We seem to read about it, watch it, and hear it all the time: there’s no doubt that people in the Western World are gradually getting fatter. There are many reasons for this trend, with both poor diet and lack of exercise being the key factors. The answer may seem simple to many people, just eat less and exercise a bit more. Yet for some people the reality is never that easy. There are many people, from all sections of society, who cannot lose the weight that they need to – so what are the options for them? At Mills and Mills Medical in Marbella, they offer a complete treatment package for their clients. As well as their specialist obesity surgeons, Mills and Mills Medical team features registered dietitians, while they can also recommend psychologists and personal trainers for those clients that may benefit, to ensure that clients receive the best possible care. I met up with Damien Moore, Marbella Mills and Mills’ amiable Clinical Advisor, to find out exactly why they have such a good reputation for providing obesity surgery.

The first stage of the process involves an in depth consultation with their obesity specialist, who discusses in detail the procedures that will follow, as well as assessing the clients’ suitability. As with all of Mills & Mills’ services, an initial assessment of the clients’ suitability for treatment is carried out. Damien explains: “Any form of surgery has to be carefully considered, there are risks and concerns that need to be thought through. With obesity surgery, it is for those people who are considered medially obese. Some people, on their initial assessment, are simply told that surgery is not the right option for them as they are not obese. We do see a few people with eating disorders who believe that they are much bigger than they actually are. We recommend counselling rather than surgery in these cases.”

Mills and Mills offer two types of obesity surgery, a gastric balloon and a gastric band. Though both reduce the amount of food the patient can consume at each sitting, they have basic differences that mean each patient is assessed as to which treatment would suit them best.

Gastric Baloon

This surgery option is most suitable for those with a BMI of between 30 – 40, this means they are classified as being obese or severely obese. The procedure itself involves placing a silicone balloon in the patient’s stomach, resulting in the patient feeling full more quickly and therefore not consuming as much food. In short, the balloon reduces the internal size of the stomach. The balloon is inserted down the throat using an endoscope, the entire process takes as little as 20-30 minutes and the patient will remain sedated throughout, normally under a local anaesthetic. The balloon is initially inserted in a deflated state, and then filled with a saline solution once in place in the stomach. Cleverly, the solution has a blue dye in it, which means that if the balloon were to split, the patient’s urine would become blue and they would be immediately aware of the issue. Reassuringly, Damien tells me he has never actually known one to split, but it’s nice to know there’s a warning system in place! Patients cannot normally feel the balloon in their stomach, and they are usually able to go home the same day of the operation.

The balloon is only a temporary solution, and is removed after 6 months. After this length of time it is hoped that the patient will have learned to eat a more healthy diet, with smaller portions. Damien has seen many patients successfully have a gastric balloon fitted, and the average weight loss during the 6 months is around 15kgs. Mills and Mills’ nutritional team put together tailor made nutrition programs for patients to follow once they have had the balloon fitted. It is important for patients to understand the basics of healthy eating and see the balloon as an opportunity to adjust their lifestyle and eating habits for the better. During the 6 month period with the balloon inserted, patients are able to contact Mills and Mills’ team for support and advice. Damien adds: “With both procedures (Gastric Baloon and Gastric Band) clients see the surgeon soon after the operation to make sure that all is well. They then have a consultation with a dietitian one month after, and can continue to see a dietitian if either the client or surgeon believes it is necessary.”

Gastric Band (or Lap Band)

The gastric band is a silicone band that is placed around part of the stomach, resulting in the patient feeling fuller more quickly. The band is usually placed near to the top of the stomach, so that there is only an initial 25% of the stomach available for food. However, the band does not completely cut off the other 75% of the stomach, food is able to slowly move down into the rest of the stomach as the band is not completely closed off, this is important as it means that the patient can still absorb the vitamins and nutrients from foods. The band is inserted laparoscopically under general anaesthetic. The surgeon makes few small incisions in the abdominal wall, and uses a tiny camera to guide them through the procedure. The diameter of the gastric band is able to be adjusted with relative ease. This is important because the diameter of the band controls how much food can pass down into the main part of the stomach and at what speed. When the diameter is smaller, the patient feels full very quickly, but if the diameter is increased, the patient can eat a little more before feeling full. The band diameter can be adjusted as the band has a long thin cord which is also inserted into the body, with the end of this cord lying just below the surface of the skin. It is then possible for a nurse to adjust the diameter of the band by simply adding more saline solution into the cord, which closes the diameter of the band. This is done by inserting a fine needle through the skin, into an access point on the cord and adding the saline. This process takes only a few minutes and is pain free.

