A growing dilemma in our society, obesity is a serious, potentially life-threatening problem. Not only does it pose considerable health risks - including heart attack, hypertension, stroke, type-2 diabetes, sleep apnea, and certain cancers - it can also devour a person's self-esteem, energy level and outlook on the future. For those of considerable obesity, medical science has come a long way in helping them attain slimmer, healthier bodies.

New techniques of weight loss surgery have been developed over the last decade, most common of which are gastric bypass and gastric banding, says Dr. Kevin Hayavi, medical director/owner of Beverly Hills Physicians Institute, one of the largest networks of beauty and health care providers in this state.

Of those procedures, the outcome can make an immense difference in one's appearance, health and psyche, said the doctor, whose multi-location practice provides cosmetic and plastic surgery at seven facilities throughout Southern California, including Valencia.

"A weight loss procedure will not only improve one's self-image and self-esteem, but it also improves one's lifestyle, quality of life and life span," Hayavi stated.

During gastric bypass surgery, Hayavi noted, a portion of the stomach is excised (removed) in order to create a smaller stomach pouch. (The reduced sized stomach is attached to the small intestine.)

"In a gastric banding procedure, a small adjustable silicone band is inserted through a thumb-size incision and via an operative camera, around the stomach, which creates a reduced-size stomach," he said.

The result of both weight loss procedures, the doctor informs us, is a smaller stomach, "which will not only restrict food intake, but will also send signals to brain, telling it that the stomach is full and no more food is needed." What ensues is a dramatic, much-desired weight loss.

Bariatric experts report that while it is possible for some patients to lose two to three pounds a week in the first year following surgery, one pound a week is more likely. Maximum loss is usually seen between 12 to 18 months post-op. (It must also be noted that without a positive and dedicated change in lifestyle and diet, patients may eventually gain weight back.) Of course, every surgical procedure has its pros and cons - and extreme weight loss surgery is no different.

The disadvantages to the gastric bypass, Hayavi notes, include a more invasive surgery, requiring several days of hospital stay, and a higher risk of mal-absorption and vitamin deficiency. (As with all surgical procedures, there are certain inherent risks which should always be discussed pre-operatively.)

"Advantages of gastric banding include a minimally-invasive procedure, shorter hospital stay and faster recovery period, and ability to adjust the band as needed by the surgeon," the physician said.

How does one know which surgery is best for them? "The right procedure," Hayavi said, "is the one that is recommended by your bariatric surgeon."

So what's a bariatric physician, you ask? These are licensed physicians (Doctor of Medicine, MD's, or Doctor of Osteopathy, DO's) who specialize in the medical treatment of obesity and related disorders. (Note: The term "bariatric" stems from the Greek root "baro" meaning heavy or large.)

Hayavi points out that among Beverly Hills Physicians' large staff of skilled specialists, bariatric physicians and surgeons offer weight management programs, laparoscopic gastric bypass, and laparoscopic gastric banding ("lap band surgery").

Is It Covered?
Medical and surgical treatment of obesity can be very expensive. But fortunately today, when obesity is regarded as a chronic medical disease with serious health implications caused by a complex set of factors - insurance companies are paying out.

The American Society of Bariatric Physicians reports that health insurance companies may cover some or all of one's bariatric treatment if patients have heart disease, metabolic syndrome, diabetes or a pre-diabetic condition.

Dr. Hayavi notes that weight loss surgical procedures are covered by health insurance if the patient's Body Mass Index (BMI: a measurement that correlates with one's degree of obesity) is greater than 35.

Loreen Worden of Allstate Insurance tells us that while every insurance carrier is unique, all look at individual cases asking the same question: "Is this necessary?" "Every case is different and will be reviewed for coverage based on circumstances," Worden said.

Post-Op - Now What?
Valencia-based plastic surgeon Dr. Edward Pechter reports that approximately 150,000 patients will undergo bariatric surgery for obesity this year - with about 30 to 40 percent of them needing plastic surgery down the line. With all that weight loss, loose skin often follows.

