To date, about 69 million Americans are considered significantly overweight and obese.  And while some of them may try dieting and exercise to shed the extra pounds, it is important to note that only 5 percent will succeed using the traditional weight loss procedures.

For this reason, some patients may have no other option but to undergo weight loss surgery such as gastric bypass, lap band, and bariatric procedure—all of which are designed to force them to consume less amount of food.

While weight loss surgery has been found to be an effective way to shed the extra pound, this usually leads to loose, excess skin especially in the abdomen (or medically referred as pannus) that not just distorts a person’s body but may also lead to foul odor, breakdown of skin, non-healing irritation, and difficulty in moving.

In most cases, massive weight loss patients also suffer from weakened, stretch muscles and exercise-resistant fats in areas particularly the abdomen, inner and outer thighs, neck, chin and jaw line, upper arm, and entire lower trunk.  With this consideration, skin removal surgery is commonly performed in conjunction with liposuction, suturing technique for the loose tissue, and muscle reduction/manipulation.

For people who have shed more than 100 pounds, the excess skin commonly occurs around the entire lower trunk which may even cover their hips, genital area, and a huge portion of their buttocks.  And because of the extensiveness of the problem, plastic surgeons have to perform lower body lift which uses a belt-like incision that travels from the abdomen to the back.

Through the incisions, plastic surgeons can remove the pannus and tighten the weakened muscles.

Aside from the lower trunk, massive weight loss patients also develop excess skin in their upper arms, thigh area, chin and jaw, and “bra line.”

In skin removal surgery, plastic surgeons usually place the incisions in the hidden areas or along the natural creases of the skin so the scars are unnoticeable.  For instance, the excess skin in the upper arms is removed through an excision which extends from the armpit to the elbow and is made in the back or inside of the arm; while the sagging skin in the inner and outer thighs is eliminated with a surgical cut that travels from the butt crease and reaches the groin where the thigh and pubic region meet.

This plastic surgery procedure is commonly used to target areas which are prone to sagginess such as the abdomen, thighs, breasts, arms, and buttocks.  For massive weight loss patients, most of them will benefit more if several body lift techniques are performed at the same time.

Examples of these techniques include lower body lift which is used to target the abdomen, buttocks, back, and thighs; and upper body lift which is performed to treat the breasts, chest, and middle back region.  If these two procedures are combined, the surgery is referred as a total body lift.

Most people who seek body lift are patients who have had weight loss surgery such as gastric bypass, bariatric operation, and lap band.  However, some women who have developed bulging fats and excess tissues in the abdominal area due to the physical effects of pregnancy may also benefit from this plastic surgery procedure.

Because of the invasiveness of body lift, plastic surgeons recommend patients who have had weight loss surgery to wait at least one year before even considering having this procedure.  In this way, their body can recover from the abrupt changes in their food intake and their weight will have enough time to become stable.

While the result of this procedure will most likely last a lifetime, plastic surgeons warn that pregnancy and weight fluctuation can reverse it.  For this reason, they usually advise women who are planning to have children and individuals whose weight is fluctuating to postpone the procedure.

In most cases, the surgery is performed at a hospital (rather than in an outpatient surgical center), particularly for patients who need the most correction.  And more often than not, it requires several days of hospital stay so they can receive immediate medical attention in case of complication.

As with any cosmetic surgery, body lift is associated with recovery that largely depends on the extensiveness of the incision and the healing ability of each patient.  To be on the safe side, they are generally advised to take some time off from work to make sure that they will have enough rest and sleep.

Panniculectomy is probably the most popular plastic surgery procedure for massive weight loss patients as it targets the midsection of the body, the area which has the most tendency to develop hanging skin and tissues that may lead to back problem, breakdown of skin, ulcers, irritation, foul odor, and poor hygiene.

Abdominoplasty (tummy tuck) is different from panniculectomy, although these two plastic surgery procedures treat the abdomen.  In abdominoplasty, plastic surgeons reshape and tighten the underlying muscles and eliminate the excess skin and fats, but in panniculectomy, they only remove the hanging skin and fats.

In some cases, panniculectomy is performed with another abdominal surgery such as hysterectomy (surgical removal of a woman’s reproductive organ) or repair of the abdominal wall.

According to plastic surgery specialists, candidates for this procedure should have excess skin and fats extending as low as their hips, genitals, and buttocks to the extent that walking, sitting, and standing have become relatively difficult.

To make sure that the result of panniculectomy will most likely last a lifetime, plastic surgeons require their patients to have a stable weight for at least one year or even longer if they have had lap band or gastric bypass surgery to make sure that they are no longer nutritionally deficient due to the sudden decrease of food intake.

