In the past decade, overweight and morbid obesity in Europe have come to be nearly as common as in the United States. Fifty percent of the Austrian population is overweight, and nearly a quarter of that number is morbidly obese. In Germany and Austria, 8 % of children are morbidly obese. The costs for the treatment of this new epidemic and its consequences put considerable strain on health budgets that are already stretched to the limit. Hence, the main emphasis is on the treatment of those who are already ill, and on prevention. Treatment of obesity is a long-term proposition. The many comorbidities can be improved by weight reduction, whereby plastic surgery also plays a role. Bariatric surgery is the surgical option of treatment. But when that works, deformity due to obesity is replaced by disfiguring flaccid skin after weight loss. Body contouring with plastic surgery is the only way to correct this problem.
Plastic surgery after massive weight loss must be planned on an individual basis. Preferably, even before a weight-reduction regime has begun, is the best time to discuss with the patient the corrections and total body concept. This will improve emotional stability, patient satisfaction, and has a positive effect on social reintegration at the end of treatment.
Full-body contouring will usually require two or more very time consuming operations. The result correlates directly with initial body mass index. Complications are frequent but can often be managed with conservative measures. Many of them are a matter of shape. Patients should be made aware of possible corrections in advance. Complications after surgery are much more frequent with a BMI above 35.
The plastic surgeon concludes the weight-reduction program by removing the last traces of the original obesity.