Dr. Joseph Francis Capella (Capella Plastic Surgery) has performed more than 10,000 body contouring after weight loss surgical procedures, including my plastic surgery. I interviewed Dr. Capella to gain his real-world perspective on body contouring post-massive weight loss. In this segment, Dr. Capella gives his expert opinion on choosing a plastic surgeon.
Dr. Capella answers readers’ and my burning questions, bringing to light virtually everything we need to know before opting for plastic surgery after weight loss. Go to part 1 of my Dr. Joseph Capella interview or read part 3 below.
Dr. Capella Interview: Choosing a Plastic Surgeon after Weight Loss
My Bariatric Life: Dr. Capella, your book, Body Contouring Surgery after Weight Loss, states that many of the surgical procedures performed on the massive weight-loss patient are complex and labor-intensive, and that the wide spectrum of body contour deformities that can follow massive weight loss often exceed the magnitude of what plastic surgeons have traditionally addressed.
Please help us to understand why weight-loss surgery patients need to work with a surgeon who specializes in bariatric plastic surgery.
Dr. Capella: Post-bariatric body contouring is a relatively new area within the field of plastic surgery, in that bariatric surgery only has become popular in the last 10 to 15 years. And because of that, many surgeons have come through their training not having been exposed to post-bariatric body contouring. Because of that these surgeries are not considered traditional procedures, in the sense that they’ve been honed over decades like many of the other plastic surgery procedures. And so what plastic surgeons may do is use these more traditional procedures and apply them to the post-bariatric patient, which often will lead to sub-optimal results.
So, it’s very helpful then, in that regard, to go to a plastic surgeon who has committed to this kind of surgery and does this surgery frequently — and this would be true for any kind of plastic surgery, for that matter. But what’s different about post-bariatric surgery contouring is it is relatively new, and probably greater than 50% or more of plastic surgeons out there right now did not have any exposure to it in their training. Obviously there are on-going conferences to educate surgeons but there’s a difference with having it as part of your training rather than learning about it from a lecture.
My Bariatric Life: Since there is no accreditation to certify that a plastic surgeon is specialized with WLS patients, what criteria should the patient look at to determine that the surgeon has concentrated expertise in post-bariatric body contouring? Put another way, how does the patient discern between marketing hype and evidence-based fact?
Dr. Capella: I think the most important question you can ask your plastic surgeon is, specifically, for each of the procedures you’re considering: How often do you do them and how many have you done? The doctor should make other patients readily available to you who have had these plastic surgeries done. And, of course, the doctor should have a wide array of images to show you of hopefully body types that are similar to yours. I think that if the doctor can fulfill all those things, he or she probably is qualified to do your surgery.
But, again, I think the most important question is: How many have you done and how frequently do you do it? Ideally the doctor is doing your procedure once per month, something like that.
My Bariatric Life: Along that same vein, how does a patient discern if the plastic surgeon has specific expertise in performing a particular body contouring procedure? I imagine there is a great difference between plastic surgery of the body and of the face. As well, a procedure such as a medial thigh lift is much more challenging than a tummy tuck.
Dr. Capella: Well, yes, that is why you have to ask the surgeon specifically. And if there’s any question or doubt, have him write it down. Because people talk. But if you say, “OK, would you please write that down?” or “Is it on your website somewhere?” I would take the website as a pretty serious venue for the surgeon describing him or herself because it can be copied, and it’s a document in a sense. So, if you’re seeing that, and the surgeon is providing you with all the information about frequency, and you feel that you’re comfortable with that, then it’s fine.
Is there a difference with the face and neck? Only in that you’d want the expertise that you feel comfortable with in that particular procedure. It is difficult for any one surgeon to say they’re experts in everything. It doesn’t exist, quite honestly. That’s why in my own practice I don’t do noses now, and things that I’m not doing enough that I feel comfortable not only doing the surgery but managing complications, too. When everything works out fine then there’s no problem. It’s when there are issues that you really test your skills.
My Bariatric Life: So, what if it requires going out of state, then, to find the best-qualified surgeon to do your surgery? I certainly know that you have patients who are out of state.
Dr. Capella: Right. I think you’ll find that surgeons who are experts in their fields do this all the time. And even on their websites they may make note of that, and make accommodations for that. So, I would just follow their instructions regarding length of time to stay in the area. And then they should make aware to you potential complications and how they might be treated, for those that may occur later. Because there are certain complications that tend to occur within a certain time period that really are unlikely to ever to happen again.
So, I think it can be done very well — and it’s been done for decades — but you have to follow the recommendations made by that surgeon and for follow-up. In cases where I want to take care of all acute issues, I say stay in the area for two weeks and then it’s very unlikely that you’ll have anything acute any more. Those other issues that can occur afterward usually can be handled by anybody locally.
My Bariatric Life: Still continuing along this vein, easy rapport with and access to the surgeon post-op is vital to patient safety and well-being. What protocols should the patient expect the plastic surgeon have in place to provide this much needed level of support?
Dr. Capella: I think every physician or their associate should be available at all times. I hear a lot of patients having a hard time reaching their physicians and this concerns me. The doctor should always be available via telephone, but in this day and age I think it’s been very helpful using the Internet to be available for less acute issues that don’t need to be addressed immediately. Questions that maybe the patient doesn’t feel comfortable or feel it’s appropriate to call about can be emailed or texted along with photographs.
Easy rapport is important, not just because it is nice but because you will not hesitate to express concerns. Just as you would with a friend you won’t hesitate to bring up concerns and issues whereas somebody you are not as comfortable with you may hold back. And in the sense of recovering from surgery, in a medical situation it can be quite serious if you feel you’re not going to call your doctor because you’re just being bothersome and he or she seems annoyed every time you call. That can have health implications. Rapport can translate into safety.
Stay tuned for part 4 of our Dr. Capella plastic surgery interview
Living larger than ever,
My Bariatric Life
Photo: Dr. Capella performing a lower body lift. The patient is lying on her side in what is called the left lateral decubital position. Photo courtesy of Joseph Francis Capella, M.D.