This question is a little vague so I'll try to hit all the angles.
•First, Gravity always wins because gravity is always in effect.
The process of aging has been discussed by many accomplished Plastic surgeons, mostly in regard to facial aging.
Two schools of thought have predominated:
•The face ages because the skin sags/stretches because of... gravity, or rather, a loss of elasticity.
•The face ages because the underlying fat/soft tissues "deflate"
Personally, I believe it is a combination of the two.
As the skin ages (all skin, not just facial) its elasticity diminishes. It doesn't snap back the way it used to.
As people age, they often lose weight in their faces (do a google search on older celebrities).
This loss of fat, with a decrease in elasticity, can cause a premature aging of the face, and neck.
Now, apply this to the rest of the body.
•Breasts: lose volume after pregnancy and menopause, lose elasticity with age (particularly larger breasts, due to gravity!) and resultantly sag.
•Abdomen: lose volume after massive weight loss, lose elasticity due to multiple pregnancies or massive weight loss, and resultantly sag.
•Arms, Thighs, Butt...
What can be done?
For most of the body, if sagging is the problem, the only option is removal of sagging skin. The loss of elasticity of the skin cannot be restored.
Exeptions to this rule include: the breasts and the face.
•for mild to moderate sagging, breast augmentation with silicone or saline implants may restore a more youthful fullness without having to remove skin.
•for some areas in the face, fillers can restore some areas of sagging or deflation.
•for the butt, sometimes fat injection or implants can be used to fill out an otherwise flattened posterior.
Monday, December 28, 2015
Post Bariatric Body Contouring - What Is Covered?
Multipart question...
Gastric bypass has become a very popular option for weight loss in morbidly obese people, increasing in popularity exponentially. Some studies have reported that the procedure is 700% more popular than 10 years ago.
As the popularity of gastric bypass increased, so too did plastic surgery after weight loss. 7 years ago, 1 in 4 people sought out plastic surgery after weight loss. Now that number is closer to 3 in 4.
The "dirty little secret" of weight loss surgery, is that while you will lose a tremendous amount of weight, you will not lose skin. The skin is worn out. Inelastic. It won't snap back to its original shape. It must be removed.
Taking into account the increase in people getting gastric bypass, and with that the increase in people seeking plastic surgery after weight loss, insurance companies began placing tighter restrictions on what it took to qualify for a covered procedure.
These days, most insurance companies will only pay for a panniculectomy (I'll explain later), and/or a breast reduction.
In addition, patients must meet criteria, commonly:
100 pound or more weight loss
1 year out from gastric bypass surgery
6 months at a stable weight
increasingly they are requiring medical complaints associated with the skin condition:
-rash unsuccessfully treated by another physician.
-back or neck pain
-an abdominal hernia present
Breast Reduction:
the amount of tissue to be removed is often determined by insurance companies using a formula called a "Body Surface Area" (BSA). There are several different ways to calculate this depending on the formula used, but they all are based on your height and weight.
Unfortunately, most people who have had massive weight loss through surgery have DEFLATED, sagging breasts, not large enough to qualify for a covered procedure by insurance.
often, weight loss patients benefit more from a breast lift, a breast augmentation, or a combination of a lift and augmentation.
I like to discuss Abdominal body contouring in terms of buying a car. General motors (when I started practicing anyway) had 3 price levels of cars:
Entry level: Pontiac
Midrange: Buick
Luxury: Cadillac
In abdominal body contouring:
Entry level: Panniculectomy
Midrange: Abdominoplasty
Luxury: Circumferential Belt Lift
In the analogy: they are all cars. They will all get you from point A to point B. The difference is how good they look and the extra features as the price goes up.
Insurance will pay for the Pontiac.
A panniculectomy is the removal of the apron of skin that hangs down over your lap. No tightening of skin up to the ribs, no tightening of muscle, no relocation of the belly-button. In fact, if the belly-button is located within the apron of skin, it is removed in this procedure.
This is an overview obviously.
Gastric bypass has become a very popular option for weight loss in morbidly obese people, increasing in popularity exponentially. Some studies have reported that the procedure is 700% more popular than 10 years ago.
As the popularity of gastric bypass increased, so too did plastic surgery after weight loss. 7 years ago, 1 in 4 people sought out plastic surgery after weight loss. Now that number is closer to 3 in 4.
The "dirty little secret" of weight loss surgery, is that while you will lose a tremendous amount of weight, you will not lose skin. The skin is worn out. Inelastic. It won't snap back to its original shape. It must be removed.
Taking into account the increase in people getting gastric bypass, and with that the increase in people seeking plastic surgery after weight loss, insurance companies began placing tighter restrictions on what it took to qualify for a covered procedure.
