For the 170,000 morbidly obese patients who undergo bariatric surgery each year in the U.S., the stomach-reducing procedure is just the first step back to health and self-esteem.

“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,” notes Dr. Jason A. Spector, assistant professor of surgery in the Division of Plastic Surgery at Weill Cornell Medical College, and assistant attending surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City.

“For many, the next phase of this journey is a series of operations collectively called ‘body contouring,’ where surgeons remove this excess tissue and sculpt and restore the body to a more normal, aesthetically pleasing look,” he says. “For most patients, it’s an amazing transformation, a return to health and confidence.”

The emerging field of post-surgical body contouring remains relatively new and unfamiliar to many non-specialists, however. So, Dr. Spector (along with Drs. Nolan Karp and Steven Levine of New York University) has co-authored a “state of the science” review article aimed at gastroenterologists, to be published in the Nov. 7 issue of the World Journal of Gastroenterology.

According to federal statistics, nearly a third (30 percent) of adult Americans are now obese, and 5 percent are morbidly or severely obese. Many are resorting to bariatric surgery to limit their food intake and absorption and enhance weight loss.

Experts estimate that in 2005 alone, U.S. plastic surgeons performed nearly 56,000 post-operative body-contouring procedures on patients who had undergone bariatric surgery.

“We typically recommend that a patient’s weight stabilizes for at least three to six months before they undergo these contouring procedures,” Dr. Spector explains. Surgeries such as tummy tucks, breast augmentation, and thigh, buttocks and arm lifts can be done separately over time, or all at once during marathon 8- or 9-hour operations involving multiple surgical teams.

Post-bariatric surgery body contouring is not without its risks.

“These risks may include blood loss during the procedure itself and a very small risk of clots,” Dr. Spector says. “A minority of patients may also experience other problems, such as abdominal hernias or fibrosis, and, of course, trouble-free wound-healing is always a priority.”

“I believe it’s extremely important to inform each patient of the potential for these and other complications,” Dr. Spector says. “It’s also important to give them a realistic view on what these surgeries can achieve.”

As procedures improve, however, so, too, do outcomes. Scars resulting from body contouring are often positioned to lie below the underwear/bikini line, for example, and surgeons use precision liposuction to “smooth out” uneven areas that arise after drastic weight loss. “This provides a more even, natural look,” Dr. Spector says.

“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,” Dr. Spector says.

For most patients, the road from an unhealthy, disabling obesity to a slimmer, healthier and more attractive body is a long one, the Weill Cornell expert says. But most say they are more than willing to take that journey.

“When it’s over, patients generally tell us that every step along the way was more than worth it,” Dr. Spector says. “They say they feel healthier, more attractive, happier. And for us, that’s the goal.”