I met Dr. Betancourt Parra at IQ interquirofanos while observing surgery with Dr. Luis Botero,. Dr. Betancourt was friendly, and immediately amendable to an interview but it took a little while to coördinate our schedules.

In person, he reminds me a bit of Dr.Carlos Ochoa Gaxiola, the kind and talented Mexican surgeon who graciously permitted me to study with him at Hospital General de Mexicali for several months while writing the Mexicali book.

Maybe it was his laid-back and open conversational style, or the braces on his teeth, giving him a bit of boyish charm that belies his years of experience.  Maybe it was his enthusiasm for his work, but whatever it was, I found the discussion to be especially informative and interesting.

Aesthetic plastic and reconstructive surgery

Dr. Betancourt is a plastic surgeon in Medellin.  He performs a wide range of aesthetic and reconstructive plastic surgery including corporal (body) and facial procedures such as rhinoplasty (nose), face-lifts, blepharoplasty (eyelid lift), breast augmentation, liposuction etc. but his true love is post-bariatric surgery procedures.

He also performs reconstructive surgery such as breast reconstruction after breast cancer.

Post-bariatric practice

Post-bariatric surgery is a subspecialty area of plastic surgery (reconstructive surgery).  Many of these patients have lost very large amounts of weight (100+ pounds) and have large amounts of sagging, drooping and excess skin.

This skin is more than aesthetically displeasing – it can also contribute to the development of skin irritations such as intertriginous dermatitis and infections.   It is particularly prone to causing problems for females – due to an excess build up of moisture, and friction in the genital areas.  It can also make simple tasks like showering, getting dressed and cleaning after using the bathroom difficult.  Patients sometimes have to “tuck” loose skin from the abdomen into support garments to prevent this skin from slipping down to their thighs.  This excess of skin (and the resultant movement/ friction) can prevent people from participating in normal activities like exercise.

The psychological impact of the appearance of, and the challenges of daily living can be extremely distressing – especially for someone who have spent months or years trying to lose weight.

The group of procedures used to treat this problem is called “Body contouring”.  For the majority of patients – this body contouring process will require several months and several separate surgeries.

Body Contouring

One of the primary procedures for body contouring is called a “lower body lift/ /belt lipectomy/ torsoplasty”.  This is actually two separate but very similar techniques; with the belt lipectomy being a modified lower body lift procedure.  However, they are often grouped together to simplify discussions about body contouring procedures.   The lower body lift or belt lipectomy is usually one of the first procedures as part of the reconstructive process after massive weight loss.

This procedure is the core procedure – which removes the majority of excess skin and tissue which is usually in the abdominal/ torso area.  This is a dramatic and large surgical procedure which I liken to “the open heart surgery of plastic surgery.”  This procedure can take 2 to 6 hours, and often requires a 1 to 2 night hospital stay.

The remaining procedures are more of a ‘fine tuning;, as they are smaller procedures with lesser effects as they are aimed at smaller, more specific areas of the body.  These procedures include brachioplexy to remove excess skin (aka “batwings”) from the upper arm/ bicep area, reduction mammoplasty to remove excess skin and drooping from the breast area, or a thighoplasty, to remove excess skin from the thighs/ upper legs.

One year minimum wait after bariatric surgery

Dr. Betancourt requires a minimum of one year after bariatric surgery before patients begin considering body contouring procedures.

This is important for two reasons:

1. Patient’s weight should be stable prior to performing surgical procedures.

2. This period gives patients a chance to adjust to their new weight.  Several studies have demonstrated that it may take months to years to adjust the mind’s eye (mental image) to a person’s actual appearance.

For an excellent article by Salwar & Fabricatore (2008) on the psychological considerations for patients after massive weight loss – click here.

Mirror versus mind’s eye

This is why many people literally “do not see” recent changes in our weight / appearance (particularly subtle/ small changes) when looking in the mirror.  However, as time passes, the mind’s perception of our image/ appearance usually changes to accommodate changes in our ‘real’ appearance – whether weight loss/ gain, signs of aging (fine lines, wrinkles) or even the loss of a limb or appendage.

When the mental / mirror image “mismatch” is dramatic, long-lasting, accompanied by depression/ anxiety or leads to dangerous practices like anorexia, hypergymnasia or self-mutilation – it is called body dismorphic disorder (BDD).  Patients who have successfully adjusted to their new size and appearance are much more likely to have realistic expectations, be satisfied with surgical outcomes and be able to maintain their weight over the long-term.

Dr. Betancourt explained that he enjoys the intellectual challenges of caring for post-bariatric surgery patients for several reasons.  These patients, often differ greatly from the majority of plastic surgery patients due to the presence of multiple co-morbid conditions relating to their previous obesity.   Patients may also have body image issues following the initial bariatric surgery as they adjust to their new bodies.  These patients may require multiple procedures for a complete reconstruction, making treatment a somewhat lengthy process.

