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With the growing popularity of gastric bypass surgery to treat morbid obesity, body contouring after massive weight loss has become a focus of the plastic surgery community. An updated and innovative method that adjusts treatment according to body type is creating improved results and enhancing the shape of patients' bodies, according to a study by American Society of Plastic Surgeons member Dennis Hurwitz.

After massive weight loss in a short period of time, skin does not retain its shape, leaving the patient with excess, baggy skin, he explains. Moreover, patients lose different amounts of body fat before the weight loss plateaus, leaving them either thin, moderate, or still heavy. Although previous body-contouring techniques worked well on smaller patients who had gastric bypass surgery, larger individuals often had visible scars above and below the underwear region after surgery, as well as skin that did not conform well to the body.

Building on techniques from colleagues at the University of Pittsburgh (Pa.) and other specialists in body contouring, Hurwitz found that effectively mapping incisions before surgery and using a combination of new and current cutting and shaping techniques led to the most-successful surgeries for moderate to larger body shapes. "All the patients who participated in the study are extremely pleased with the end result. In fact, 39 of the 40 patients in this study rated the outcome of their surgery very good or excellent."

With moderate to larger patients, not only is it important to map the excess tissue to be removed, but to anticipate the movement of the skin left behind. This allows the plastic surgeon to visualize where the scars will be after the tissue is removed and place them where they will be hidden by underwear or in a belt-like position. Ultimately, it allows patients to feel better about their bodies after the surgery.

The second step is use of particular cutting and shaping techniques. For instance, when the patient is a moderate to large size, Hurwitz feels surgeons should use more liposuction than had been utilized during this procedure previously to allow the skin to shift into place and reduce overall bulk, giving a more-pleasing volume and look to the body. Other methods include using a scalpel instead of electrocautery to minimize skin damage; placing the patient in various positions to make it easier to stitch the skin together; and using permanent, rather than absorbable, stitches placed deeper in the tissue. Suturing deeper with permanent braided stitches, which are significantly stronger than absorbable smooth ones, holds the skin better for moderate and heavy patients, making it less likely for the wound to open or slowly spread.