These days, most insurance companies will only pay for a panniculectomy (I'll explain later), and/or a breast reduction.
In addition, patients must meet criteria, commonly:
100 pound or more weight loss
1 year out from gastric bypass surgery
6 months at a stable weight
increasingly they are requiring medical complaints associated with the skin condition:
-rash unsuccessfully treated by another physician.
-back or neck pain
-an abdominal hernia present
Breast Reduction:
the amount of tissue to be removed is often determined by insurance companies using a formula called a "Body Surface Area" (BSA). There are several different ways to calculate this depending on the formula used, but they all are based on your height and weight.
Unfortunately, most people who have had massive weight loss through surgery have DEFLATED, sagging breasts, not large enough to qualify for a covered procedure by insurance.
often, weight loss patients benefit more from a breast lift, a breast augmentation, or a combination of a lift and augmentation.
I like to discuss Abdominal body contouring in terms of buying a car. General motors (when I started practicing anyway) had 3 price levels of cars:
Entry level: Pontiac
Midrange: Buick
Luxury: Cadillac
In abdominal body contouring:
Entry level: Panniculectomy
Midrange: Abdominoplasty
Luxury: Circumferential Belt Lift
In the analogy: they are all cars. They will all get you from point A to point B. The difference is how good they look and the extra features as the price goes up.
Insurance will pay for the Pontiac.
A panniculectomy is the removal of the apron of skin that hangs down over your lap. No tightening of skin up to the ribs, no tightening of muscle, no relocation of the belly-button. In fact, if the belly-button is located within the apron of skin, it is removed in this procedure.
This is an overview obviously.
Techniques In Fat Injection
Fat injections, or fat transfer, to the face and other areas of the body have increased in popularity in recent years, but it is hardly a new technique.
Fat transfers have been described in medical journals since as early as 1893 for the correction of deep scars.
Modern techniques in fat transfer through fat injections were developed by Plastic Surgeons. With the development of liposuction in the 1980s Plastic Surgeons now had access to an abundant supply of fat they could now use to reintroduce into the same patient to improve cosmetic problems. The earliest use of liposuctioned fat in cosmetic procedures was 1984 by Plastic Surgeon Dr. Yves-Gérard Illouz of France.
With refinements in technique, fat grafting has become the procedure of choice for an array of cosmetic problems, including facial scarring, lip augmentation, and facial wrinkles (such as several otherwise difficult-to-address areas such as the nasolabial fold and forehead furrows). It also remains an excellent way to improve the contoura of deep or depressed scars.
Fat transfer can be a permanent solution for patients that regularly receive hyaluronic acid injections (Juvederm or Restylene).
In some instances, fat injection can be a faster, more affordable alternative to a traditional facelift, to correct lines of aging. Patients with excess skin in the jowl or neck areas may not be good candidates for fat grafting alone.
Is fat grafting right for you? Maybe. The best way to determine if you would benefit from a fat injection procedure is to schedule an appointment with a Board Certified Plastic Surgeon, the only Board recognized by the American Board of Medical Specialties to perform Cosmetic Surgery.
William A. Wallace, MD FACS of Fleming Island Plastic Surgery is both Board Certified by the American Board of Plastic Surgery AND by the American Board of Surgery. He is a Member of the American Society of Plastic Surgeons, the American Society of Aesthetic Plastic Surgery, and a Fellow of the American College of Surgeons.
For more information, please review the Fleming Island Plastic Surgery website.
Fat transfers have been described in medical journals since as early as 1893 for the correction of deep scars.
With refinements in technique, fat grafting has become the procedure of choice for an array of cosmetic problems, including facial scarring, lip augmentation, and facial wrinkles (such as several otherwise difficult-to-address areas such as the nasolabial fold and forehead furrows). It also remains an excellent way to improve the contoura of deep or depressed scars.
Fat transfer can be a permanent solution for patients that regularly receive hyaluronic acid injections (Juvederm or Restylene).
In some instances, fat injection can be a faster, more affordable alternative to a traditional facelift, to correct lines of aging. Patients with excess skin in the jowl or neck areas may not be good candidates for fat grafting alone.
Is fat grafting right for you? Maybe. The best way to determine if you would benefit from a fat injection procedure is to schedule an appointment with a Board Certified Plastic Surgeon, the only Board recognized by the American Board of Medical Specialties to perform Cosmetic Surgery.
William A. Wallace, MD FACS of Fleming Island Plastic Surgery is both Board Certified by the American Board of Plastic Surgery AND by the American Board of Surgery. He is a Member of the American Society of Plastic Surgeons, the American Society of Aesthetic Plastic Surgery, and a Fellow of the American College of Surgeons.
For more information, please review the Fleming Island Plastic Surgery website.
Subscribe to:
Posts (Atom)
