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Key-points of the strategy in plastic surgery in an obese patient with mass
Therapeutic strategy
Parts of the body on which to have plastic surgery
Plastic surgery without weight-loss, plastic surgery for local obesity
Plastic surgery

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Plastic surgery

Plastic surgery without weight-loss, plastic surgery for local obesity
The human body is covered by layers of skin and fat. Fat is essential for life, and plays many roles: isolation against cold, energy reserve, shock absorber, etc … In order to understand how surgery to eliminate excess fat works, one should take a look to some scientific data:
 
The two layers of fat and the functioning of their cells (metabolism)
Two very diverse layers of fat are found peripheral to the body:

- The superficial layer (just below the skin): this covers the whole body ; the cells that make it up have a limited capacity for storage and easily release the fat they absorbed. Therefore, this layer responds well to diet.

- The deep layer: It is a true organ for storage. It exists only in certain parts of the body, as in the thighs (the famous riding breeches). The cells of this layer are greedy and store five times more fat than the cells of the superficial layer.
However, in normal conditions, these fat cells are meant to maintain their fat content. This explains why the body changes its shape as time go on because some clusters appear little by little, along with the weight changes, and then never disappear. That is why a diet is not efficient on this layer.

The amount of cells in these two layers establishes itself during childhood and then does not change.
Any surgical removal of fat tissue is permanent, which explains the efficiency of liposuction.
 
Distribution of fat in the human body
Distribution is programmed by genetics and hormones.

- Genetics: Each person has a different capacity for storage. One knows that, for a same amount of ingested food, some will lose weight, others will maintain their weight, and others will even gain weight. Genetics can also explain how certain women have riding breeches and others not.

- Hormones : Generally speaking, men and women do not sore their fat in the same places. We are talking about android and gynoid obesity.
Android obesity is mostly present in men, sometimes in women as well. The place for storage is located in the upper part of the body, and the lower limbs are always thin.
In gynoid obesity, the opposite occurs : fat is located beneath the hips towards the lower part of the body. If the upper part of the body is slim, diet is less efficient, and can even get the upper part slimer whereas the lower part does not change. Then the difference between up and down will be increased.
 
Surgery

- Liposuction : removal of fat under firm skin
It is often the unique solution for obesity located in the lower part of the body, since diet is not efficient here.
The procedure was established twenty years ago by Dr YG.ILLOUZ and has become the most popular surgical plastic operation worldwide.

- His success can be attributed to his excellent results: up to 10 litres of fat can easily be removed, i.e. three dress sizes.
- There are no apparent scars: they measure a few centimetres and can be hidden in the folds of the skin.

Liposuction of the riding breeches is carried on through very a very small incision.

- The results are permanent : patients frequently ask ' Will it come back again ? ' The answer is : if all the cells of storage have been removed in a given place, it his technically impossible. Recurrence can be observed if all the cells have not been removed, and if a sudden uncontrolled weight-gain occurs.

The main issue in liposuction is not the recurrence ; it is the skin. Will the skin shrink? Is there still enough elasticity to avoid the so-called ' waves ' ?

During the preoperative visit, the surgeon assesses the quality of the skin, and warns the patient against the likelihood of a cutaneous excess. The probability of waves is not a contra-indication, because what the patient is usually seeking with this operation is to be able to dress, not to undress.
She will be able to wear jeans again, because the reduction in volume can be very important.

New techniques will help the surgeon handle the skin problem, two in particular:

- The diameter of cannulas: In the beginning of liposuction, cannulas measured 10 to 12 mm and destroyed the fibrous tissues, thus causing a skin-shrinkage. Nowadays, cannulas usually employed measure 3 to 4 mm. The procedure is longer, but far less traumatic.

- The superficial liposuction: The deep layer is not the only target for liposuction, the superficial one will be also cured through very small cannulas, which create a second layer of healing of the skin.

Places to treat:
Almost every place can be treated. There are 20 places more likely to be treated.

Removal of fat and skin: if the skin is not firm, the surgeon has to remove skin altogether with fat. For more details, refer to the chapter 'surgery after massive weight-loss'.

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