الفهرس 
OBESITYOnly 14 pages are availabe for public view
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Abstract
O
besity is one of the nation’s most serious health problems and is expected to increase in prevalence and severity. Health care providers must take an active role in identification, evaluation, and treatment of high-risk individuals.
Morbid obesity is associated with a medley of comorbid conditions and poor long-term outcomes. Overweight and obese individuals should be treated with diet, exercise, and behavioural therapy. The failure of this approach is an indication of Bariatric surgery.
Bariatric surgery should be considered in adult patients with documented BMI greater than or equal to 35 and related comorbidity or a BMI of at least 40. Bariatric surgery reduces obesity-related complications and reduces long-term morbidity, mortality, and health care resources use.
Bariatric surgery has established itself as the most reliable way to achieve significant weight loss in overweight and obese populations. Surgical procedures to reduce excess body weight have evolved and are now considered safe, especially when performed by experienced surgeons in a center of experience. Bariatric surgery not only causes weight loss but has a significant impact on comorbidities and the overall mortality of obesity. The indications for, and populations benefited by, bariatric surgery continue to expand. The new designation, metabolic surgery, carries a significance that can have an impact on how some of the most devastating diseases faced by medicine today are managed.
Bariatric surgical procedures can be classified into three categories: malabsorptive, producing weight loss by interfering with caloric digestion and absorption; restrictive, producing weight loss by limiting caloric intake; and mixed, producing weight loss through both mechanisms.
After massive weight loss, patients are often left with loose, ptotic skin envelopes and irregular bulges. The shapes and body distributions of these deformities are often difficult to predict, although it is generally agreed that younger patients, and patients with elastic skin, will suffer the least severe consequences. Postoperative deformity could only loosely be predicted based on preoperative appearance, degree of weight loss, and age. Some patients shed a much greater portion of their weight from one portion of their body, in comparison to other anatomic regions.
One of the regions of the body which suffer from different degrees of deformities after massive weight loss are the buttocks, as they are considered an important element of sexual attraction and a major component of the concept of beauty especially for females. The ideal buttocks involve more than projection and volume. A balanced, harmonious proportion with the rest of the body is a hallmark of gluteal beauty. Surgeons must be familiar with those features that characterize beautiful buttocks before they can attempt to recreate them.
Regarding the buttocks deformities after massive weight loss in females, there are different types and degrees of deformities which depend on many factors as, the body mass index before and after the weight loss, the shape of the body, aesthetic analysis of the gluteal region and the fat distribution in the gluteal region. The fat distribution in the other regions like abdomen, flanks, back and thighs plays an important role in the contour of the buttocks and gives an idea about the surgical techniques which are suitable for every degree of deformities in order to recreate beautiful buttocks. These deformities include buttocks ptosis, loss of projection, and buttocks irregularities due to irregular distribution of the fat as it accumulates in some areas and atrophies in other areas.
The Pittsburgh Rating Scale is a useful organizational tool for assessment of body deformities after massive weight loss. Regarding the buttocks as a regional score, they are assessed on a scale ranging from 0 to 3.
The management of buttocks deformities in females after massive weight loss depends on the degree and the type of deformities. There are different surgical techniques for gluteoplasty which include buttocks lifting or gluteal dermolipectomy for treatment of buttocks ptosis and excess skin, gluteal implants or dermal fat flaps for correction of poor projection, liposuction for correction of the irregularities and fat injection which can be used for correction of the irregularities or lack of projection.
In the majority of these cases, there are more than one deformity which need combined surgical techniques to obtain successful results such as, correction of buttocks ptosis and excess skin only by buttocks lift leaves flat buttocks and poor projection which can be corrected by gluteal implant, dermal fat flaps from the excess skin or even fat injection which is obtained from the liposuction of irregularities or from excess fat in other regions such as abdomen, flanks and thighs and reinjection of this fat in the gluteal region to reach the desirable buttocks contour.
In general, buttocks contouring procedures improve when surgeons first perform systematic aesthetic and anthropometric analyses that characterize the different types of buttock deformities and apply this information to plan the most appropriate surgery for each patient. Careful and accurate surgical techniques make it possible for us to achieve optimal postsurgical results that produce increased patient satisfaction and enhanced body image.