The gastric band is a permanent procedure, it is done for those people who are morbidly obese with a BMI of over 40. They would therefore gain little benefit from losing 15kgs with the balloon procedure. But neither the balloon nor the band solve morbid obesity on their own. The success of the procedure relies largely on the commitment of the patient, they must still control what they eat and how much, as it is possible to cheat both the band and balloon, by frequently consuming small amounts of very high calorie foods. However, these procedure do, quite literally, provide an invaluable lifeline for many people who feel they have tried every other alternative. It is a fact that obesity is directly linked with many diseases, including heart disease, stroke, high blood pressure and certain types of cancer. The majority of patients that have obesity surgery procedures do so because they realise that their life expectancy is being reduced due to their weight. Mills & Mills provides a ray of hope and a solution for such people.

Mills & Mills Medical Marbella

www.millsmedical.com

0034 952 908 538

Liposuction enables the surgeon to remove areas of fat that you have not been able to shift with diet and exercise, so called “storage fat” areas.

It is probably the most misunderstood operation within the field of Aesthetic Plastic Surgery since a lot of patients still view liposuction as a replacement for exercise and weight loss.

Where is liposuction effective?

Liposuction can be done on your abdomen, hips, thighs, inside of the knees, ankles, upper arms, neck and back, these are all possible areas. Regarding patient happiness and effectiveness of the procedure, probably love handles, outer thighs and lower abdomen are the favourites.

Where is it less effective?

I wouldn’t say less effective, but problematic are especially the inner thighs and inner arms, because patients have to understand that there is an imminent risk of saggy skin in these areas, should too much fat be removed. I would also report certain limitations in the area of the ankles, and calves, where liposuction can absolutely be beneficial, but gross fat deposits are fairly uncommon

How much fat can be removed?

There are safety limits regarding the maximum amount of liposuction. There are different formulae to calculate this, depending on your body weight. This would have to be discussed individually, just bear in mind you cannot push it endlessly.

Will removed fat come back?

This is a tricky question. Your body won’t replace the fat cells that are removed, so you should have a long-lasting change in your body shape, especially if you exercise, eat a healthy diet, and maintain a healthy weight after your operation. However, other fat cells can enlarge enormously, so the burden of responsibility for your lifestyle cannot be taken off your shoulders.

How long do I have to stay in hospital?

Most liposuction cases can be done as a day case, but this will of course depend on the amount of fat removed. There are no clear guidelines by Spanish health authorities. Healthcare commission guidelines seem to suggest that the limit for a day case is in the area of two litres.

What are the complications?

Generally, the larger the amount of fat removed, the higher the incidence of small irregularities that may require a small touch up to perfect the result.

Like in any operation, infection is always a possibility, in very large liposuctions systemic complications like embolism and thrombosis have to be taken into account.

There might be drainage of irrigation fluid for a few days after the operation from the stab incisions, which is normal and usually ceases quickly.

Is it possible to inject the fat that is taken out somewhere else?

Technically, this is absolutely possible. The fat for transplantation needs to be processed in a special way.

Regarding the results, there is a variance of “take” of the fat graft that can be very different from patient to patient.

In some patients, fat transplants can yield absolutely fantastic results, in others, the  transplanted fat can be absorbed very quickly. Apart from a meticulous technique, individual factors greatly contribute to that.

I think nothing points against transplanting fat, if fat is harvested anyway, but I do not recommend to specifically harvest fat from one area in order to do so.

Dr Alexander Aslani

Dr.Alexander Aslani is a Specialist Plastic, Aesthetic and Reconstructive Surgeon.  He has held Consultant appointments in academic units of Plastic, Aesthetic and Reconstructive Surgery since 2002, specializing in reconstructive microsurgery of the breast and head and neck as well as aesthetic surgery.

Apart form his academic positions, he has been in private practice in Salzburg and London, and is now director of Cirumed Clinic Marbella.

Dr.Aslani cooperates with many established specialists along the coast.

http://www.cirumed.es/

952 775 346

607 307 515