Bariatric surgery can result in remarkable amounts of weight loss. Unfortunately the outcome always leaves excess loose skin and rolls of fatty tissue. The abdomen is often the main focus of attention. This 35-year-old woman had a duodenal switch performed 5 years ago and lost 160 pounds. Although still obese, she had significant deposits and rolls of skin excess on her abdomen and flank areas. Because she had chronic infection in the intertriginous areas, she actually had some of her surgery covered by insurance. This is very uncommon however. Most insurance companies will not cover abdominoplasty. Sometimes the panniculectomy portion-which is simple removal of the lower apron of excess skin and fat, is covered but diastases repair, transposition of the umbilicus and more extended procedures are not covered. Many patients will pay extra to have these procedures performed.
Several variations of abdominoplasty exist including circumferential-which is a 360° skin removal, extended-which goes to beyond the hips and starts into the flank area and fleur-de-lis which involves horizontalas well as vertical skin excess removal.
This patient had an extended abdominoplasty and although she could have had a circumferential; she had very good results with a more limited procedure. Typically these patients will still have skin excess which manifests as a dogear deformity. This can typically be treated with a future, more limited procedure such as a buttock lift.