Body Contouring after Massive Weight Loss

Abstract

We are all aware that there is a global epidemic of obesity in adults and children. According to current estimates, more than 1 billion adults are overweight. The UK Department of Health predicts that one in three adults and a fifth of all children, a total of 13 million people, will be clinically obese in the UK by 2010 and will present a crippling burden to the NHS. There has been a huge increase in surgical procedures to facilitate weight loss in the US. Figures from the American Society of Plastic Surgeons show that the biggest increase in demand for cosmetic surgery in the last 2 years has been to remove skin excess in massive weight-loss patients. This book with two CD-ROMs edited by an experienced surgeon, Dr Aly, is therefore timely. The book opens with a very good review of the surgical treatment of morbid obesity of which the laparoscopic adjustable gastric band procedure is just one of five surgical possibilities. The authors emphasise the importance of a team approach to such patients, including a psychiatrist, dietician, exercise physiologist, bariatric surgeon and a plastic surgeon. The main part of the book describes surgical techniques to excise redundant skin divided into anatomical regions. Procedures such as belt lipectomy, lower body lift with medial thigh lift, and buttock lift are all well presented with the appropriate anatomy and very good illustrations. This is reinforced by the two CD-ROMs – one clearly demonstrates the operation of belt lipectomy and the second, upper-body lift. Dr Aly rightly emphasises the high complication rate associated with operating on this group of patients. In a consecutive series of 70 patients having belt lipectomy, 56 had at least one major complication, for example, seroma, wound dehiscence, psychiatric difficulty, infection, tissue necrosis as well as pulmonary embolus and deep vein thrombosis. At the end of each chapter, Dr Aly's experience is highlighted in a ‘Summary of Pearls’. Surgical operations of the upper half of the body are equally well covered. The presentation of this text is extremely high as one would expect from Quality Medical Publishing. The list of contributors to the book is both impressive and comprehensive and each chapter is well annotated with the appropriate references to the scientific literature. Overall, this book is a must for the presumably small group of surgeons who will become involved with this group of patients. It is not for the faint-hearted: the possibility of major complications is real but this is a good start for surgeons developing on an interest in this area. My only criticism is that the CD-ROM on upper body lifting could have been better edited but otherwise I strongly recommend this book and give it five stars.