Body Contouring After Massive Weight Loss

This assignment delves into the complexities of body contouring surgery following substantial weight loss. It examines various procedures like arm lifts (brachioplasty) and medial thigh lifts, analyzing their outcomes and potential complications in patients who have undergone significant weight reduction. Additionally, it explores the impact of these procedures on the quality of life for individuals.

DISCUSS THE EFFECT
OF A MEDICATION OR
SYSTEMIC DISEASE
AND HOW THIS WILL
IMPACT OPERATIVE
PATIENTS.

TABLE OF CONTENTS
INTRODUCTION..............................................................................................................1
Investigation of aesthetic procedure- Body contouring surgery ..............................1
To investigate how a particular systemic disease can increase the risk of
complication to these procedures............................................................................2
Advice or treatment procedures by dermal clinicians ..............................................4
CONCLUSION................................................................................................................. 5
REFERENCES.................................................................................................................6

INTRODUCTION
Body contouring surgery is the process of removal of extra weight along with excessive
saggy skin and fats from body. It also helps in improving the shape of underlying tissue (Obesity
And Surgical Wound Healing: A Current Review, 2014). There are various body contouring
procedures some of them are:One of them is facelift surgery, It helps in removal of excessive
sagging fats from neck, midface and jowls. Same in the series is tummy tuck surgery, It
removes the extra fat and skim from the abdominal area and tighten the surrounding muscles.
Another type is Arm lift surgery It helps in removal of sagging skin and fats from the upper arms
and reshape it. Similarly, in the series is Liposuction. It is process that help in the removal of
extra fat from body (Ellison, Steffen and Sarwer, 2015).
This particular assignment regarding the effect of medication or systematic disease on
the operative patients. This also includes the process of healing procedures and complication
faced by particular patient during this process. Along with this it also includes the effect of
disease on the healing procedures along with the suggestion and treatment given by dermal
clinicians to come up with these complications.
Investigation of aesthetic procedure- Body contouring surgery
Body contouring surgery is the set of aesthetic procedure which help in the improvement
of body posture by modifying the shape and size of different part of the body. It is generally
performed at waist, thighs, buttock, upper arms and abdomen. The process of Branchioplasty, a
type of body contouring surgery which concerns with arm lift surgery, the surgeon put incision
from elbow to arm pits to remove the extra fat and tight the skin (Arm lift, 2015). In case of
obesity, liposuction technique is used to remove fat and incision that is made in arms should
must be large enough to insert the tube. Thus, the wounds made during body contouring
surgery are deep and long. Adipose tissues of upper arm, elbow and arm pit are involved in this
surgery. Pain after surgery while healing of wound is mild and generally decrease after 48 hours
of surgery. Recovery procedure last for two to three weeks and depends on the age and healing
power of person (Hurwitz, 2014).
Healing process in Branchioplasty generally consists of three stages. First stage is of the
clotting of the wounds. The neutrophils and macrophages start collecting at the place of wound
and begin the inflammatory phase. But any stress on the wound can lead to tearing of wounds
and may burst the blood vessels under the skin. It is necessary for the patient to restrict the
movement just after the surgery. In case of lack of proper dressing it can result in infection with
the sign of redness, swelling, formation of puss and extreme pain. For this the patients are
provided with non steroidal anti inflammatory drugs to overcome the pain. It is considered that
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the as fast as immune system eradicate infection, the process of healing become better (Soldin,
Bain and Mughal, 2016). Second stage of healing includes the formation of tissue that were
damaged during arm-lift procedure that take place after 2-3 days of clotting stage. Tissue of
upper arms and elbow are easy to heal as they heal at faster rate. But the tissues present in
armpits require extra care. Small amount pf pressure can tear the muscles and tissues. The
patients are therefore required to keep their arm lifted to fasten the healing procedure. In case
of bleeding or tissue injury patients, need immediate care and have to bear a lot of pain (Dauwe
and et.al., 2015).