Plastic surgeons start the procedure by administering general anesthesia that will put their patients in a state similar to sleep.  And once the drug takes effect, they will create a vertical incision that starts from the lower area of the breast bone (sternum) to the pubic bone, and another horizontal cut that covers the pubic area.

Through these incisions, plastic surgery specialists can remove the excess skin and fats and then pulled together the remaining skin to close the surgical wound.  In some cases, small tubes are inserted to drain the excess fluids which can promote faster recovery.

As with any surgery, panniculectomy involves risk of complications and recovery.  With this, it is important for patients to rigidly follow their surgeon’s post-operative instruction that will reduce the risks and promote faster healing.

During the recovery period, patients are restricted to lift more than 10 lbs. and perform rigorous exercises that may put pressure on their abdominal area.

Most people who have had lap band, gastric, bypass, and other types of weight loss surgery should expect to develop a severe case of hanging flap of skin which may even cover their hips and genital area.  For this type of patients, circumferential tummy tuck is the most ideal approach in order to address the large amount of panniculus.

This invasive plastic surgery procedure, as its name suggests, involves the use of an incision that covers the entire circumference of the waistline, allowing them to raise the sagging buttocks and thighs.  If needed, they may also reposition the belly button to a new location to achieve a more natural result.

Because of the extensive length of the incision and the higher risk of complications, plastic surgeons treat circumferential tummy tuck as the last approach for patients who will not benefit from the traditional or minimally invasive techniques.

In almost all cases, this invasive surgery is performed under general anesthesia that can put a patient to sleep throughout the operation.  Once the drug takes effect, plastic surgery specialists carefully make a circumferential incision that covers the torso.

Through this extensive incision line, doctors can manipulate the tissue and muscle in front and back of the body starting from the ribs and ending to the knees.  This is performed by using liposuction to remove the excess fats and other contouring procedures such as tightening of the abdominal muscles.

Aside from the incision around the torso, plastic surgeons create a second cut to free the navel to the tissue and place it to another location.  After this, they will remove the hanging flap of skin and tissue and then close the incisions through sutures or stitches.

In most situations, people who have had circumferential tummy tuck will need other contouring procedures such as arm lift, upper body lift, and neck lift.

In comparison with other body contouring surgeries, circumferential tummy tuck involves longer recovery and higher risk of complications.  With these considerations, most plastic surgery specialists recommend at least several days of hospital stay so that patients can immediately seek medical attention in case complications arise.

This plastic surgery procedure can treat different areas of the body that tend to sag after weight loss such as the buttocks, breasts, abdomen, and thighs.  But for patients who have lost a significant amount of weight, they will most likely benefit from combining “isolated” body lift techniques; for example, individuals who have an excess flap of skin around the hips, buttocks, and thighs are recommended to have lower body lift, while those who have sagging skin in the lower rib cage and back are best suited to have upper body lift surgery.

To perform the lower body lift, plastic surgeons create a belt-shaped incision around the waist and down the inner thighs.  In this way, they can remove the excess fats and skin, lift the buttocks, and improve the overall figure.

But since the procedure does not treat the excess skin and tissue around the abdominal area, plastic surgeons usually complement this with abdominoplasty or what is more commonly referred as tummy tuck surgery.

Contrary to a popular belief, tummy tuck and other body lift techniques are not just performed for aesthetic reasons.  In fact, this procedure is used to treat the physical symptoms associated with panniculus—hanging skin and fats around the abdomen—such as foul odor, breakdown of skin, ulcers, non-healing irritation, and back problems due to the weight of the excess tissue.

Meanwhile, massive weight loss patients may also need upper body lift in which plastic surgeons create an excision along the bra-line skin that will allow them to remove the back fat rolls and narrow the waist.  With this approach, they can also eliminate the excess skin under the breasts, and then lift the abdominal skin by suturing it to the lower rib cage.

For patients who have developed excess skin in their upper extremities, they are recommended to have upper arm lift surgery which involves an incision that is placed on the inside of the arm extending to the elbow, or across the underarm if there is only a minimal amount of hanging tissue.

As with any plastic surgery, body lift involves risk of scarring, although the incision lines are usually hidden to make them less noticeable.

The Lap Band is a silicone band placed around the entrance to the stomach; the band causes the patient to eat far less, making the pounds drop off. It works because you feel full on just mouthfuls of food.

Until now, you had to show a Body Mass Index (BMI) of at least 35.

A five-foot-six person weighing 216 would qualify.

