Charles K. Herman

Mid-body contouring in the post-bariatric surgery patient

Background: Obesity has become an increasingly important health care problem. It is estimated that almost 20 percent of the adult U.S. population is obese, including approximately 5 percent of the population considered morbidly obese. Recent advances in bariatric surgery have improved the safety and efficacy of weight-loss operations. As a consequence of the above factors, there has been a 150 percent increase in the number of gastric bypass and vertical banding gastroplasty procedures performed over the past 3 years. Post–bariatric surgery care has become an integral part in the care of these patients, with plastic surgeons playing an important role. Methods: The senior author (B.S.) has developed unique variations of the circumferential and near-circumferential abdominoplasty operations to fulfill the needs of these patients. Seventy-five consecutive mid-body lift procedures have been performed over the past 5 years. The basic operation involves circumferential incisions, anterior flap undermining, and simultaneous flap thinning, without resorting to the need for an anterior midline incision. Results: A dramatic improvement in appearance results from the anterior resection and the lateral thigh and buttock lifts that this procedure affords. More recently, the lower back roll has been removed as well. A cohesive operative sequence that includes optimized patient preparation and positioning, tailoring of flaps for improved contour with avoidance of unnecessary midline scars, a strong superficial fascial system closure, and coordination with the entire operating room team has been developed. Conclusion: The procedure is associated with a low complication rate, a dramatically shortened operative time, and high patient satisfaction.

Advances in weight loss surgery and body contouring after weight loss

Correspondence: Charles K Herman 100 Plaza Court, Suite C, east Stroudsburg, PA 18301, USA Tel +1 570 420 6220 Fax +1 570 420 6221 email charleshermanmd@hotmail.com Abstract: Surgical treatment for morbid obesity has been increasing over the last few years. Historically, bariatric surgery had been plagued by complications, both technical and metabolic. The criteria to decide if a patient should have bariatric surgery required that the patient’s morbid obesity was contributing to an otherwise imminent demise. Now, with improved techniques, laparoscopic surgery and better understanding of the metabolic consequences of bariatric surgeries, it is presumed that the benefits outweigh the risks of bariatric surgery in increasing numbers of patients. Additionally, the post-bariatric procedures for body contouring have many documented complications. Most of these can be related to the nutritional status of obese patients and the relative immunodeficiency that obese patients possess. After a thorough literature search it appears that bariatric surgery and post-bariatric body contouring are, indeed, safer than previously thought.

Dorsal Augmentation Rhinoplasty with Irradiated Homograft Costal Cartilage

Augmentation of the nasal framework requires a working knowledge of nasal and facial anatomy, as well as the principles of facial proportion and balance. Dorsal augmentation rhinoplasty is a valuable means of improving nasal appearance in patients with a low and/or concave nasal dorsum, obtuse nasofrontal angle, and low radix. It frequently is combined with other techniques, including columellar strut grafting, nasal tip grafting, and tip suturing, as dorsal deficiencies are often associated with poor tip projection and support and a shortened columella. Our experience with dorsal augmentation rhinoplasty, including the use of irradiated homograft costal cartilage for grafting in 56 surgeries, is described. A high level of patient satisfaction with a low percentage of complications has been seen.