Many have embraced a very low carb diet – think Adkins diet.
Almost all have maintained regular aerobic exercise – walking and biking are the most popular with my patients.
A few of my patients have been helped with nutritional guidance from a physician or nutritionist.
I cannot remember a patient who mentioned a prepackaged food or liquid diet system.
And here are a few patients I will never forget:
One gentleman lost 60 pounds when he quit drinking with the help of Alcoholics Anonymous.
One lady was able to stay 180 pounds overweight despite her gastric bypass through continuous and careful overeating. She finally dropped her weight 150 pounds when she addressed her emotional issues with a psychologist and the help of Overeaters Anonymous.
One lady lost over 100 pounds by jogging. She started really, really slow and got faster and faster as she lost weight. She became addicted to a runners high which I guess is better than most addictions.
Several of my patients were able to slim down only after leaving a dysfunctional relationship.
One teenager lost 40 pounds just by giving up soda.
One lady in her 60’s lost 100 pounds after having bilateral knee replacements. She had been very, very sendentary and once pain free, became more active.
So there you have it folks; Dr. Sowder’s Guide to Slow, Deliberate, Difficult, Soul Searching, Sweating, Hungry but Long Term Weight Loss. Just think, I could have written that best seller and here I am just giving it away.
@lisalynnsowder
