GRAND RAPIDS, MI - When Dr. Ryan Mitchell was in his plastic surgery residency, he developed an interest in a growing area of practice - body contouring for patients who have sustained a major weight loss.
The surgery to remove the excess skin left behind is becoming more in demand, as obesity rates rise and bariatric surgery becomes more common, he said.
Mitchell, who recently joined the Bengston Center in Grand Rapids, pursued a fellowship to specialize in the treatment.
'It became my passion,' he said.
His draw to the specialty is the chance to address quality-of-life and physical needs of the patient. Many of the patients he has met, although they have lost in the range of 100 pounds and are much healthier, experience a bit of 'buyer's remorse,' he said.
Even with diet and exercise, they can't lose the excess, sagging skin.
'People have said I look worse now than I did before. One patient said when she was larger, she was just the largest person on the beach. Now when she goes to the beach, she feels she gets looks and attention because she doesn't fit into either mold,' he said.
Body contouring procedures often target the belly, arms, legs and buttocks area.
The problems caused by excess skin are not all cosmetic. There also are functional problems, particularly with the skin around the belly. That area is prone to rashes and infection. And for some patients, the excess skin on the thigh prevents them from wearing slacks.
While health insurance sometimes covers removal of the overhanging skin on the abdomen, patients usually must pay out of pocket for contouring procedures on other parts of the body.
Mitchell said the cost of surgery varies depending on a number of factors. But as a general range, the cost to patients can run from $14,000-$16,000 for abdominal surgery and $6,000-8,000 for arms, including surgical and hospital fees.
A dual U.S-Canadian citizen, Mitchell received his medical degree in plastic surgery from the University of Manitoba. He did his fellowship in body contouring and reconstructive surgery at the University of Pittsburgh Medical Center.
To undergo body contouring surgery, patients must meet certain criteria, Mitchell said.
'They have to be weight stable for about 12 months,' he said. 'In some of them, their weight tends to fluctuate. Once they have reached their plateau, that's when they are optimized for surgery.'
Because some post-bariatric patients are at risk of malnourishment, patients must be on a high-protein diet to improve wound healing, he added.
He cautions patients that there will be scars. He can often hide abdominal scars in the area that would be covered by undergarments or bathing suits, but scars can't be hidden on upper and lower extremities.
'Almost every surgeon has the ability to do what I do,' Mitchell said. 'The question is whether they are passionate in order to do it or comfortable to do so. What I specialize in are the larger cases.'
He cites research showing that plastic surgery can help a patient maintain weight loss. A study in the October 2013 journal Plastic and Reconstructive Surgery found those who underwent body contouring regained an average of 11 pounds, compared with 50 pounds for those who did not undergo surgery.
The plastic surgery may be 'the final hurdle to get somebody to the place they've always wanted to be,' Mitchel said. 'To me, that's the rewarding part - to be able to be involved in someone's life and to be able to make that final difference.'
Sue Thoms covers health care for MLive/The Grand Rapids Press. Email her at sthoms1@mlive.com or follow her on Twitter, Facebook or Google+.
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