Final stage of the healing procedure is the remodeling phase, which can last from a
week to a month. In this stage tissues are remodeled and apoptosis take place that leads to
fibrosis and scar tissues. On an average a healthy person can get completely healed within 2
weeks and can join the routine life work.
There are some minor complication which occur in some cases of arm lift surgery which
includes: fluid collection under the skin of elbow and arm, skin infection along with puss under
the skin, separation of wound and damages to nerves present under the skin of particular area
of arm and elbow (Gilmartin and et.al., 2016). Wound infection is the most common
complication and generally treated with use of antibiotic. But in some rare cases blood vessels
burst out under the skin of wounds and need proper sealing and causes severe pain to patients.
Seroma also called extra fluid that is collected under the operated skin need to be drained. A
needle is inserted and fluid is removed, it is also a painful process ((Ellison, Steffen and Sarwer,
2015)).
To investigate how a particular systemic disease can increase the risk of complication to these
procedures.
Obesity results in the poor outcomes in many medical practices. Obesity is a state of
extreme fat collection in body, which causes negative health impacts over the body. It causes
many post operation difficulties mainly related to wound healing, oxidative stress and immune
deficiencies (Jones and Janis, 2015). It is discussed that healing procedure consists of three
stages. The first stage is regarding clotting the wounds but obesity results in the development of
infection at the site of surgery. Infection in turn effects the procedure of wound healing and
wound bed preparation by delaying the time. To attain the optimal healing it is necessary to
reduce the obesity that eradicate the formation of infection.
Second and last stage of healing is related to tissue formation and remodeling of tissues.
Any complication in tissue formation can delay the healing procedure. But in this case, obesity
creates multiple complications that include the fascial dehiscence, impairment in the wound
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healing procedures and in some cases may result in complete wound failure. This in turn
increase the overall cost if surgery for patients and healing time of wound.
Obesity increases the complications related to the wound healing due to the two
important factor: poor vascularity of the adipose tissues and tenuous intrinsic anatomic
properties (Gusenoff and et.al., 2015). Due to insufficient and poor vascularity the oxygen
tension decreases that result in very less synthesis and formation of collagen cells. This
ultimately result in decline of the capacity of body to fight against the infection and to decrease
the support of necessary mechanism that help in the healing procedure. There is need of
oxygen perfusion to heal the wound more rapidly, but it is decreased due to the vascular
insufficiency. This is due to several factors such as decreases in the elastin and increased level
of collagen in the body (Danilla and et.al., 2014). Such type of changes in the extracellular
matrix result in increase in rigidity of the adipose tissues. These events result in the restriction of
capillary proliferation, along with this there is the presence of the larger blood vessels in the
obese people. The decrease in the capillary density and presence of high number of large blood
vessels result in the decrease in oxygen perfusion which ultimately effects the healing
procedure in the obese people.
It is also found that obesity is also associated with the expression of 11f3-hydroxysteroid
dehydrogenase type 1 which is a glucocorticoid enhancing enzyme. These glucocorticoids
suppress the process of angiogenesis. As a result of this, the adipose tissues present beneath
the skin of wounded area become hypoxic due to the suppressed angiogenesis and increase in
hypoxia inducible factor 1 alpha. This increase in the inducible factor 1 alpha starts the process
of fibrosis and inflammation by activating the collagen I and III activities. Thus, the over
expression of such factors and enzymes result in the wound impairment and delays the process
of healing (Rafferty and Snyder, 2015).
Due to presence of lower level of oxygen tension in the wounded tissues plays the major
role of exposing wounds to infractions. Obesity in the patients going through surgery faces
greater risk of exposure to infection because of the hypo perfusion of the subcutaneous adipose
tissues that are commonly found in the obese patients. The condition of obesity also decreases
adiponectin concentration in the adipose tissue that are present below the wounded areas. This
deficiency in the adiponectin lowers the wound healing through two mechanism: by the
response of ischemic stimulation adiponectin stimulates the angiogenesis by AMP-activated
signaling of protein kinase. Second mechanism involve the activation of ERK signaling pathway
that promote the keratinocyte proliferation which is a critical process in the reepithelialiazation of
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wounds. Thus decrease in the production of adiponectin hinders the process of adequate
perfusion and reepithelialiazation of the wound healing (Hurwitz, 2014).
