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The patient will initially come into contact with the obesity surgeon. There are three options available, based on the patient’s medical history, nutritional habits, age, height and activities.

Patients have a very high chance of losing excess weight with gastric band surgery.

Although this may be true for some, there are other patients in whom a gastric bypass may eventually be deemed necessary after gastric band surgery.

Combination gastric band and bypass surgery is based on the patient’s medical history and other accompanying elements.

About 90% of obese patients also display aesthetic problems that need to be restored. More often than not, these are not just cosmetic, but they may also be functional problems. For example, a sagging abdomen poses hygiene and intertrigo problems, while it also burdens the spine due to its weight; gigantomastia causes grooves on the shoulders, back pain, intertrigo and general difficulties when walking or dressing.

Our experience so far on similar cases has led us to master a treatment plan that offers excellent results if followed strictly.

A procedure that must be performed at the same time as obesity surgery is abdominoplasty, apart from case 2, i.e. when the gastric band may not be enough for complete weight loss. In this case, the abdominoplasty is postponed for six months, so as to determine whether a gastric bypass is also necessary. The abdominoplasty results remain even after the weight loss. Based on our observation of cases like these, simultaneous abdominoplasty has better results at the end of the weight loss program rather that if performed at a later date.

Obese women usually also need a breast reduction or lift along with obesity surgery. This is postponed until after the end of the weight loss program. Once the weight is lost, the breasts become atrophic and laxity is pronounced. If the surgeon performs the procedure before all the weight is lost, they may have to perform breast augmentation surgery at the end of the program.

An upper limb lift should be performed at the end of the program and may be combined with the breast reduction or lift. Upper limb laxity is not necessarily the result of weight loss, so the plastic surgeon must monitor the patient regularly during the weight loss program.

The thigh and gluteal lift are also performed after the weight loss. This laxity is not necessarily the result of weight loss and patients may follow certain procedures to prevent or suffer minimal laxity, which may even be acceptable to the patient.

A special physiotherapy program has been designed and included in the weight loss program. The program encompasses:

Exercise using a special vibration machine under the supervision of trained staff.

Special massage using the LPG Endodermologie device. The ideal program for each patient is selected by the plastic surgeon and commences on the first follow-up visit.

Passive exercise program with muscle contractions prompted by the use of current.

Few patients eventually require gluteal or thigh lift surgery after following this program. However, even if they do, the procedure will not be as extensive. A new revolutionary method that uses special meshes for gluteal and thigh lifts achieves more stable results and requires much smaller incisions.

In obese patients, gynecomastia is a very common condition. Weight loss usually brings about skin laxity and an unpleasant aesthetic result. In male breasts, this laxity can only be treated surgically, while physiotherapy hardly helps. In men, a breast lift will leave scars, which are ungainly and cannot be easily hidden, as is the case with women. However, they are inevitable. Based on our experience and observations, there is less skin laxity following weight loss if the patient also undergoes simultaneous liposuction in the breast area. At least 60% of the patients will eventually avoid a breast lift procedure.

Liposuction plays a major role in obesity surgery. The plastic surgeon cannot easily guess the shape of a patient before they became obese. The patient’s medical history and other information will assist the surgeon to propose liposuction in parts of the body that will require intervention following the weight loss. We propose liposuction to be performed at the same time as obesity surgery, since our experience has shown that the laxity is less pronounced in the parts where liposuction has already been performed. In addition, the postoperative physiotherapy program we have designed assists in achieving better results.

Overall, the part of the body that experiences the least skin laxity is the face. Only a small number of patients will require a face lift and they are mainly of a more advanced age. In our opinion, the patients who experienced laxity of the face after weight loss and requested a face lift would have probably undergone the procedure even if they had not lost the weight.


Physiotherapy and exercise play a vital role in restoring the consequences of weight loss and age. The physiotherapy programs designed and implemented worldwide must be selected by the specialists each time (e.g. plastic surgeon). Different skin types and aesthetic problems require different approaches. In addition, different body parts require different programs. Physiotherapy mainly aims at building muscle, toning, tightening the fascia, achieving better tissue and skin perfusion, and stimulating lymphatic flow. Significant improvement in cellulite, skin laxity and texture may be observed in a very short time. The program runs twice a week for six weeks. It is made up of active 10-minute exercise on a vibration machine, followed by special 35-minute individualized massage for each patient and passive exercise with the use of currents.

If these programs commence immediately after the obesity surgery, the consequences of weight loss on the skin will be minimized. At least 40% of patients will require no cosmetic surgery, irrespective of skin and body type. Another 40% will end up with an acceptable amount of skin laxity and cellulite and the need for cosmetic surgery will be limited. The remaining 20% will require minor surgery to correct aesthetic and functional problems.