"After weight loss of 100 pounds individuals may be carrying as much as 10 or 15 pounds of excess skin," said Pechter, who has practiced locally for more than 20 years and was trained in the Division of Plastic Surgery at UCLA, where he maintains a teaching affiliation. "Body contour surgery can put the finishing touch on successful weight loss."

Such surgical specialties, all of which are performed by Pechter, include body contouring surgery (including mini and full abdominoplasty, also known as a "tummy tuck"), liposuction, arm lifts (brachioplasty), breast surgery (including augmentation, lifts and reduction), facelifts, and eyelid repair (blepharoplasty).

The physician, who has published his innovations in body contour surgery with the "Grid/Staple Adjunct to Abdominoplasty" (found in the journal Plastic and Reconstructive Surgery) and "The Versatile Helium Balloon Mastopexy" (in an upcoming issue of the Aesthetic Surgery Journal), concurs that excess skin following extreme weight loss surgery can be unsightly and uncomfortable. It can also pose some distinct problems, specifically, skin-against-skin contact, which can cause rashes or ulcerations, Pechter said.

While body contour surgery can create firmer, better-looking bodies, there are some risks attached. "Removal of large amounts of skin can impair circulation to the remaining skin so that skin necrosis (loss of blood supply to that part causing cellular/tissue death) or skin loss is a risk of body contour surgery," Pechter cautioned. "Nicotine and carbon monoxide in cigarette smoke diminish circulation to the skin so smokers are at greater risk of this complication. "

Who fares better skin-wise after weight loss? Pechter's reply: "Younger patients generally have better skin elasticity than older (over 40) patients, but this is highly individual."

"Patients with Asian and African-American heritage generally have better skin elasticity than patients of Caucasian and Hispanic heritage," he added, noting that patients who smoke generally have poorer skin elasticity than non-smokers.

The veteran UCLA-groomed physician reminds readers that well trained plastic surgeons "know which techniques are safest for any given individual."

More Help from "Above"
Like Doctors Hayavi and Pechter, Dr. Chrystal Fernandez of Above And Beyond Laser Skin Clinic also understands what it's like when people lose large amounts of weight and are faced with loose "redundant" skin. She sees them routinely at her Valencia office (as well as at her Irvine location). An RN, scientist and PhD, Fernandez notes that the amount of loose skin determines the best plan of action.

"The course of treatment can be anything from VelaShape (which utilizes light and radio frequencies to heat and reduce excess fat, or "adipose") to surgery," she said.

Feeling "like a wonderful massage," Velashape is designed to tighten and firm the skin, Fernandez said, adding that it has FDA approval for cellulite reduction as well as circumferential reduction in as little as four to six treatments (done once per week).
Laser skin tightening, Fernandez states, requires six to eight treatments done once a month to stimulate collagen remodeling, "which in turn tightens and firms the skin."

"In cases where there is facial volume loss I would recommend laser skin tightening as well as a filler to replace the volume that has been lost," she stated.

A member of The American Society for Plastic and Surgical Nurses, Fernandez likes helping people look their best following weight loss. "As we all know, weight loss is a tough road and everyone who succeeds should definitely be proud of their accomplishment and not feel uncomfortable about redundant skin - this is where skin tightening treatments or surgery can take them to the next level," she said. "I enjoy helping people feel better about being in their own skin. Not only do they look good on the outside, they feel fantastic from the inside in respect to their self-image."

Certainly, losing weight - whether through bariatric surgery or strict calorie counting - is no easy endeavor. The key, of course, is to maintain that new you by following a healthy lifestyle and diet, and maintaining a regular exercise program.


For more Information...
• Dr. Chrystal Fernandez of
Bellissima Inc. 295-0855
www.aboveandbeyondlaser.com
• Dr. Kevin Hayavi of Beverly Hills
Physicians Plastic Surgery & Cosmetic
Laser Centers 800-788-1416
www.beverlyhillsphysicians.com
• Dr. Edward A. Pechter 255-2151
www.drpechter.com
• Loreen Worden of Allstate
Insurance 298-5011
www.easyaccessinsurance.com