Sometimes all you need is a jump-start.
A combination of genetics and carbohydrates had left 57-year-old Alan D. Goodwin behind the fitness curve with a beer belly that a serious and difficult workout schedule wasn't helping. He was unhappy with his appearance, frustrated with his exercise results and medically unhealthy.
"I looked like I was carrying a kangaroo baby," says Goodwin, who, at 5 feet 5 inches, was quite rounded out by his condition. "And it's not that I wasn't trying to lose weight." He had been devoting himself to four or five workouts a week with a personal trainer, which improved his strength and appearance -- except in the middle. His belly wouldn't budge. And his health was suffering as a result.
A history of health problems -- kidney stones, diabetes and heart problems -- aggravated by his gut drove him to consider another solution.
He contacted Dr. Mark Foglietti, director of the Cosmetic Surgery Institute in Beachwood, chief of plastic surgery at both Marymount Hospital in Garfield Heights and University Hospitals Health System Richmond Heights Hospital and director of plastic surgery residency at South Pointe Hospital in Warrensville Heights.
"It's not uncommon to see a man with this condition -- a normal-sized chest, skinny legs, and a firm, protrusive belly -- who can't get rid of the bulge," says Foglietti.
He explains that a secondary fatty layer called the omentum, located under the muscles inside the abdomen, causes the problem. As the body ages and metabolism changes, the fatty layer can thicken and become resistant to diet and exercise.
"One year ago, if a patient with this deformity came to me, I would say nothing could be done because of the abdominal pressure," says Foglietti.
But Foglietti and a colleague, Dr. Rick Gemma, general surgeon at South Pointe Hospital, are working together to develop a new procedure so something can be done. The procedure, called a "beer-belly abdominalplasty," is like a tummy tuck with a general surgeon present to assist with removal of the omentum. Once it is removed, the muscles and skin can then be tightened. It then takes about a year's worth of dedicated diet and exercise to fully build the muscles again. Once removed, the omentum will stay gone.
The procedure is considered cosmetic (and therefore elective), but Foglietti is in the process of asking for a research grant to study the health aspects of it.
"The research I'm requesting a grant for is to show that insulin needs of diabetics will decrease when we remove the fatty layer," he explains. "Certain blood levels that are detrimental to the heart will improve."
Prior to and after surgery, Foglietti will follow patients' insulin requirements and cholesterol levels to gauge results. "It's an innovative surgery," he says, "and as far as I know, South Pointe is the only place it's being done."
What was Goodwin's reaction to the results? "The surgery has completely changed my life," he says. Yes, much of the difference he sees in his life is psychological. "I no longer see my belly staring at me in the mirror." But it's a stimulus to make him work harder to get fit and stay healthy. And now, he does get the full benefits from working out. "I feel the surgery gave me a jump start, a chance to start over and be truly healthy inside and out," he says.
Cosmetic surgery is often thought of as a luxury surgery performed purely for vanity. But it can also be considered a medical procedure with long-term health benefits that result from lifestyle changes. It can be expensive, and most insurance companies have very strict criteria patients must meet before receiving even partial benefits. But, more and more, people are considering elective procedures as the way to a healthier life.
That kind of thinking is central to the mission of many plastic surgery practices, such as the Lu-Jean Feng Clinic in Pepper Pike. "You must be healthy outside and inside," says Dr. Lu-Jean Feng, clinical associate professor of surgery at Case Western Reserve University School of Medicine and medical director of her clinic. "For that reason, all cosmetic surgery is health related. You cannot separate health from happiness."
If this is the case, can a nose job help prevent disease? What about a tummy tuck? How about a brow lift? According to Feng, the answer is "yes" -- if you consider things like better breathing, improved self-esteem and a renewed commitment to taking care of yourself as being beneficial to good health and longevity.
Bariatric surgery does much to help control and prevent diseases associated with obesity. The follow-up plastic surgery required for better mobility and proper hygiene is said to have health benefits, as well.
"With bariatric surgery, patients can lose 100 to 150 pounds suddenly," says Dr. Gregory Fedele, with the Center for Plastic and Cosmetic Surgery in Willoughby Hills. "But often the skin does not have enough time to snap back or contract down, and sometimes it has lost its elastic properties."
This can lead to excess skin and sagginess. Excess skin, especially around the abdominal area, can hang down significantly -- sometimes 6 inches, sometimes down to the knees.
"It can impair the ability to walk and the ability to stay clean and dry," Fedele says. A procedure called a pannicuectomy can be performed to remove the pannus, or hanging skin, from the lower abdomen.
Also, because bariatric surgery patients lose weight from all parts of the body, they might also need to remove hanging skin from the arms, thighs, back and buttocks. A body contouring/lifting procedure can remove this excess skin, making it easier for people to move around. This in turn makes exercise more efficient and pleasurable, inspiring patients to work harder at keeping the weight off and holding obesity-related health problems at bay.
One of the most common procedures performed in response to a disease is reconstruction for women who have suffered from breast cancer. They depend on surgeons to recreate what has been lost. Dr. Steven Goldman, acting chief of plastic surgery at University Hospitals of Cleveland, sees many patients for this procedure.
"Reconstruction is almost always part of the treatment," he says. When he performs reconstruction, he is sometimes asked to do a little tweaking to achieve a more desired outcome for the patient. "In my own bias, the procedures -- cosmetic and reconstructive -- complement each other," he says.
Goldman also often sees patients seeking breast reduction surgery, another procedure that has both health and appearance benefits.
Feng says cosmetic surgery procedures have a tremendous domino effect. "In a very broad sense, plastic surgery is very good for health," she says, "but you have to think broadly. It's much better to prevent disease than to treat it."
