Obesity is an increasingly important health care epidemic in the United States affecting approximately 23% of the adult population who have a body mass index (BMI) >30. Five percent of Americans are estimated to be morbidly obese (BMI ≥40). General morbidity and mortality are increased in obese patients and life expectancy may be reduced by as much as 20 years. Obesity has many associated comorbidities, many of which are reversed with weight loss (see Box 14.1).

Weight loss techniques vary from straightforward diet and exercise to more invasive surgical interventions. Bariatric surgery is reserved for patients who have failed to lose weight through conventional means. Multiple bariatric surgical procedures have been developed including laparoscopic gastric banding and gastric bypass. Advances in surgical techniques, along with a rising public interest, have resulted in an approximately 600% increase in gastric bypass surgeries between 1998 and 2002. A gastric bypass effectively reduces the capacity of the stomach, resulting in an earlier sensation of satiety. The large extent of weight loss is secondary to a reduction in food intake with typical results averaging 69% to 82% of excess weight lost over 12 to 54 months.

Regardless of the weight reduction method, massive weight loss (MWL) results in major changes for the patient that are both physiologic and aesthetic. These patients have been shown to have a reduction in their presurgical comorbidities as well as an increase in self-esteem, body image, and eating behaviors. Unfortunately there are some side effects from both the gastric surgery and the MWL (see Table 14.1). Many obese patients lose skin elasticity due to the persistent stretching of the skin as their body
surface area increases. After MWL, the skin is often incapable of retraction and there are resultant areas of redundant skin. Personal hygiene and skin infection-related issues, along with desire for improved body contour, often result in a plastic surgical consultation. Many body contour procedures are offered by plastic surgeons, most of which can be done in an appropriate office setting. Plastic surgeons aim for multiple goals with body contour surgery, listed in Box 14.2. Because of the poor quality and large quantity of redundant tissue, the goals of surgery often cannot be achieved with liposuction alone, and usually require direct excision of tissue.