Transcription:
Surgery After Significant Weight Loss

Amanda Wilde (Host): Big lifestyle changes like significant weight loss can definitely do wonders for your health, but those changes can also leave you with unwanted excess skin and drooping. Fortunately, Dr. Marc Elkowitz, Director of Plastic Surgery at Jamaica Hospital is here to talk about exactly how to best address those issues.

Welcome to Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm Amanda Wilde. Dr. Elkowitz, thank you so much for being here today. I really appreciate your time.

Marc Elkowitz, MD, FACS (Guest): Great. Happy to be here.

Host: Now. We know a significant weight loss can have a dramatic effect on the body, but what parts of the body are most commonly affected?

Dr. Elkowitz: That's a great question. When people lose a lot of weight that, you know, the success is initially felt at their weight loss, and that's a great thing, and that's a huge success, but a lot of patients then have issues with the results of that weight loss, the excess skin that used to be essentially filled up is now sagging.

So we see facial sagging, we see neck sagging, we see breast sagging. We see arm sagging, even thighs, the medial thighs, the inner thighs have excess skin and sagging. And I think probably the most common next to breast sagging is probably abdominal sagging, where the lower abdomen just hangs with extra skin. It, people don't like the way it looks with, you know, many ways with good reason, they're frustrated because they did so much work to get where they are and now they still can't wear a bathing suit or get into the right clothing and things like that. So we always look at this as kind of the second half and the journey where you've had either surgery or through diet and exercise, however we get patients to the level where they've lost all that excess weight and they become healthier and they, their blood pressure improves all those things. Now they look at themselves and say, I'm not really where I want to be.

Host: What types of procedures do you offer to help with those types of issues?

Dr. Elkowitz: So in plastic surgery, we correct most of those problems. We could do a neck lift to take away the extra skin in the neck. We could do a breast lift. Sometimes a breast lift is just removal of excess skin and reshaping of the breast. Sometimes I'll put an implant in as. When patients lose a lot of weight, a lot of times, you know, the opposite of when patients gain weight, when people gain weight their breasts can get larger.

Well, the opposite is equally true. They lose weight and the breasts essentially become deflated and smaller, which is why they're sagging. A lot of times adding a little bit of volume with an implant will really help. We could remove excess skin on the arms. We could do a tummy tuck or abdominoplasty for the, for the belly, thigh lift, medial thigh lift. There's an operation where we could do what we call a circumferential thigh lift, where essentially it's like pulling your pants up. It's removing all that extra skin all the way around the front, the back the sides. And we're really reshaping and, arguably creating a whole new body.

Host: Yeah. These results that you're talking about, are they permanent? Do they last?

Dr. Elkowitz: Yeah. I mean, removing that skin for the most part is permanent. Why do I say for the most part, we're still always aging. As you get older, things can sag, but this is not an aging issue. This is a excess skin issue. This is kind of like, I always tell patients your birthday suit is too big. So we trim away the skin and we essentially give patients a new body. That is long-lasting. The other reason that it could be as long lasting as if, if the patient has the surgeries and then continues to lose weight. And that's not necessarily a failure, because what we find often is that when patients lose a good amount of weight and then they plateau, although this surgery is not a replacement for weight loss, a lot of times, patients are very kind of debilitated with all this extra hanging skin in the lower abdomen hanging in, in the way. There's hygiene issues. And when a lot of those things are corrected, the patients kind of get like another boost and they could exercise more and move around more, do more, and that leads to more weightloss.

Host: Well, I was just going to say, who is the ideal candidate for these types of procedures?

Dr. Elkowitz: When we look at those procedures, there's a lot of different procedures. So there's not a correction after weight loss procedure, like we said, there's neck lifting or breast lifting, or some of these surgeries are much more involved than others. So, as a surgeon, as a doctor I like to evaluate the patients and discuss with patients with those risks are. Obviously if there are significant health issues we want consider those health issues be cautious. I also tell patients a lot, this stuff could be a lot of fun, but we also have to be very careful. It's serious business. If done safely, the vast majority of these procedures are very safe and very well tolerated, but we want to be careful. A lot of patients who have lost a lot of weight are losing a lot of weight because they've had other health problems and that's why you have to be involved with reputable people.

A good portion of what I see and do in my practice is correction of other surgeries. I think it's important for patients to have trust in their surgeon, reputable surgeon, well-trained surgeon, and equally, if not more importantly, is a surgeon, that's willing to call you back. Patients with these surgeries need a lot of communication with their surgeon.

And the one thing that's important is a good relationship with your surgeon that God forbid there's ever a problem or, or an emergency, that you've got someone who's going to help you.

