ABSTRACT

Obesity is a global disease with epidemic proportions. Bariatric surgery or modified lifestyles go a long way in mitigating the vast weight gain. Patients following these interventions usually undergo massive weight loss. This results in redundant tissues in various parts of the body. Loose skin causes increased morbidity and psychological trauma. This demands various body contouring procedures that are usually excisional. These procedures are complex and part of a painstaking process that needs a committed patient and an industrious plastic surgeon. As complications in these patients can be quite frequent, both the patient and the surgeon need to be aware and willing to deal with them.

UNDERSTANDING THE PROBLEM

India is at the crossroads of many diseases. On one hand, we have not been able to conquer the communicable diseases. On the other, medical problems of the affluent have fast caught up with us. Obesity is a worldwide epidemic affecting over 1.1 billion people.[1] Of the Indian population 5% is morbidly obese. With a flood of “fast-food joints” drowning our society and the common urban man not having time for a healthy life-style, we are staring down the barrel.

What is more worrying is the rapid increase in childhood obesity. Apart from that, since surgical procedures in general are more economical in India, many obese patients have started thronging to the medical tourism capital of the world.

Obesity, defined as a body mass index (BMI) equal to or greater than 30, is associated with a high risk of morbidity and mortality. Fortunately bariatric surgery often leads to massive weight loss (MWL) that is considered as 100 pounds (approximately 45.45 kg) or more. Shermak et al. defined MWL as 50% or greater loss of excess weight.[2] This often results in redundant tissues of the lower trunk, upper back, breasts, arms, and thighs. Loose skin often causes intertrigo, difficulty in walking, urinating, or performing sexual activity, and consequent low self-esteem. This necessitates various body contouring procedures, usually excisional, in these patients.

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