Who Will Ask More For Abdominoplasty After Excess Weight Loss?

The increasing incidence of morbid obesity suggests that the quantity of bariatric surgical procedures will continue to increase each year, as many patients who have experienced massive weight loss are left with functional and esthetic consequences as a result of residual, loose skin.

However, new research published in the International Journal of Surgery, July 2018, suggests that redundant skin with body contour irregularities and disfiguring appearance, which is the aftermath of fast loss of significant amount of fat in concomitant with suboptimal skin retraction.

The research team looked at gender difference in asking for abdominoplasty after significant weight loss in overweight and obese patients.

Redundant skin with body contour irregularities and disfiguring appearance, which is the aftermath of fast loss of significant amount of fat, in concomitant with suboptimal skin retraction. Furthermore, continuous friction and irritation of the skin folds with movement and superadded bacterial and fungal infection together with dependent lymphedema worsen the overall patient’s body-image and results in functional, hygienic and psychological implications. Correcting skin excess could improve all corollaries, including esthetic, and functional problems while giving profound satisfaction with appearance; it has shown to improve both psychological and social aspects of the patients’ lives.

The area of main concern is the waist/abdomen, especially in women, with expectations of reduction of the skin folds, preventing complications, and improving mobility and psychosocial functioning. For that reason, there is a subsequent increase in the number of patients seeking additional corrective procedures, following bariatric surgical operations. Among those, abdominoplasty is considered one of the most popular esthetic body-contouring procedures. Abdominoplasty is not only cosmetic; albeit its aim is to improve the functional, psychological and overall appearance of patients. The most important expectation of body contouring surgery is improved appearance, followed by improved self-confidence and quality of life. The vast majority of the procedure is still targeted toward women, with little attention toward men, and men still represent a smaller fraction of the cosmetic surgery industry in general.

A study stated that among adults (or overall), 84% of men and 72% of women were satisfied with their appearance, while among adolescents, 63% of males and 34% of females experience no problems directly related to excess skin. Biörserud et al. stated that women are more liable than men to have surplus skin over the upper arms, thighs, and flanks. One may notice that a larger percentage of men are more satisfied with their overall appearance compared to women after bariatric surgery and weight loss.

More than two third of the patients developed redundant skin all over the body especially on the abdomen, but only a small number of them are seeking abdominoplasty. About 1/3 of female patients sought body contouring after 3 months from the operations versus one male patient. Reversely small number of male patients who developed redundant skin; were seeking for abdominoplasty 12 months after the operation.

Male patients are asking for body contouring later; after 12 months when they have significant EWL, they become closer to their ideals or may shift their ideals towards a more comfortable and better body shape, suggesting that as patients become closer to their ideal, these ideals may shift.

Obese females feel more uncomfortable and unsatisfied with their physical appearance; they have a wrong perception of their image and consequently diminish their self-esteem, sometimes showing difficulties in functional areas such as work, relationships, and social activity. Women tend to accept cosmetic surgery more readily than men because of higher expectations regarding their physical appearance. Female patients, in comparison to men, are more motivated for abdominoplasty, consulting earlier, have more fashion problems in selection of clothes. Their insight improve more after weight loss, and their ideals will shift earlier and ask for perfect body image, may allow patients to no longer feel ‘tied down’ by their conditions”.

Men may also be able to achieve some of the results of cosmetic surgery through exercise, diet, and weightlifting. Besides many other variables, maybe the root of men’s low desire for abdominoplasty is they feel it is not necessary and are more satisfied with their overall appearance compared to women. Men might have a perception that excess skin is unproblematic; they are concerning about pain, risk, and recovery time of surgery. Male may be the only source of income in the family, they were hesitating to seek the abdominoplasty, time away from the family and the work.

The motivation for abdominoplasty in females is similar to the amount of EWL or waist circumference. Female patients are looking for body contouring three months after surgery, while male patients more often than not request body shaping following one year after surgery, the age groups are inverted in genders; female patients asking for body contouring in younger age group while male patients in older age group.

These findings are described in the article entitled  Gender difference in requesting abdominoplasty, after bariatric surgery: Based on five years of experience in two centers in Sulaimani Governorate, Kurdistan Region/Iraq, recently published in the International Journal of Surgery. This work was conducted by Hiwa Omer Ahmed, et al., from the University of Sulaimani, Hatwan Hospital, and Sulaimani Teaching Hospital.