It is well known that obese patients do experience both physical and metabolic changes in their skin. The very function of the superficial epidermal barrier, lymphatic fluid flow , sebaceous glands and sweat glands is distinctly different from those of non-obese patients. These changes lead to compromised skin quality which can result in an increased frequency of chronic wounds, skin infections and inflammatory conditions. Obesity is associated with changes in the micro-circulation (the microscopic sized blood vessels) that result in diminished small vessel blood flow. These changes are thought to be related to the increased frequency of high blood pressure and insulin-resistant diabetes in the obese patient population. The lower blood flow that results may also lead to modified collagen function and structure. Since collagen is integral to wound healing processes, wound healing is therefore impaired.
Obese patients that undergo bariatric surgery and then go on to lose significant amounts of weight do frequently experience resolution their systemic obesity-related diseases (i.e. hypertension and diabetes). However, it has been widely recognized by plastic surgeons that many of the changes that occur in the actual skin do not return to normal once the weight has been lost. A recent study (J Plas Recon Surg Vol 125, Num 1, Jan 2010, p343.) examined surgical skin specimens from patients that underwent post-bariatric body contouring, including lower body lifts. The investigators showed that the general collagen architecture of the bariatric skin specimens were abnormal and “loose” in comparison to non-bariatric skin samples. The specimens showed a marked decrease in the thickness of collagen bundles in the dermis of the skin, as well as multiple areas of collagen resorption throughout. These changes may be the result of chronic skin infections, which are common in the obese and post-bariatric populations, and also a major source of complaint of patients who present for panniculectomy surgery.
