As weight-loss surgery for morbid obesity has become more and more common, so too have the plastic surgery procedures many people need afterward, according to researchers.

While obesity surgery can spur massive weight loss, it leaves many people with folds of excess, loose skin. The problem is more than a cosmetic issue, as the hanging skin can be painful and susceptible to infection.

So for many people, obesity surgery is only the first in a series of surgical procedures. Writing in the World Journal of Gastroenterology, a group of New York plastic surgeons details the “body contouring” procedures commonly needed after massive weight loss.

Often, they say, a traditional “tummy tuck” is not enough, and patients need a belt lipectomy, in which excess skin around the whole circumference of the waist and hips is removed.

In addition, both women and men often have sagging in the breast area. For men, surgeons will remove the excess skin and underlying tissue, while many women opt for breast implants in addition to a breast lift.

Other problems after obesity surgery include flabby skin on the upper arms that cause a “bat wing” appearance when the arms are lifted, as well as excess skin hanging from the thighs. Again, the surgical solution is to remove the excess skin and tissue.

“Massive post-surgical weight loss leaves most with unsightly excess folds of skin and fat, and in some ways the patient can actually look worse, not better,” Dr. Jason A. Spector, the lead author of the review, said in a statement.

But body contouring can offer most of these patients an “amazing transformation” to a healthier, fitter body, added Spector, an assistant professor of surgery at Weill Cornell Medical College in New York City.

Still, like the weight-loss procedures themselves, body contouring is not without risks, including blood loss during surgery and a small risk of blood clotting.

After surgery, some patients suffer wound infections, abdominal hernias or numbness in the area where skin was removed. And all patients should be willing to accept the inevitable scars.

But as post-obesity body contouring has grown more common, outcomes have improved along the way, according to Spector.

“And as we perform more and more of these procedures - some surgeons are now well into the hundreds of cases - we’re bound to get better at them, refining techniques and improving outcomes even more,” he said.

Spector and his colleagues point out that body contouring after obesity surgery is now the fastest-growing field within plastic surgery.

Nearly 56,000 such procedures were performed in the U.S. in 2004, according to the American Society of Plastic Surgery.

SOURCE: World Journal of Gastroenterology, November 7, 2006.