It is well known that collagen synthesis is the most important and essential part of the
wound healing mechanism. It helps in formation of the tensile strength of the wound. It is also
found that collagen I and III are responsible for the wound healing. This procession of formation
of collagen and its action is suppressed by the obesity. Due to the presence of excessive
amount of adiposity in the skin below wound area result in the expression of collagen III and an
immature and disorganized collage type I fibers. In the absence of the collagen the matrix
formed by this collagen type is not able to remodel properly thus lead to reduction in the
strength of the healed wound.
Nutritional deficiencies play the major in improper and delayed wound healing.
Deficiency of Vitamion D due to obesity result in the lack of absobtion of Calcium (Soldin, Bain
and Mughal, 2016). BMI is the important factor for the Vitamin D deficiency, which is further
associated by obesity Calcium is the major requirement which act as factor IV, as it help in the
activation of many inter-cellular reaction which act as the primary catalyst in the production of
clotting factor VIII, IX and X. Calcium is also required in many other process that includes:
activating the neutrophils, regenerating the epidermal cells, help in the migration of cells to
wounded area and modulation of the keratinocyte differentiation and proliferation (Toppino,
2014). Thus, proper nutrition also plays the important role in the healing procedures of wounds.
Advice or treatment procedures by dermal clinicians
On the basis of above discussion it is clear that healing of wounds require a set of well-
coordinated steps that includes: hemostatsis process, inflammation, fibrogenesis, contraction,
granulation tissue formation, reepithilialization and finally neo vascularization. In order to
achieve all these cellular response and the proper functioning of homeostatic mechanism there
is a need of adequate amount of vitamins, minerals, proteins and other important nutrition
(Ferrada and Anand, 2015).
According to the stages involved in healing the dermal clinician will advise and perform
the following treatment procedures to improve the healing process:
Clot formation stage
The first stage involved in healing is the clotting of wound and complication in this stage
result in the infections. Clinical tries to cover the wound by anti bacterial dressing to protect the
area from infection. In case of infection clinician provides patients with oral tablets and creams
that are applied over infected area. The dermal clinician also suggest taking calcium as the
main component of diet. It is known that the calcium helps in the activation of the neutrophils
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that will aid patient in dealing with infections. Recent studies also proves that calcium helps in
the activation of the clotting factors VIII, IX and X that help in the clotting of wound to heal it
faster (Wang and et.al., 2014).
Tissue formation stage
This stage of healing involves the tissue formation, it is discussed that obesity aids in the
formation of inducible factor 1 alpha which result in dis-functioning and hinders the process of
tissue formation. Another impact of obesity is decrease in the oxygen perfusion that also delay
the healing procedure. To come up with these complications dermal clinicians suggest patients
to have intake of vitamin D. Vitamin D has an immunomodulatory mechanism in the adipose
tissue that help in the formation of the new tissues (Boni and et.al., 2013). It is also found that
vitamin D reduce the lipid accumulation and enhance the oxygen perfusion in the vessels
surrounding it which aids in unveiling the anti inflammatory effects in the adipose tissues.
Tissue remodeling stage
This is the final stage of the healing wounds. Obesity results in the formation of the
immature and unorganized collage factor type I and III which result in the healing of wound but
having weak strength. Thus, it hinders the process of remodeling performed by tissues. For this
the clinicians provide patients with medicines and diet plan which is rich in Vitamin A and zinc.
