Definitely there will always be patients who seek bariatric surgery with the intention of achieving an improvement in their physical appearance, however, the main reason for most of our patients is finding a healthier lifestyle and an improved quality of life, which will be fully achievable with the help of gastric sleeve surgery or some of the other approved bariatric procedures such as gastric band, gastric bypass, duodenal switch, etc.
The guidelines for bariatric surgery
Sometimes we receive calls from people requesting information for the gastric sleeve surgery and when discussing further with them we discover what their body mass index does not qualify them for such a procedure, this is why there are well established international guidelines specifying who is a candidate for gastric sleeve surgery and who is not.
The fact that the bariatric surgeon you contact tells you about these guidelines will depend on his/her professional and moral ethics, but we can openly tell you that if your Body Mass Index is “low” you should seek other treatment options for obesity to help meet your goals without having to undergo a bariatric procedure, because even though they are excellent procedures and have proved to be highly effective, such guidelines exist and all bariatric surgeons should follow them.
It is worth mentioning that there are exceptional cases where one or two points of BMI (Body Mass Index) does not make them bad candidates for this surgery considering the great benefits that the procedure will provide, if they have some of the diseases caused by obesity. When defining whether or not you are a candidate for these procedures common sense should exist in your surgeon and you as a patient.
What is bariatric surgery?
Speaking specifically of its definition, it is important to know that bariatric surgery is a branch of general surgery based on the manipulation or modification of the gastrointestinal tract of the patient in order to help with weight loss. This is achieved thanks to changes in the ability of the digestive tract to absorb or accept food either by reducing the capacity of the stomach and/or causing and incomplete absorption of ingested food. This will lead, in a very summarized explanation, to the use of body fat as a form of energy source, which in turn will cause weight loss by reducing body fat percentage, not only on the outside (under the skin) but also internal (from viscera/organs). If you want to know more about the different options on treament for obesity you can visit our related article about the treatment options for obesity.
Cosmetic surgery, unlike bariatric is a branch of general surgery aimed at altering the physical appearance of a person, in this cases, based on procedures focused on the direct reduction of body fat (externally, beneath the skin) using liposuction and / or resection of portions of fat and skin. In other words it is a completely different approach because as you can see, the change is only on some specific parts of the body and only on the fatty tissue found under the skin.
In short, and with all due respect to plastic surgeons, our colleagues and friends, bariatric surgery addresses the problem of obesity at its root, decreasing the amount of overall body fat (visceral fat and under the skin) by reducing the percentage of it in the whole body’s economy, while cosmetic surgery does not solve the problem from its base but only changes the physical appearance of those parts of the body that "bother" the patient and they want to modify.
Why it is not a good idea to consider plastic surgery if you want to lose weight
By considering to have plastic surgery, visceral fat stays intact (which is what actually leads to metabolic, hormonal and vascular diseases such as diabetes, hypertension, high cholesterol, myocardial infarction, etc.). In our practice we see that about 50% of our patients have a history of some sort of cosmetic surgery, either liposuction, tummy tuck, panniculectomy, etc.
Unfortunately the problem is not being treated at its origin which is excess calorie and carb intake, most of those patients who undergo a cosmetic procedure eventually end up requiring a bariatric procedure some years or even months after.
Then, by exposing this concept, what we want to convey it is that cosmetic surgery has no place when a person has excess fat under the skin? The answer is NO, plastic surgery is also a subspecialty of great prestige and has its specific indications in these cases, however just like in bariatric surgery there are guidelines that must be followed to consider a person as a candidate for cosmetic surgery; using different measurements and taking into consideration certain factors one of which is also BMI, a plastic surgeon whose practice is governed by these guidelines considers that the patient that has a high BMI is not a good candidate for a cosmetic procedure since the results won’t be optimal and they generally request the patient to drop some weight before having the cosmetic procedure.
Morbid obesity is a disease that must be treated properly
This is why we consider that the person who is planning to change its appearance because it is "chubby" should first consider the problem for what it is: a disease, and not just look at it as an esthetic issue.
As we have discussed in previous articles, obesity is a disease that affects the patient from many angles of equal or greater importance than the emotional or psychological point of view. So before opting for a purely cosmetic procedure should seek to resolve permanently the underlying problem with a bariatric procedure.
Once the patient has lost weight properly, which occurs between 12, 18 or even 24 months after bariatric surgery usually is when cosmetic surgery, also known as post-bariatric surgery has more sense and gives much better results since the plastic surgeon works with excess skin instead of excess fat and skin, which in theory makes the final results more satisfactory to him and the patient.
Now, you might think it is preferable to try first a cosmetic procedure to avoid undergoing something as “aggressive” as bariatric surgery. This is something that might sound logical, but the truth is that if the necessary changes are NOT made in the lifestyle and nutrition of the patient in a few years or even months, the fat will be back and the cosmetic procedure will not be even noticeable.
Moreover, bariatric surgery in a patient with prior lipectomy or abdominoplasty makes it technically more difficult because the inability of abdominal wall/cavity to distend at the moment of the laparoscopic procedure, this is very technical and at the end of the day, not so important because a previous cosmetic procedure does not prevent or contraindicates it but it does make it less "comfortable" to work for the bariatric surgeon.
This is our personal opinion on this issue, which we decided to develop due to the high frequency of occasions in which of bariatric surgery is confused with cosmetic surgery being that they are two completely different things. Both, however, in the proper order they make an excellent addition to the person who is looking to improve their health, noting that the definition of health is a state of complete physical, mental and social well-being.
Do you have doubts about what would be best for your particular case?, contact us. Tell us your experience if you had one or both procedures.
Written by: Gabriel Rosales
Dr. Gabriel Rosales is a highly skilled, board certified surgeon in constant pursuit of learning the latest innovations in the weight loss surgery field to give his patients the best care possible.