Evolving Body Contouring Strategies for Patients After Massive Weight Loss: Insights from Bariatric and Pharmacologic Interventions

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors Manuscript ID: surgeries-3582437   Dear Authors,           I have completed reviewing your manuscript on " Post-bariatric patient evaluation for body contouring: a narrative review".  Body contouring has become an important part of aesthetic enhancement since many people seek weight loss treatment for various reasons, it is necessary to evaluate the preoperative and postoperative things regarding the clinical outcomes.   Here are my comments:   1. While the manuscript was inclusive with regard to the type of weight loss as mentioned in the abstract " Significant weight loss, whether through bariatric surgery, lifestyle changes, or medication-assisted approaches, why did you mention "post-bariatric"   2. Abstract needs revision, totally.

3.Lines 41 and 42 : Excess Skin - How does affect? add the reason here, so that it will be clearer for the readers

4. Language correction - requires extensive editing of English

5. Lines 54 to 56: Rewrite these lines clearly. Particularly, this part "not only to those who have experienced massive weight loss but also to a much broader population". Here, massive weight loss through which manner? medications? diet? exercise? Ozempic? Mounjaro?

6. Authors said "50% excess weight loss". It did not mean what you want  mean. It means aiming or providing 50% excess weight loss than the target or goal of the patient or treatment plan or objective. 

7. It should be like this "reduction of at least 50% of excess weight"

8. Rephrase this "Massive Weight Loss is defined as achieving at least 50% excess weight loss (%EWL)".

9. Lines 97 to 101: Add reference

10. Correct the formatting errors

11. Lines 108 to 110: Rewrite those lines, they were unclear

12. Lines 117 to 120: "Maintaining a stable weight.............fully eligible for body contouring surgery". Improve the writing style of these lines

13. Line 146: Modify this sentence, clearly. "sleep apnea resulted in important improvements in almost all patients, after bariatric surgery"

14. Check the usage and suitability of the word resolution, especially while stating resolution of diabetes.

15. Line 154: It is HbA1c test.

16. Line 193: This sentence seems incomplete "It results in reduced nutrient uptake causing deficiencies".
 
17. Table 1 : "simportant"? "numer"? correct them

18. 3.3.4: correct the sub-heading

19. Repeated (3.3.4 ; 3.3.5)

20. Line 372: Rephrase this : "Weight loss patients often have more significant skin excess compared"

21. Discussion presents the summary of the previous sub-headings, authors need to revise and rewrite that completely.

22. Write the full form of SMAS

23. Authors need to add the purpose of tables (1 and 2) in appropriate places of the manuscript.

24. Conclusion: written in a perspective of advising physicians. Modify that, highlight the outcomes of your review.

 

Comments on the Quality of English Language

I highly recommend using a language editing service

Author Response

Comment: I have completed reviewing your manuscript on " Post-bariatric patient evaluation for body contouring: a narrative review".  Body contouring has become an important part of aesthetic enhancement since many people seek weight loss treatment for various reasons, it is necessary to evaluate the preoperative and postoperative things regarding the clinical outcomes.   Here are my comments:  

1. While the manuscript was inclusive with regard to the type of weight loss as mentioned in the abstract " Significant weight loss, whether through bariatric surgery, lifestyle changes, or medication-assisted approaches, why did you mention "post-bariatric"  
2. Abstract needs revision, totally.

Response: Thank you very much for your suggestions. Abstract has been totally revised.

 

Comment: 3.Lines 41 and 42 : Excess Skin - How does affect? add the reason here, so that it will be clearer for the readers

4. Language correction - requires extensive editing of English

Response: Thank you for your feedback. We have clarified the sentence and extensively revised the English language throughout the article.

Comment: 5. Lines 54 to 56: Rewrite these lines clearly. Particularly, this part "not only to those who have experienced massive weight loss but also to a much broader population". Here, massive weight loss through which manner? medications? diet? exercise? Ozempic? Mounjaro?

