Plastic surgery to complete weight-loss treatment

Jan 18 2010

He's completing their challenging journey and making them whole.

Reconfigured body after reconfigured body, the hands of Alexander Moya, M.D., Director of the Center for Weight Loss Body Contouring and Assistant Director of the Geisinger Center for Aesthetics and Cosmetic Surgery at Geisinger Medical Center (GMC), skillfully addresses the excess skin his patients contend with following the loss of dozens, if not often hundreds, of pounds. According to Dr. Moya, it's this final therapeutic step of removing this skin and reshaping their bodies that often puts weight-loss patients at peace with themselves and what they see in the mirror every morning.

"Many patients never expected they would need to pursue plastic surgery to feel complete. It often finishes their journey as weight-loss patients," said Dr. Moya. "They look in the mirror and fear they are still big. They fear that all of that skin will somehow fill up again. They're not mentally accepting of the fact they've lost all this weight."

It's these patients that motivate Dr. Moya, who tailors every procedure to each individual he sees.

"These are the most grateful patients I've ever had. The joy I see in their faces is incredible. After undergoing our surgical procedures, they come in more confident. They're happy. It makes sense to them, why they went through bariatric surgery," said Dr. Moya.

According to Dr. Moya, the biggest reason these weight-loss patients initially seek him out is their skin.

"They've lost the elasticity in their skin and it no longer conforms to their new body size. It just sags in pockets. There's no shape to it," said Dr. Moya, who explains that plastic surgeons are trained in general body contouring but not specifically in the weight-loss area. "When I first began operating on weight-loss patients, there were complaints after undergoing the procedures I was trained on and I knew there had to be something better."

Until recently, there had been one procedure that was primarily used. This involved a single lower-body incision, similar to that of a belt, to remove excess skin of the abdomen, flanks and hips. Dr. Moya, however, felt this was insufficient, as it only treated the lower abdomen and did not give a defined waistline. The standard surgery also required surgeons to reposition the patient several times while in the operating room and the recovery period involved a two-day hospital stay.

Dr. Moya couldn't find a better surgical option so he invented it.

"Corset trunkplasty" is his new, innovative surgical technique for body contouring after major weight loss. This procedure incorporates a more complex pattern of incisions on the body, allowing for the effective removal of excess skin. The approach, performed in only one position, comprehensively removes redundant skin in a single surgery; this includes skin from just below the breastbone down to the pelvis. The result: an entirely recontoured waist. It creates a full-length and well-defined waistline such as one that would be seen with a corset.

The technique allows for dramatic body reshaping because it maximizes removal of excess skin and utilizes the remaining skin to close what are often very large tissue defects. Altogether, this procedure involves three incisions that are interconnected to look like an "I". Because these incisions do not extend around the entire trunk, patients do not have to be moved during the operation, making it easier to perform and resulting in an easier recovery.

"This is an aggressive body contouring approach that can provide many patients, who have various amounts of excess skin, with an aesthetically pleasing waistline, but leaving several feet of fine scars. Because of the manner in which it is performed, it is a safe technique with minimal wound healing issues. I end up shifting skin from other areas which, if not addressed, would have a negative effect on the long-term abdominal contouring result." explained Dr. Moya.

"More and more patients want to undergo this single-stage corset procedure" said Dr. Moya. "My patients are looking forward to the incredible shapes that I can provide them, regardless of the vertical scar. In fact, for many of them, it is not just about what it does on the outside but also what it does on the inside. The boost to their self-esteem trumps any external scar."

As for patient satisfaction, patients tell Dr. Moya they can't believe the huge transformation they've undergone. Many can't believe they have what they consider to be a "normal" body. These patients now can look in the mirror and see a smoother, well-defined waist with the loss of at least several inches off their waistline.

Three years later, the corset trunkplasty has become a more recognized procedure for the massive weight loss patient. In fact, Dr. Moya teaches a course at Geisinger, which attracts plastic surgeons throughout the country who are interested in learning how to perform the technique. In addition, a recent course was sent via a live feed to plastic surgeons at the University of Miami. He has also had the honor of presenting his contouring approach at three major plastic surgery conferences.

"This is exciting. It's creating a buzz in the plastic surgery field," he said.

According to Dr. Moya, plastic surgery is often the final phase of a patient's weight-loss journey. Bariatric surgery addresses the physical health; plastic surgery can address the patient's emotional health.

"I listen to my patients. I have to understand what they're looking for. What are their concerns about their body? What's the most important thing?" said Dr. Moya. "We talk extensively so that I can understand who they are and what they're looking for. This is a model that gives plastic surgeons the most success."

After presenting the patient with several options, he/she can decide what works best for them.

"My job is to make sure that if they pick this procedure that it's right for them. About 99 percent of the patients you treat are happy that you addressed the issue they came in to see you about. Plastic surgeons should learn as many contouring techniques as they can and then tailor them to the patient. This leads to a great outcome both mentally and physically," said Dr. Moya.

About 85 percent of Dr. Moya's patients are women ranging in age from 20 to 70, with the average age around 43. His patients have lost anywhere from 80 to 350 pounds.

Dr. Moya began his studies in general surgery but soon transitioned to plastic surgery, which gave him an outlet for creativity.

"I like that plastic surgery deals with the entire body from the head to the feet. It's very challenging," he explained. "I've discovered that I can take the patient as an individual and tweak the treatment to fit them. My ability to create and be creative is still there. I can apply my experience with training to come up with a plan that works well for each patient."

He received his medical degree from Georgetown University School of Medicine, and completed his internship and residency training in general surgery at Mount Sinai Medical Center of Greater Miami. Dr. Moya also completed a fellowship in plastic surgery from the University of Utah to further his training.

Dr. Moya's other areas of interest include breast surgery, facial surgery and facial rejuvenation. He is a member of the American Society of Plastic Surgeons. Dr. Moya also participates in the American Board of Medical Specialties (ABMS) Maintenance of Certification Program™ (Plastic Surgery).

Approximately 50 percent of Dr. Moya's current patients are weight-loss patients in need of body contouring. He also sees non-weight loss patients seeking procedures for their face, breasts or body.

Dr. Moya is proud that the Geisinger Center for Weight Loss Body Contouring is one of a handful of centers worldwide that treats the "whole" patient. "We treat our patients with a multidisciplinary team. It's a fantastic model for rest of the country to follow. Healthcare professionals in nutrition, bariatric surgery and plastic surgery all work together for the best possible outcome for our patients," he noted.

Dr. Moya wants to provide patients nationwide with the option to consider his new corset trunkplasty surgical procedure.

He is eager to "get the word out" about this procedure and teach it to as many surgeons as possible. "I've seen the tremendous response from this. I want to share it with as many patients as possible," he added.

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