[Outline surgery after massive weight lossing or gastroplasty].

The silhouette surgery in case of obesity or after gastroplasty and massive weight loss is near the usual outline surgery. However, many differences shall be well-known: more and more cases appear and demand is rapidly growing. The main demand for surgery is aesthetical improvement. The development of gastroplasty has greatly increased the demand of this outline surgery. At the beginning of gastroplasty, plastic surgeons sent pathological obeses to the first "gastroplastician" visceral surgeons. Now, after massive weight loss (over 60 kg), general health is improved, but aesthetical aspect is often worsened; so the patients turn back to the plastic surgeons. The therapeutical program associated combined surgeries, for example: breast plasty and abdominoplasty performed during the same procedure or important and multilocular lipoaspirations. Large skin excess and persisting over weight influence surgical procedure. A strict preoperative planning is mandatory to obtain safe, quick and satisfying result. Preoperative informations concerning results and postoperative evolution (like, for example, the possibility of blood transfusion, infection and scars em leader ) are very important. Usually, five procedures will be necessary over a 3 or 4-years period of time: abdominoplasty, body-lifting, arm and thigh-lifting, breast surgery for ptosis, hyper- or hypotrophia of the chest, lipoaspirations and, in a few cases, face lifting em leader. We describe this so particular outline surgery, its techniques and usual evolution.