الفهرس 
ANATOMY OF HUMAN SKINOnly 14 pages are availabe for public view
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Abstract
Obesity is a chronic disease consisting of excessive fat accumulation in adipose tissue. Clinically, obesity is defined on the basis of BMI; but recent guidelines recommends using the BMI in conjunction with the waist circumference. The prevalence of obesity among adults has been increasing over the last 30 years in virtually every country in the world. In 2014, more than 1.9 billion adults were overweight, of these over 600 million were obese according to the World Health Organization (WHO). As the prevalence of obesity increases, it has become a major public health concern as obesity is not only a disastrous disease, it is an important risk factor for many co-morbidities as well, beginning with head and ending with toes involving almost every organ in between.
Obesity results from chronic imbalance between energy intake and energy expenditure. But this is the simple fact. Energy homeostasis is largely regulated by the brain, GIT, other organ systems and the adipose tissue itself control it through complex neuro-biologic circuits involving a variety of chemical mediators and neuro-chemical pathways. That’s why the management of obesity is not that easy as it may seem; it requires a multidisciplinary team of medical, nutrition and behavior experts as well as appropriately trained health care professionals in collaboration with the patient, in order to be able to maintain the weight loss.
Non pharmacological treatment is our first step by adopting a healthy lifestyle with proper nutrition, regular physical activity, appropriate sleep time and time for stress reduction, recreation and happiness are foundational in the treatment plan. Behavioral therapy is a key component as well, as it helps the patient to develop long term behaviors to promote a sustained weight loss. Medications are only adjunctive therapy to lifestyle intervention in patients with certain criteria. Combination is much more effective for a complaint motivated patient. There is a variety of medications that are FDA approved and shown to be effective.
Surgical treatment for weight loss is recommended for adults with BMI ≥ 40 kg/m2 or BMI ≥ 35kg/m2 with obesity related co-morbidities who have not responded to the behavioral treatment with or without medications. Bariatric surgery is the appropriate option for those patients to improve their health, reduce co-morbidities and their quality of life as well.
Bariatric procedures are of Restrictive, Malabsorptive or a combination of both. The restrictive procedures as Sleeve Gastrectomy are simpler in comparison to malabsorptive ones and tend to produce more gradual weight loss. The malabsorptive procedures as BPD can achieve a profound weight loss but the patient is much more liable to metabolic complications that may be devastating, and most of these procedures became already obsolete. The combined procedure as RYGB is considered the best of them all.
Bariatric surgery has been increasing proportionately with the increasing incidence of morbid obesity. Post bariatric patients fulfil important improvements in their health, co-morbidities and their quality of life; on the other hand, patients are typically not always prepared for the consequences of the MWL. MWL have pathophysiological impact on the patient`s skin; there is a lot of nutritional considerations in these patients. Routine levels should be checked, and routine supplementations are mandatory. There is psychiatric considerations for these patients as well and this is especially important to plastic surgeons prior to agreeing to perform BCS so as to paint realistic expectations about their anticipated results.
In the last decade, there was a dramatic increase in MWL patients seeking body contouring procedures as a result of the increasing incidence of bariatric surgery. The benefit of this surgical cure is decreasing comorbidities and improving of quality of life. Meanwhile, the resultant redundant skin folds can lead to intertrigo, ulceration, infection, difficulty in mobilizing and excercising; In addition to the psychosocial impact of redundant skin. The redundant skin can interfere dramatically with the patients’ physical function, that’s why the surgery should be considered a reconstructive rather than an aesthetic one.
Abdominoplasty is the most common body contouring procedure performed nowadays after MWL. Proper patient selection and evaluation will help the surgeon very much with choosing the most suitable type of surgery to the patient. Abdominoplasty treats deformities limited to anterior trunk.
Circumferential lower truncal dermato-lipectomy is much more suitable for a patient with a general laxity and/or ptosis or deformities involving more than the anterior lower abdomen as thighs, buttocks, and lower back; MWL patients make the largest group of such patients. There are two categories of this procedure, the belt lipectomy and the lower body lift, each with special advantages and disadvantages and performed upon patient requirements.
Extended abdominoplasty is the best choice for MWL patients who laxity of the skin is extending to the flanks and back but not requiring a circumferential procedure.
Fleur de lis or Anchor line abdominoplasty is the combination of the horizontal and the vertical line incisions that is excellent for MWL patients with excess abdominal skin is evident in the upper quadrants; in patients with median or paramedian supra-umblical scar as in our unique type of patient.
So each patient is unique in every possible way and each one must be addressed individually according to his own health parameters and requirements.