Losing bat wings and saddlebags

Dr. Benny Meilik strides through the halls of Tel Aviv's Sourasky Medical Center in his light blue scrubs, having just finished another surgery. Like the patients he sees in his private office just two blocks away, this one was looking for a tighter tummy and a more attractive appearance. The difference, however, was huge - several dozen kilos' worth of difference, actually. While massive weight loss from bariatric surgery usually leads to a much improved appearance and level of function, some patients continue to suffer. Their unwanted weight may be gone, but the skin that once covered it stays behind. What's left is a drooping mass of flesh that hangs off the body. This has nothing to do with muscle tone, Meilik explains. "They can practically live in the gym," he says, "but the excess skin will remain." Upstairs in his office, Meilik reviews photos of his patients before they undergo body contouring, the advanced plastic surgery procedures that follow massive weight loss. The images, frankly, are shocking. The grotesque folds and pockets of flesh so change the look of these people that they make the skin seem like melted wax. One could be forgiven for thinking it the work of makeup artists for a ghoulish horror movie. It looks unnatural and grotesque - and the patients feel that way, too. "It's not just tough to look at, it's extremely uncomfortable. As these extra folds of skin rub against each other constantly, the friction can cause rashes, scabs and foul odors. It really is like a disability, and these people are suffering because of it," says Meilik. "A large percentage of the people I treat are single, or divorced, and although they have lost a tremendous amount of weight, the extra skin makes their bodies quite unattractive. There's no way that they can expose themselves before someone else; there's no chance that they can maintain a physical relationship. I have had patients tell me, 'I preferred being obese. Before, I was fat, but my body looked normal. I could go to the beach. I had no problem getting into bed with someone. Now...!'" One of Meilik's patients, an obese teenager who has not had bariatric surgery, suffered so much from the teasing he endured over his drooping, flabby chest that he did not leave his house for three years. Meilik performed a breast reduction that, while not solving the boy's obesity, allowed him to wear normal clothing and gain the confidence to rejoin society. "That's why this is so important - and people don't realize it - because it isn't just about cosmetics, it's about allowing people to function like normal people, to give them a body they can feel comfortable in." To help people suffering from this condition, doctors like Meilik have had to develop techniques so far beyond the normal demands of plastic surgery that they have become a special field of their own. Even the nomenclature for the unique folds and bulges of skin is new, and is constantly changing, he notes. "In the States, they call the flesh that dangles under the arms 'bat wings.' The sagging pockets on the hips are 'saddlebags.' In Israel we don't use such disparaging terms," he says. The surgery can last up to nine hours to complete with the help of a specially trained crew. The most severe cases call for a "total body lift" - an elaborate process of liposuctioning away fat and tissue, and cutting and pulling and reshaping of skin. "For someone like this, a tummy tuck and a breast reduction just aren't enough," Meilik says. Actually, he might rebuild a woman's sagging breasts and tighten her back at the same time by trimming the "lateral chest roll" that remains after her weight loss and stuffing it into her chest. Likewise, he can use rolls of skin from the lower back and hips to "build" a firm, round bottom. The transformation is downright Frankenstein-like. And it really does, well, bring people to life. "They're better physically, emotionally and socially after undergoing this treatment," Meilik says. For the doctor, with his piercing blue eyes and trim beard, this is turning into quite a rewarding second career. He only started studying medicine at 28, after flying planes in the air force. He doesn't have to come here each week for the grueling surgeries; if he wished, he could stay in his private practice and stick to the much simpler - and much more lucrative - nose jobs, tummy tucks and breast enlargements. Yet Meilik spends a great deal of time at the hospital with these unique patients because the challenge of helping them is so stimulating, and the reward of seeing them happy is so great. "This is what I'm talking about," he says, turning to photos of a woman with a nasty sunburn. "This is a 53-year-old woman who had lost 90 kg. after bariatric surgery, and was so excited about her new figure after the body lift we did for her that just three weeks after surgery, she went to the beach - for the first time in her life." Clearly, she has taken to her new, normal figure. As for the painful lesson about exposure at the beach, Meilik says with a smile, "She'll learn."