Host: This is really major body contouring we were talking about. Can you discuss what the recovery process is from that?

Dr. Elkowitz: Sure. It's an interesting thing, because with a lot of these surgeries, like I said before, that some of them are not such large operations. Some of them are larger operations, but one thing to keep in mind, most of these procedures are for the most part, skin operations, their skin, fat. I mean that as opposed to bone operations, joint operations, muscle operations. In general, those are the things that tend to be more painful, have longer recovery, need even physical therapy, things like that, much more involved.

When we're doing surgeries that are mostly skin fat, we're not getting down into muscle and bone, they tend to be a lot less painful, a lot easier to recover. And I think, frankly that's why you see you know, this day and age a lot of these procedures being done. I imagine, most people know someone who has had a breast reduction or had a tummy tuck or had liposuction. It's commonplace. I think it's commonplace partially because it's usually very well tolerated.

Host: Yeah, it does seem to be more and more common. What's the followup process from your end as the doctor, is there a long-term followup process since this is such a significant surgery?

Dr. Elkowitz: Yeah, I would categorize, follow up into essentially three, three groups. One is the early followup, acute follow-up days after surgery a week or two after surgery, where as a surgeon, you really have to keep an eye on your patients. You're looking for any complications or problems. And then you have of that medium timeframe. In the next few months, you see the patients now and then just to make sure that nothing is developing. Problems aren't developing, that the patient is happy, that there's nothing that we could maybe intervene with early on. And then I like to see my patients further out quite frankly, because I like to see how the results are.

Most patients are very happy. I like to see the smiles. It sounds corny, but it's nice to hang out with the patients in the hallway and have them tell you that they haven't worn a bathing suit in a decade and now they are. I always tell patients that the final follow-up is for me, not for them.

Host: And it sounds like what we're ending with is it really opens the door to lots of freedom with bodies that maybe these people have not experienced for a long time.

Dr. Elkowitz: Yeah, there's a lot of things we can do for patients. I think that the hardest part is the weight loss itself. Most people have struggled with weight loss on one level or another. It is not an easy thing to do. I think the fun part is my part. I come in and I help patients get to where they really want to be. I think if someone is significantly overweight, there's the medical problems. There's like we said, the blood pressure and things like that, but there's also the part that they're just unhappy with their body. They're unhappy with what they see in the mirror. They lose the weight and to some degree they're better off and they're happier, but bridging that jump to really looking in the mirror and being happy is where all these things come in. You could argue that that's the unsung hero, right? It's not really the weight loss in itself. It's what you want that body to be. And that's not just the weight loss, that's the whole process. And that's not to say that every patient that loses weight needs these corrective surgeries, but a lot do.

Host: Yeah, and you do the fine tuning to help each patient live the dream. So thank you for the work you do to offer lots of options and choices for people dealing with this aftermath of significant weight loss.

Dr. Elkowitz: You know, it's interesting that you say options and choices. Cause I think that's just it. Almost going back to the first question you asked me. All of these things may or may not happen. Sagging of the breasts, sagging of the neck, sagging of the abdomen, they all may or may not happen. Every patient has different concerns and different wishes. We prioritize. It's not always possible to go to sleep and wake up with everything done. A lot of surgery. But we like to prioritize. Some patients come in and say, X Y and Z don't bother me, but A, B and C are driving me crazy. That's the job of the patient and the surgeon to get together and figure those things out.

Rapport is very, very, very important. Pre-op and post-op, we mention rapport with the surgeon post-op, but rapport with your surgeon pre-op is just as important because we need to all be on the same page as to what are we doing here? Why are we here? What's the goal? I don't like when everything is the goal. I like to pick and choose, prioritize, and go from there.

Host: We have a bit of magic here, but we also have realistic expectations of a surgery.

Dr. Elkowitz: Absolutely realistic expectations are the surgeon's job to make sure that the patient understands what those realities are. And sometimes it's a little disappointing to the patient because they think sometimes not all, but sometimes patients think, oh, plastic surgery, that's just a magic wand. It's not, it's hard work. It's choices, it's decisions. It's all of those things. And it's the surgeon's job to make sure that when the patient goes to sleep for an operation they wake up getting what they thought they were getting.

Host: And that all starts with the surgeon that you as a patient can trust and communicate with. And you're a great example of that.

Dr. Elkowitz: Without that, it's a non-starter.

Host: Thank you, Dr. Elkowitz.

Dr. Elkowitz: Thank you.

Host: To schedule an appointment with Dr. Elkowitz at Jamaica hospital, please call 718-206-7001. For more information about the services Jamaica hospital offers, visit our website at Jamaicahospital.org/podcasts. I'm Amanda Wilde. Thanks for listening and be well.