Vitamin A increase the rate of collagenesis and epithelialization that enhances the process of
collagen synthesis and cross link them to increase the strength of healing wound. This help
tissues in gaining the proper shape and strength (Yassin and et.al., 2013). During the
inflammatory and fibrogenesis process the zinc assist in increasing the immune and
inflammatory response, epidermal regeneration, collagenesis and matrix degradation.
Dermal clinician also suggest the patients for the intake of vitamin B12 which help to
increase the tensile strength of the wounds and aids in facilitating the superior wound healing
mechanism. He also suggests taking iron helps in increasing the antibacterial activities against
the infection caused on the wounded area.
CONCLUSION
From the above report it can be concluded that body contouring surgeries help in getting
rid of the obesity in the better way. But obesity itself poses complication for patients in the
healing procedure of the wounds involved in surgery. However by the help of dermal clinicians
these problems can be eradicated in much better way. The treatment procedures and
suggestion given by dermal clinicians help in the enhancing the healing procedure and inhibits
the infection from occurring on wounds.
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REFERENCES
Books and journals
Boni, L., & et.al. (2013). To our Master…. Celebrating excellence. 11(S1). S2-S5.
Danilla, S., & et.al. (2014). The Body-QoL®: measuring patient reported outcomes in body
contouring surgery patients. Aesthetic plastic surgery. 38(3). 575-583.
Dauwe, P. B., & et.al. (2015). Infection in face-lift surgery: An evidence-based approach to
infection prevention. Plastic and reconstructive surgery. 135(1). 58e-66e.
Ellison, J. M., Steffen, K. J., & Sarwer, D. B. (2015). Body contouring after bariatric
surgery. European Eating Disorders Review. 23(6). 479-487.
Ferrada, P., & Anand, R. (2015). Repair of the Open Abdomen Hernia, Scope of the
Problem. Encyclopedia of Trauma Care, 1416-1419.
Gilmartin, J., & et.al. (2016). Quality of life among adults following bariatric and body contouring
surgery: a systematic review. JBI database of systematic reviews and implementation
reports. 14(11). 240-270.
Gusenoff, J. A., & et.al. (2015). Medial thigh lift in the massive weight loss population: outcomes
and complications. Plastic and reconstructive surgery. 135(1). 98-106.
Hurwitz, D. J. (2014). Aesthetic refinements in body contouring in the massive weight loss
patient: trunk. Plastic and reconstructive surgery. 134(6). 1185-1195.
Jones, A. P., & Janis, J. E. (2015). Essentials of plastic surgery: Q&A companion. CRC Press.
Rafferty, J. F., & Snyder, J. R. (2015, December). Reoperative surgery for persistent anal
fistulae. In Seminars in Colon and Rectal Surgery (Vol. 26, No. 4, pp. 174-181). WB
Saunders.
Soldin, M., Bain, C. J., & Mughal, M. (2016). Body Contouring Surgery after Bariatric Surgery.
In Obesity, Bariatric and Metabolic Surgery (pp. 713-721). Springer International
Publishing.
Toppino, M. (2014). 10 Lower GI Tract in Obesity. The Globesity Challenge to General Surgery:
A Guide to Strategy and Techniques, 141.
Wang, X., & et.al. (2014). 2014 Scientific Session of the Society of American Gastrointestinal
and Endoscopic Surgeons (SAGES) Salt Lake City, Utah, USA, 2–5 April 2014. Surg
Endosc. 28. S240-S286.
Yassin, N. A., & et.al. (2013). Ligation of the intersphincteric fistula tract in the management of
anal fistula. A systematic review. Colorectal Disease. 15(5). 527-535.
Online
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Arm lift (brachioplasty). (2015). [PDF]. Available through
<https://specialistcosmeticsurgery.com.au/wp-content/uploads/2015/08/SCS-A4-Arm-
Lift.pdf>. [Accessed on 16th September 2017].
Obesity And Surgical Wound Healing: A Current Review. (2014). [Online]. Available through
<https://www.hindawi.com/journals/isrn/2014/638936/>. [Accessed on 16th September
2017].
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