This is a very modern chapter of medicine, with a large role for plastic surgery. The patient undergoing bariatric surgery will have huge health benefits and although the body benefits are important, there is the side effect of flabby and redundant skin.

In addition, it must be considered that after such weight loss this skin, for reasons not yet explained, becomes less elastic. It does not retract with weight loss, becoming redundant and hanging, forming true aprons in the abdomen, the back (upper and lower, with several folds), the breasts, the arms and the thighs.

The patient, who has improved health and has become happier to have overcome the obesity, necessarily becomes a patient of plastic surgery.

Plastic surgery has had to grow technically, creating increasingly improved technical protocols and systematization to offer the patient the solution of the problems that involve his whole body, in the smallest possible number of operative acts and surgeries and in the shortest possible time, lowering costs while ensuring greater patient safety.

An example as a past reference in my professional life, was the case of a patient I operated in 1974 at the Hospital das Armed Forces of Brasilia. It was my first case of post-bariatric plastic surgery, when the technique was not even established as routine in general surgery, and was unknown to most surgeons.

Dr. Jofran Frejat, a skilled doctor, had arrived to Brasilia from England, and he confronted this case in a pioneering way.  After the surgery, the patient developed clinically in a wonderful manner and lost 80 kg. I was summoned to the plastic surgery service, (I was the head of the HFA plastic surgery service at the time), and conducted the surgery by first operating on a thigh. By obtaining good results and with a good clinical response of the patient, we operate the other thigh, abdomen, back, breasts and arms. It was a time when the technique of liposuction did not yet exist, which presently helps us so much. Still the case was very successful and the patient was happy.

It was only in the late 1990s where this surgery became popular. With our previous experience, we systematized the service by dividing the initial treatment into two main operations: in the first surgery, we operate the abdomen with an incision that extends through the patient’s back (if applicable), completing 360 degrees, treating as well the back, raising the sagging buttocks and the side of the thighs.

Through the same operation technique, thigh surgery may be performed. Through entering the inner face in order to remove the sag, reducing its diameter.

The second surgery, performed in a single surgical time, is done with a minimum interval of 30 days. This includes the upper back, arms and breasts.

The order of these two surgeries can be reversed, initially operating what I call the “upper level” and then the “lower level” – depending on the area the patient first wants to improve.

These combined surgeries require well-trained staff and a perfect systematization of the operative procedure, (where the patient will be changed position at the table once or twice, depending on the case), in addition to a perfect harmony with the anesthetists, surgical technicians and nursing within the surgery Center.

It is a surgery to be performed within a hospital environment. Although we have rarely had cases that went to the ICU, this support is essential for this surgery.

During these two surgical procedures, we treat the abdomen, lower back, upper back, buttocks, thighs, breasts and arms.  With these, we can correct some 90% of deformities, but there will always be a desire to improve any remaining details, and this can elicit complementary surgeries, as many as necessary, to meet the wishes of each patient. The results are extremely gratifying for these patients.