Skin Changes Due to Massive Weight Loss: Histological Changes and the Causes of the Limited Results of Contouring Surger
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ORIGINAL CONTRIBUTIONS
Skin Changes Due to Massive Weight Loss: Histological Changes and the Causes of the Limited Results of Contouring Surgeries Rodrigo I. Rocha 1,2 Rolf Gemperli 1
&
Wilson Cintra Junior 1 & Miguel L. A. Modolin 1 & Giulia G. Takahashi 1 & Elia T. E. G. Caldini 3 &
Received: 16 March 2020 / Revised: 28 October 2020 / Accepted: 29 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Outcomes of body contouring surgeries in patients who previously had obesity are limited because of the loss of skin quality. This study aimed to evaluate the morphometric characteristics of collagen and elastic fibers of the skin in the abdominal epigastric region of patients who had massive weight loss following bariatric surgery and compared such with the skin characteristics of patients with morbid obesity. Methods This observational study compared skin fragments from the epigastric region of 20 patients who had massive weight loss due to bariatric surgery and 20 patients with morbid obesity. The morphometric analysis was performed on the collagen system using the Picrosirius/polarized light method and on the elastic system using the Weigert’s resorcin-fuchsin method. Results Reduction of thick collagen fibers (p = 0.048), increased thin collagen fibers (p = 0.0085), and increased elastic fiber density (p < 0.001) were observed in the massive weight loss group. No differences were found between the groups regarding mean age (p = 0.917) and total amount of collagen fibers (p = 0.3619). Structural dermis alterations in the massive weight loss group demonstrated collagenous remodeling, with consequent reduction of thick, organized, structured, and directed fibers in favor of thin, misaligned, and loosely arranged fibers. Weight loss was also associated with increased skin elasticity. Conclusion The morphometric changes in the collagen and elastic system scientifically explained the already established clinical perception of cutaneous alterations in patients who had massive weight loss following bariatric surgeries. Keywords Skin changes . Weight loss . Obesity . Body contouring surgeries . Skin . Histology . Collagen . Elastin
Introduction The worldwide prevalence of obesity has practically doubled since 1989 and represents a global epidemic [1, 2]. Bariatric surgery is considered the most effective treatment in patients with morbid obesity (BMI > 40 kg/m2 or > 35 kg/m2 with
* Rodrigo I. Rocha [email protected] 1
Division of Plastic Surgery, Hospital das Clínicas, Medical School, University of São Paulo (USP), 255 Dr Enéas de Carvalho Aguiar Avenue, São Paulo, SP 05403-000, Brazil
2
Office, University of São Paulo (USP), 352 Teodoro Sampaio Street, Suit 101, SP 05406-900 São Paulo, Brazil
3
Laboratory of Cellular Biology, Department of Pathology, Medical School, University of São Paulo (USP), 455 Dr Arnaldo Avenue, São Paulo, SP 01246-903, Brazil
significant comorbidities) [3, 4]. Weight loss occurs progressively and rapidly until stabilization is achi
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