I had a chance to sit down with the popular Plastic and Cosmetic Surgeon Dr Justin Perron from Brisbane, QLD, at the recent 40th ASAPS conference. I asked him some commonly asked questions about skin removal procedures after massive weight loss. Dr Perron is one of the most sought after surgeons in QLD for this type of procedure.
How long do you suggest patients be at a stable weight before they undergo skin removal procedures?
At present, current guidelines suggest that we should be at least six months of stable weight after the weight loss surgery before we should start looking at or considering surgery. I personally think that six months is the absolute minimum. Really it should be up to a year because there can be some weight loss after that as well. Certainly if you haven’t gotten to your goal weight, then you’ve got time after that six months to do it. I think particularly for body contouring surgery six months is not sort of necessarily the time that you should be looking at. It should be more of the weight goal that you’re looking at.
What are the more common procedures you perform to remove excess skin? Eg. body lift, arm lift, etc.?
It depends on the patient. Everyone ages and loses weight in a slightly different way.
Probably the most common areas are arms, breasts, midsection or abdomen, lower back and thighs. For anyone of those areas or anyone of those combination procedures, I would typically do or offer circumferential lower body lifts, plus one other procedure. Then for a second round of surgery we do the other two areas that you’d consider a problem.
What are your views on performing more than one procedure at a time? What are the pros and cons?
I think part of doing more than one procedure is really a balance between patient safety and sort of the economics of having to do multiple, multiple procedures. I think for me personally without putting patient’s safety at risk safely, certainly a circumferential body lift, plus one other small procedure is reasonable.
Part of that management with a patient asleep is not only having a good protocol for how to manage important things like DVT prophylaxis, but it’s also postoperative management as well and educating patients about the need to stay mobile and the risks of things like DVTs and having a very frank discussion about these risks. As long as we manage them well afterwards and intraoperatively, those risks decrease significantly.
What do you find the biggest challenges are for skin removal patients after massive weight loss?
The biggest challenge for patients first is managing patient expectation. I think that’s probably the biggest thing from an operative point of view. The biggest issue is trying to get enough that it’s going to give a good result. Getting the best result from that first operation is essential.
Getting your weight down to the lowest possible spot that we can is also very essential.
When does someone qualify for Medicare coverage with skin removal after massive weight loss? What about private insurance?
There’s a few important parts to that. First part is having a large weight loss. A large weight loss is considered anything greater than about 10% to 15% of your current body weight. After that as long as you’re having symptoms from the results of that weight loss, so rashes under the skin or infections, pain on movement or inability to wear clothes properly, then those are the qualifying factors for what would be considered Medicare covered weight loss. If they’re Medicare covered, that usually means that most health funds will cover that as well.
If you’ve got several areas of the body, which is very typical for a massive weight loss patient, they should generally be covered under those numbers.