RealSelf asks Dr. Stoker why Becca couldn’t get surgery on the May 28th episode of ‘Extreme Weight Loss.’
One of the most intense nail-biting moments of last week’s Extreme Weight Loss episode was Becca’s final weigh-in. As we watched her step on the scale (with those pink heels) –- we all breathed a collective sigh of relief when the scale revealed a final weight of 192 lbs.
Dr. David Stoker, a Beverly Hills-based cosmetic surgeon, who had helped Becca’s brother Dave remove volumes of hanging, sagging skin after losing 212 pounds — could now safely do Becca’s transformative surgery.
In case you don’t remember, Becca and Dave are twins that lost over 418 pounds total as a team with the help of Chris Powell. They were also expected to undergo their body lift surgery as team. But, when Dr. Stoker evaluated the duo -– Dave was deemed ready for surgery while Becca was not.
This was especially heart-wrenching as Becca had worked out more diligently than Dave and weighed less. Nonetheless, Becca would need to fall under the 200-pound mark for safe surgery.
So, that got us thinking. If you hit the exercise bike harder and weigh less –- wouldn’t you be wheeled into the OR first? So, all sibling rivalry aside -– we decided to ask the surgeon ourselves.
RealSelf: Why would a surgeon delay a total body lift despite the fact that a person has worked hard and lost an extreme amount of weight?
Dr. Stoker: Rebecca had thicker tissue and her most problematic area was her abdomen -– the area where she still carried a large portion of her fat. Even though her brother was heavier, his fat was more evenly distributed and he didn’t have as much thickness of fat underneath his abdominal skin.
Some tissues I find too thick to be optimal for operation. If you have a large slab of fat under the skin -– the fat heals more slowly than other tissues in the body. Fat has a low density of blood vessels that [are needed] to bring in the healing factors after a surgical procedure. So, the skin might want to heal — but the fat might want to separate or fall apart because of the inadequate blood supply. [In addition], it’s more susceptible to infection and doesn’t hold sutures very well.
I want sturdy tissues with an excellent blood supply to heal quickly. I have been down every road with every type of skin. This is not your every day tummy tuck we are talking about -– the risks are higher.
RS: We imagine it isn’t easy to give the news that a patient isn’t ready for surgery. Can you speak to this?
Dr. Stoker: Many patients fly from all over the world because of my reputation for these [more complex] surgeries. We try to help them understand their candidacy through video consultation or photographs –- but usually, I have to feel the tissue to make my final call.
And, it’s a really tense moment. [Turning down patients for surgery] is very hard. It’s often a hollow victory for people who lose 200 pounds (or more) to look in the mirror and be devastated by what they see.
My biggest concern is that I deliver the news in a way that inspires the patient to succeed through more diet and exercise –- rather than cause them to be depressed and compensate in a negative way through [the behaviors] that caused them to be obese in the first place.
I don’t want the patient to feel rejected by me -– and I don’t want them to be hurt or depressed. I want them to be excited about how far they’ve come — but sometimes, the tough news is that they’ve got to work harder to get there.
RS: So, how do you best inspire patients to keep their heads up, work hard and return when they are better surgical candidates?
Dr. Stoker: I like to set my patients up for success. I try to give a very clear objective. Typically, I don’t just say, “Oh, you need to lose 50 more pounds…” –- I ask them about their exercise and diet routine –- and advise them what they should do differently to get there. I say, “Start today and do it every day. And, I tell them to think of me. Everyday I’m cheering them on.”
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