But now, the FDA says people with a BMI of 30 and other health conditions associated with obesity can qualify. Those health woes include:

·         High blood pressure

·         Sleep apnea

·         Type II diabetes

·         Heart conditions

(Read our previous Lap Band post about the procedure also helping asthma patients to breathe better.)

With a BMI of 30, that same five-foot-six person would tip the scales at 186, say Lap Band doctors.

Obesity is serious business and the U.S.’s second highest cause of preventable death. Only smoking causes more mortality. Because about one-third of Americans are obese, the related health care spending is estimated at about $147 billion, double what was spent ten years ago.

According to the manufacturer, about 600,000 people since 2001 have had the device implanted, accounting for about 40% of all bariatric surgery procedures.

Another hurdle involved with having Lap Band surgery is showing you’ve tried – but failed – to lose excess weight in the past with other methods. (Read more about insurance requirements  for covering Lap Band surgery or bariatric surgery.)

Patients also require pre-surgical counseling so they’ll know what stomach restriction requires. Lap Band doctors say you can only consume about a cup of eats at meals so you must eat certain items – like protein – first to ensure good nutrition.

When a person carries 100 to 150 pounds of excess weight, skin is stretched beyond its ability to spring back.  After weight loss, large sheets of skin hangs from arms, the stomach and thighs.

Patients who lose 100 or more pounds often find they must have the loose skin surgically removed in a plastic surgery procedure known as body shaping or body lifting.

Drooping skin flaps around so much, exercise is prevented with proper hygiene made harder. Moreover, clothes are impossible to find. (Learn more about Lap Bands.)

The operation to remove all the loose skin in one surgical session is known as a total body lift. (Read more about body shaping.)

Last August 15th, at the height of the summer training camp for football players everywhere, we carried a blog post about New York Jets Coach Rex Ryan and his Lap Band. (Read Ryan’s Lap Band post.)

Now, three months later, Ryan is knocking off the weight (to 288 pounds in October from 350) and discovering the changes he must adopt, including:

• Giving up eating a whole pizza
• Forgetting about cheeseburgers
• Being scared of general anesthesia
• Obeying the owner’s instructions

The Jets’ owner, Woody Johnson, is heavily invested in other health related affairs like diabetes so health is a top priority in that workplace. A huge stomach and a reported 7000 calorie daily diet did not exactly create an image of health.

If you thought coaches and players in the National Football League could  fear nothing, Ryan says he was afraid of surgery because he read there is always a chance you won’t wake up.

We may not know field goal statistics but we do know something about anesthesia and plastic surgery. Given a non-smoking patient healthy enough for surgery and a board certified anesthesiologist, virtually all general anesthesia patients wake up! According to Lap Band doctors, the risk is very, very low. (Read more about the Lap Band procedure.)

Coach Ryan also had some fun with his weight loss by challenging two other players to a weight loss contest during training camp. In three weeks, Ryan dropped 20 pounds while a nose tackle shed 33.6 and an offensive tackle lost 26.2 pounds while on a cookie diet. But both tackles are much younger and were working out all day long on the football field, burning as many calories as lumberjacks.

The other major Lap Band sports star, John Daly, is very comfortable with 117 fewer pounds on his frame. Daly likes his Lap Band so much, he recommended that his grown daughter also get one.

Last word was, Daly’s daughter had dropped 100 pounds and was wearing jeans for the first time ever.

Daly was once quoted, “Getting a Lap Band was the best thing I ever did!”

But that was before Daly signed on as a pitchman for Loudmouth Clothes, became an underwear model and had his own television show on the golf channel – Being John Daly.

Some meat-and-potatoes guys, what you might call real manly men in the National Football League (NFL) have discovered the joys and benefits of Lap Band surgery.

In one instance, the husky New York Jets coach Rex Ryan saw Lap Band doctors and decided to go ahead with the outpatient surgery in March, 2010.

His breaking point came when a photographer snapped a picture of his bare belly, thereby exposing his extremely rotund mid-section and 340 pound frame for the entire world to see.

Said Coach Ryan: “Whoa, that’s not a real good shot!” (The coach is pictured, before Lap Band.)

Like many Lap Band patients, Coach Ryan tried a number of weight loss schemes including a liquid diet but then gained it all back. He even considered weight loss surgery. Sound familiar?

The New York Post reported that Ryan was a little over the top with the manly meat-and-potatoes thing because he consumed a whopping 7000 calories daily, much of it contained in his favorite, Mexican food.

After the Lap Band, Coach Ryan lost 40 pounds in about three weeks.

A Lap Band wraps around the top of the stomach and drastically restricts the amount of food patients can eat.

