This informative article, which kicks off this excellent edition of Clinics in Plastic Surgery, provides a sensible and balanced review of when, why and what to do with the massive weight loss patient group. The recommended wisdom will be familiar to a lot of bari-plastic surgical teams across the UK. Timing of body contouring surgery should be a minimum of one year from bariatric surgery, with weight stability for at least three months. BMI should be less than 30, unless for functional / physical indications. Medical comorbidities should be formally reviewed and optimised prior to surgery, and special consideration given to deep vein thrombosis / pulmonary embolism (DVT / PE) risks. Nutritional assessment of this patient group is imperative; formal review by the bariatric team including nutritionist / dietician with protein intake, supplements, micronutrients and physical condition all required. An assessment of the patient’s psychosocial status is mandatory; with the standard aesthetic case approach plus review of support networks and professional optimisation of formal psychiatric conditions. The case for combined / multiple procedures is discussed, commonly used combinations stated, along with the disadvantages. This is a great summary of the issues involved in the assessment of massive weight loss patients, ideal for surgeons new to this area and for those close to exams!

Preoperative evaluation of the body contouring patient. The cornerstone of patient safety.
Naghshineh N, Rubin JP.
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Stuart Hamilton

NHS Lothian, UK.

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