Bariatric surgery
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Bariatric surgery is a surgical method of treating obesity, used in patients with morbid obesity or obesity complicated by metabolic diseases. The goal of the procedure is not only weight reduction, but primarily reducing the risk of health complications associated with excess adipose tissue, such as type 2 diabetes, hypertension, obstructive sleep apnea, or fatty liver. Bariatric surgeries affect the mechanisms regulating appetite, satiety, and the absorption of nutrients. Nowadays, they constitute one of the most effective methods of treating severe obesity, however, rapid weight loss after the procedure can lead to distinct aesthetic changes encompassing the face, skin, and silhouette.
Bariatric surgery - what it is
Bariatric surgery includes a group of surgical procedures performed to treat obesity through a permanent change in the anatomy of the gastrointestinal tract. These procedures are mainly used in people with a BMI ≥40 kg/m² or BMI ≥35 kg/m² with coexisting metabolic diseases and complications of obesity.
Modern bariatric surgery is based on two main mechanisms:
- limiting the volume of food consumed,
- reducing the absorption of calories and nutrients.
Bariatric surgeries also affect the hormonal system of the gastrointestinal tract. The secretion of hormones responsible for hunger and satiety, such as ghrelin, GLP-1, or peptide YY, changes. As a result, patients experience faster satiety and a reduced appetite.
Bariatrics is not an aesthetic procedure nor a “quick weight loss” method. It is an element of the comprehensive treatment of the chronic metabolic disease that is obesity. The procedure requires medical qualification, dietary preparation, psychological care, and many years of post-operative follow-up.
In clinical practice, bariatric surgeries often lead to a loss of 20% to even 40% of initial body weight within the first 12-24 months after the procedure.
Bariatric surgery - types
There are several basic types of bariatric surgeries, differing in execution technique and mechanism of action.
The most commonly performed procedures include:
Type of surgery | Mechanism of action | Characteristics |
|---|---|---|
Sleeve gastrectomy (sleeve gastrectomy) | Gastric volume restriction | Removal of approx. 70-80% of the stomach |
Gastric bypass | Volume restriction + partial exclusion of absorption | Stomach reduction and bypassing part of the intestine |
Mini gastric bypass | Mixed mechanism | Shorter and technically simpler version of the bypass |
Gastric band | Mechanical restriction of the amount of food | Currently performed less frequently |
Biliopancreatic diversion | Strong restriction of absorption | Procedure used mainly in severe obesity |
Currently, sleeve gastrectomy remains the most commonly performed procedure. It involves the surgical removal of a large part of the stomach, which leads to both a reduction in the amount of food consumed and a decrease in the secretion of ghrelin, i.e., the hunger hormone.
Gastric bypass additionally alters the course of the intestinal passage, thereby limiting calorie absorption and having a very strong impact on the hormonal and metabolic balance.
Modern bariatric surgeries are most commonly performed using the laparoscopic technique, which reduces the risk of complications and shortens recovery time.
Bariatric surgery - principles of operation
The mechanism of action of bariatric surgery is much more complex than simple stomach reduction. These procedures simultaneously affect the digestive, endocrine, metabolic, and neurobiological systems.
The most important biological effects include:
- reduced sensation of hunger,
- faster onset of satiety,
- improved insulin sensitivity,
- reduced inflammation in the body,
- reduction of adipose tissue mass,
- changes in gut microbiota.
After surgery, a rapid energy deficit occurs. The body begins to use fat stores as a source of energy, leading to rapid weight loss. In the first months after the procedure, the reduction can be as much as several kilograms per month.
At the same time, rapid loss of adipose tissue affects not only the abdomen or thighs, but also the face, neck, breasts, and buttocks. This is precisely why many patients observe aesthetic changes after surgery resembling intensified aging processes.
It is worth emphasizing that after a bariatric procedure, the body is in a state of intensive metabolic remodeling. Deficiencies in protein, vitamins, and microelements can additionally affect the condition of the skin, hair, and subcutaneous tissue.
Bariatric surgery and changes in appearance - aesthetic effects
Significant weight loss after bariatric surgery very often leads to distinct aesthetic changes. They affect both the face and the entire silhouette.
The most common aesthetic effects include:
- skin laxity,
- loss of facial volume,
- sunken cheeks,
- sagging of the facial oval,
- deepening of the nasolabial folds,
- excess skin on the abdomen, arms, and thighs,
- sagging of the breasts and buttocks,
- prominence of facial bone structures.
These changes result primarily from the rapid loss of subcutaneous fat tissue. Skin that has been stretched for years by an excessive amount of fat tissue often does not regain its full elasticity. This is particularly visible in people over 40 years of age, in patients with high initial obesity, and after very rapid weight reduction.
Within the face, an effect referred to as “post-bariatric face” may appear, resembling volumetric aging. The face becomes slimmer, less taut, and more sunken.
In aesthetic medicine, various methods are used to improve skin quality and restore lost volume, including:
- biostimulating treatments,
- microneedle radiofrequency,
- HIFU,
- tissue stimulators,
- lipotransfer,
- laser treatments,
- surgical lifts after massive weight loss.
The choice of therapy depends on the degree of laxity, skin quality, and the extent of lost subcutaneous tissue.
Bariatric surgery and Ozempic face - similarities of the mechanism
“Ozempic face” is a colloquial term for changes in facial appearance appearing after rapid weight loss associated with the use of GLP-1 receptor agonists, such as semaglutide. The mechanism of these changes is very similar to the effects observed after bariatric surgery.
In both cases, there is:
- a rapid reduction of subcutaneous fat,
- loss of volume in the middle part of the face,
- reduced support for the skin,
- increased tissue laxity,
- increased visibility of aging processes.
The difference lies mainly in the way weight loss is induced. In the case of bariatric surgery, the changes result from surgical modification of the gastrointestinal tract, whereas when using GLP-1 drugs, the dominant role is played by pharmacological appetite suppression and the slowing of gastric emptying.
However, the aesthetic consequences can be very similar. The face may look more tired, older, and less firm despite the improvement of metabolic parameters and the reduction of obesity.
The greatest risk occurs in people:
- over 40 years of age,
- with thin skin,
- with a low baseline amount of facial fat,
- with very rapid weight loss,
- with protein and nutrient deficiencies.
Nowadays, an increasingly important role is played by an interdisciplinary approach combining obesity treatment with the prevention of aesthetic changes and improvement of skin quality during the weight reduction process.
