Before Undergoing Bariatric Plastic Surgery
Dr. Barry Eppley – Indianapolis Plastic Surgery

While some patients may be anxious to get on with the 'final' stage of their weight loss journey, it is important to wait until at least several months after you have reached your weight loss goal. This allows your body a period to recover and adjust metabolically to the new weight, allows time for the skin to accommodate to your now smaller frame. This also allows you to acquire new eating habits for long-term weight maintenance.

While there is no magic waiting period, most plastic surgeons would like their patients to have a stable weight for close to six months before considering elective body contouring surgery. A stable weight means minimal fluctuations of only a few pounds. Patients who have had gastric bypass, due to intestinal absorption changes, aren't usually ready for body contouring surgery for a year or longer after the surgery. Patients who have had the lapband procedure lose weight at a much slower rate and it may be much longer than a year after their procedure. Extreme weight loss patients who have done it on their own without surgery can be done within six months after they have hit a stable weight.

The most important reason to wait is to allow your body time to recover. Wound healing for almost every body contouring procedure requires a lot of nutrients and energy to heal properly. You want your energy stores and your immune function to be in the best shape possible. In short, you don't want to be malnourished going into major surgery. With the stress of major body contouring surgery, even a mild nutritional problem may become apparent in the postoperative period resulting in wound healing problems.

Ideal daily requirements for good healing after body contouring surgery include protein (70 – 75 grams), vitamin A (25,000 units), vitamin B12 (500 ug), folate (400ug), vitamin C (2 grams), iron (100mg), and zinc. (20mg) To achieve this level of supplentation, multivitamins and protein drinks and bars may be adequate in some cases. For many patients, however, this oral approach may not be sufficient. For this reason, there are available formulated supplements unique to the needs of the bariatric patient including ProMend (Bariatric Advantage, Irvine, CA) and ProCare Surgical Formula (NutrEssential, Wilmington, CA) These formulas bring to the table the necessary vitamins as well as protein, free amino acids, arginine, and glutamine which are essential building blocks for new tissue formation. ProCare is preferred as it comes in a powder form which is better absorbed in the gastric bypass patient as opposed to pills.

The postbariatric patient is a unique surgical patient because of the magnitude of the procedures and their often compromised nutritional situation. Oral vitamin and protein supplementation should be started one month before most body contouring surgeries and continue for one month after. While this will not eliminate all wound complications, it will decrease the numbers that occur and the length of time that any wound complications will take to heal.