One guy, said to be the only active NFL player with a Lap Band, 6-foot-3, 26 year old Max Jean-Gilles of the Philadelphia Eagles noticed chest pains and shortness of breath at a playing weight of 388 pounds. His Lap Band doctors want to see him at a playing weight of 320 pounds.

Sure, macho football players must be big, but not obese to do their jobs. In fact, a sports story about the Jean-Gilles Lap Band mentions at least eight NFL football players who died of obesity related diseases before turning 50.

Commented a psychiatrist: “Saying ‘I play football’ is no longer an excuse for obesity.”

Jean-Gilles saw a psychiatrist before getting the Lap Band because most insurance firms require counseling and education about the procedure so that the patient will fully understand what he or she is getting into.

Any Lap Band procedure is a lot more than just getting skinny! (Read more about the Lap Band.)

Many Lap Band patients say that six months to a year after dropping anywhere from 80 to 150 pounds, they find:

• High blood pressure drops
• Type II diabetes may go away
• Sleep apnea and heavy snoring disappear
• Hyperlipidema, or, high blood cholesterol and triglycerides resolve

The latest scientific findings include MWL patients being able to breathe so much better, half eliminated their prescription breathing  medications.

Naveen Skikka, M.D., a member of the American College of Allergy, Asthma and Immunology (ACAAI) and colleagues studied the health records of 320 bariatric surgery patients at Henry Ford Hospital in Detroit from one year before surgery to one year after surgery.

The MWL patients had Roux-en-Y gastric bypass which surgically cuts into the stomach and intestines. (Lap Band does not.) But anybody who loses tremendous body weight by any means would experience the same after effects.

The important factor is that obesity is associated with asthma and other respiratory complaints.

Back in 2005, the American Journal of Surgery carried an article about 500 Lap Band patients who were given questionnaires. Lap Band doctors wrote that 163 responded will 11 reporting having asthma before surgery. After losing massive amounts of weight, nine said they no longer needed asthma drugs.

Dr. Skikka’s study is probably more accurate because he had access to all actual health records maintained by physicians.

Of the 320 patients — which included 85 percent women — 20 percent took at least one respiratory medication, including:

• Bronchodilator inhalers
• Inhaled corticosteroids
• Oral corticosteroids
• Leukotriene antagonists and other drugs

All that is important because all medicines have undesirable side effects while some drugs can clash with others.  Moreover, prescription medications, as many of us have noticed, can be hard on the family budget.

During the year of study after weight loss surgery, the researchers crunched the date and found that only 3.8 percent of the group still required medications for their asthma.

Overall, 49% fewer medications were filled while half of the patients on prescription medications were able to eliminate the drugs in the year after surgery.

Bottom line? Massive weight loss = massive health boost. Lap Band offers that with only minor complications.

 (Read our previous teen Lab Band article.)

Now, a year later, yet another study on teen Lap Band users at the Royal Children’s Hospital in Melbourne Australia examined 50 “severely obese” patients, aged 14 to 18.

Why is that important? Good question!

Currently, the Lap Band is only approved in the United States for patients 18 and older. That means insurance companies are quick to inquire about exact ages when asked to cover a young patient who may be 100 pounds or more overweight.

(An extra 100 pounds on a five-foot-two teen boy or girl is very definitely not a good thing, regardless of what the insurance company says!)

If that patient is, say, 17 years and eleven months old, guess what? Right! Lap Band insurance does not kick in.

Lap Band doctors say that type of overweight often leads to other health woes, including:

• Type II diabetes
• High blood pressure
• Sleep apnea
• Heart disease

(Read more about Lap Bands)

The Australian teens were divided into two groups. One had the Lap Band implanted while the other group was hammered with information about diet, exercise and other healthy behavior changes. (Bet that went over really well with teens!)

Guess which group had lower weight after a year? Yep, the Lap Banders.

Columbia University also studied how 24 youngsters with body mass indexes (BMIs) over 40, aged 14 to 17, fared with a Lap Band. (A healthy BMI is 25.) After only six months, weight was down and the other associated diseases were starting to disappear.

But the most eye-opening results came from the study in Australia. Just take a look at these results:

Lifestyle counseling group:  lost 6.6 pounds or 13.2 percent of excess body weight.

Lap Band group: lost an average 76 pounds or 78.8 percent of excess weight.

Here’s a no-brainer: which method would you choose?

The F.D.A. is currently studying the use of Lap Bands in patients under 18. Given the success of Lap Bands, we wonder which way they will swing?  Think parents will still have to pony up to cover Lap Band costs?

(Read the teen weight loss surgery article in Science Daily.)