Body countouring surgery in massive weight loss patients has spread all over the world due to global increase of obesity or "globesity" as defined by WHO. Obese and ex-obese patients are at high risk of minor and major complications (eg. pulmonary embolysm and severe infection) and their treatment needs an accurate selection.
Obese patient is addressed by general practiotioner to an internal medicine physician in order to investigate his general health condition and define primary and secondary disease that led to obesity. A psychiatric evaluation is required to eventually find and solve or stabilize a mental disorder. Patient over 70 years old and with ASA score IV are excluded from surgical management of care. A multidisciplinary discussion defines appropriate treatment. When patient is suitable to surgery, a general surgery procedure is performed (most of patients undergo to sleeve gastrectomy procedure). After target BMI is reached, massive weigh loss patient is addressed to plastic surgery for body contouring surgery. It is advised referral of ex-obese patient with unstable weight, BMI over 32, and unsolved internal or psychiatric disorder. If patients is considered suitable,he is included in plastic surgery path that usually starts with abdominoplasty, proceeds with mastopexy, arm and thight lift, lower body lift, until facelift. Since 2005, almost 1500 patient had consultation at our clinics and almost 1300 of them, received body countouring procedure. Multidisciplinary approach to massive weight loss patients is necessary to minimize complications and to include suitable patients for general and plastic surgery procedures.