This article is an attempt to educate readers about a method of managing excess skin that may occur following the loss of a large number of pounds after weight loss surgery. It presents a dramatic and unflattering picture of such excess skin, which, in the perspective of the article, appears only to be managed through plastic surgery.
The take-home message from this article is that through the lens of a plastic surgeon, body contouring surgery is almost a necessity following weight loss surgery. The improvements in health and feelings of wellness are not sufficient; formerly obese patients “need” a riskier surgery, the headline tells us.
This article failed to provide any framework for comparing the relative benefits and risk of the body contouring surgery as well as lacking any suggestion of other approaches for management of excess skin.
The costs of contouring are presented as tens of thousands of dollars; in addition, mention is made that they are not necessarily covered by insurers.
The article did not provide any data indicating the percentage of individuals who had had plastic surgery to remove excess skin after weight loss surgery who were satisfied with the outcomes. The perspective of a single patient was presented, concluding that for her “the pain and effort was worth the result. ” But the reader has no idea if this is typical or not.
The article details what are described as “huge scars” after surgery, along with “a long and painful recovery”. Contouring is described as “riskier” and “requiring longer recovery time” than bariatric surgery, though again – there was no quantification provided. The artilce mentions that some patients will have revision done to improve upon the original contouring procedures. Again, no data were given on how common this really is, other than to say that it, in the view of one plastic surgeon, it has “dramatically increased”.
Describing “intense discomfort that interferes with activity” as “a common problem” is hyperbole. While it may be accurate to state that many individuals who have had weight loss surgery report having hanging skin as a result, the number with excess skin and the number with discomfort associated with that skin is not the same. Providing some actual figures for these would help provide a reader with some context.
This article presents body contouring after weight loss surgery as something inevitable. It turns excess skin into a disease that must be treated. While there are individuals for whom excess skin can develop into a situation that is of health concern, this is not always the case. Further, excess skin does not just occur after bariatric surgery but can be a consequence of loss of large amounts of weight even without a bariatric procedure.
Although several plastic surgeons appear to have been quoted for this story, the perspective from a bariatric surgeon or a weight loss surgery program would have been more balanced rather than speculation about what patients are or are not told about excess skin.
While presenting quite an unpleasant picture of what excess skin following the loss of a large amount of weight might be like, the article failed to provide any other options that consumers might choose to manage excess skin.
The story says this has been “a hot topic at all the national conferences over the last couple of years”. It is unclear as to whether this indicates that there are lots of adequately trained plastic surgeons who are trained for these types of procedures or whether it is only available at certain centers. It is perhaps telling that one plastic surgeon interviewed stated that the increase in need for surgical revisions required after contouring procedures is because there are surgeons who “lack adequate experience”. The article would have been much more valuable to readers if it had provided some guidance for how consumers might evaluate the skill and proficiency of a plastic surgeon they were considering consulting for this type of work.
The article states that surgery to remove excess skin “is still relatively new”. While the numbers of people who may seek removal of hanging skin following weight loss surgery is undoubtedly increasing, plastic surgery to remove excess skin and for recontouring is actually not new. The fact that there are few studies of complication rates may relate more to the individualized nature of the procedures than to their novelty.
This article does not appear to be based solely or largely on a press release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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