Dr. Betancourt states that this is what makes it so gratifying; to be able to provide patients with dramatic body changes, help improve their self-image and enable patients to successfully adjust to their new lives.  He also finds it very rewarding because of the high level of patient satisfaction after these procedures.

These patients account for approximately 1/3 of his practice.

Education and Training

Dr. Betancourt has been a plastic surgeon for twelve years.  For eleven years, he worked in a public hospital, Manuel Uribe Angel in Enviagado, providing reconstructive surgery services to all patients at all socio-economic levels in Antioquia, Colombia .  For the last several years, he has devoted a significant portion of his practice to the sub-specialty of post-bariatric surgery.  He has attended several post-bariatric surgery conferences to learn new techniques and exchange ideas with many of the leaders in the field including Dr. Alaly (USA),  Jean François Pascal (France) and Dr. Ricardo Baroudi (Brazil).

Dr. Betancourt attended medical school at Universidad CES (University of Health Sciences) and graduated in 1993.  He is currently a professor at CES.

He competed in general surgical residency at the public hospital, Hospital Ipiranga in Sao Paulo, Brazil before completing his plastic surgery fellowship at the Universidad Santo Amaro, (in Sao Paulo, Brazil).

He is a member of the Colombian Society of Plastic Surgery (SCCP), as well as the Brazilian Society of Plastic Surgery.

Dr. Betancourt speaks Portuguese and English in addition to his native Spanish. He reports some trepidation with his English but was readily able to communicate with me without difficulties.

Dr. Juan David Betancourt Parra

Torre de Especialistas Intermedica 

# 1816

Calle 7 No.39 – 137

Medellin

Tele: 352 0264

Email: plasticjdb1@une.net.co

Website: www.plasticjbd.com

International Patients

While the majority of Dr.Betancourt’s patients are from the local area, he does see international patients. After an initial contact by email, or via his internet page, Dr.Betancourt solicits a complete medical history including previous surgical reports (from previous bariatric or plastic surgery procedures) and current photos.  Patients will also need to have blood work, and EKG as part of the pre-operative evaluation.  Additional studies may be needed depending on the individual’s history and diagnostic test results. (Patients may be referred to Internal Medicine specialist, as needed).

Following the on-line/ email communications, patients will be seen, for an in-person consultation and full physical examination. Dr. Betancourt’s office will make arrangements for a translator and companion to accompany the patient, as needed.  With the patient’s assistance, a full surgical treatment plan will be designed at that time – which discusses how many surgeries and what the anticipated timeline and recovery will be.

As discussed above, the torsoplasty/ belt lipectomy is usually the first procedure performed, often followed by reduction mammoplasty/ mammoplexy.

With the torsoplasty, patients are usually hospitalized for 1 to 2 nights.  They are encouraged to be active and ambulatory as soon as possible after surgery to prevent post-operative complications such as thrombosis and pneumonia. Dr.Betancourt usually engages private nurses to assist patients following their discharge from the hospital.

Sufficient recovery from return travel usually requires 3 weeks, and is monitored by Dr.Betancourt.

Dr. Betancourt also provides psychological / counselling referrals as needed for patients.

Additional References / Reading and Resources on post-bariatric surgery

* Recommended reading:  Langer V, Singh A, Aly AS, Cram AE. (2011).   Body contouring following massive weight loss. Indian J Plast Surg [serial online] 2011 [cited 2013 Aug 11];44:14-20. Available from: http://www.ijps.org/text.asp?2011/44/1/14/81439

Excellent article with general overview of the issues and procedures with before and after photographs.

* Recommended reading:  Shrivastava P, Aggarwal A, Khazanchi RK. Body contouring surgery in a massive weight loss patient: An overview. Indian J Plast Surg [serial online] 2008 [cited 2013 Aug 11];41:114-29. Available from: http://www.ijps.org/text.asp?2008/41/3/114/43607

Additional Readings

“Distressing skin problems” – a 2011 first person story about skin problems after massive weight loss from the UK paper, Daily Mail.

Aldaqal SM, Makhdoum AM, Turki AM, Awan BA, Samargandi OA, Jamjom H. (2013).   Post-bariatric surgery satisfaction and body-contouring consideration after massive weight loss.  N Am J Med Sci. 2013 Apr;5(4):301-5. doi: 10.4103/1947-2714.110442.

Giordano S, Victorzon M, Koskivuo I, Suominen E. (2013).  Physical discomfort due to redundant skin in post-bariatric surgery patients.  Plast Reconstr Aesthet Surg. 2013 Jul;66(7):950-5. doi: 10.1016/j.bjps.2013.03.016. Epub 2013 Apr 9.  [free full text not available].

Song AY, Rubin JP, Thomas V, Dudas JR, Marra KG, Fernstrom MH. (2006).  Body image and quality of life in post massive weight loss body contouring patients. Obesity (Silver Spring). 2006 Sep;14(9):1626-36. [no free full text available].