Response: Thank you for your comment. We have clarified the sentence. Please see lines 55 to 59.

 

Comment: 6. Authors said "50% excess weight loss". It did not mean what you want  mean. It means aiming or providing 50% excess weight loss than the target or goal of the patient or treatment plan or objective. 

7. It should be like this "reduction of at least 50% of excess weight"
8. Rephrase this "Massive Weight Loss is defined as achieving at least 50% excess weight loss (%EWL)".

Response: Thank you for your comment. We have clarified the sentence including the scientific definition of Excess Weight Loss. Please see lines 59 to 62.

 

 

Comment: 9. Lines 97 to 101: Add reference

Response: Thank you for your comment. We have clarified the sentence including references.

Comment: 10. Correct the formatting errors
11. Lines 108 to 110: Rewrite those lines, they were unclear

Response: Thank you for noticing that. We have rewritten and clarified those lines.

 

Comment: 12. Lines 117 to 120: "Maintaining a stable weight.............fully eligible for body contouring surgery". Improve the writing style of these lines

Response: Thank you for your comment. We have now improved and clarified that sentence.

 

Comment: 13. Line 146: Modify this sentence, clearly. "sleep apnea resulted in important improvements in almost all patients, after bariatric surgery"

Response: Thank you for your feedback. We have now re-written that sentence.

 

Comment:14. Check the usage and suitability of the word resolution, especially while stating resolution of diabetes.

Response: Thank you for your comment. We have now changed the word diabetes resolution with remission, as nowadays more appropriate.

 

Comment:15. Line 154: It is HbA1c test.

Response: Thank you for you comment. We have now changed it.

 

Comment:16. Line 193: This sentence seems incomplete "It results in reduced nutrient uptake causing deficiencies".

Response: Thank you very much for this comment. We have now re-written and clarified that sentence.
 
Comment: 17. Table 1 : "simportant"? "numer"? correct them

Response: Thank you for noticing that. We have corrected the typos in Table 1.

 

Comment: 18. 3.3.4: correct the sub-heading

19. Repeated (3.3.4 ; 3.3.5)

Response: Thank you for noticing that. We have now corrected the sub-headings.

 

Comment:  20. Line 372: Rephrase this : "Weight loss patients often have more significant skin excess compared"

Response: Thank you for your comment. We have clarified the sentence. Please see lines 366 to 369.

 

 

Comment: 21. Discussion presents the summary of the previous sub-headings, authors need to revise and rewrite that completely.

Response: We have now completely re-written the Discussion section including  the previous major sub-headings.

Comment: 22. Write the full form of SMAS

Response: Thank you for your comment. We have now written the full form of SMAS (Superficial Musculoaponeurotic System).

 

Comment: 23. Authors need to add the purpose of tables (1 and 2) in appropriate places of the manuscript.

Response: Thank you for your feedback. Both tables have been corrected and made according to the journal format. They have been cited in the Results section, please see lines 238 and 241.

 

Comment:   24. Conclusion: written in a perspective of advising physicians. Modify that, highlight the outcomes of your review.

Response: Thank you for your feedback. We have now highlighted the outcomes of our review in the conclusion section.

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for submitting this narrative review
This review considers body contouring after significant weight loss by both bariatric surgeries and medications.
Please change the title to include both methods of significant weight loss.
Table 1 is very well constructed and summarize the whole review.
Please comment on post bariatric anaemia especially iron deficiency anaemia.
Comment on the need of blood transfusion especially in combined post bariatric surgeries

Author Response

Comment: 1Thank you for submitting this narrative review
This review considers body contouring after significant weight loss by both bariatric surgeries and medications.

Response: Thank you for your kind comments and recognition of the scope of the review. We appreciate your acknowledgment of the focus on both bariatric surgeries and medications as methods of significant weight loss.

Comment: 2Please change the title to include both methods of significant weight loss.

Response: Thank you for this suggestion. We agree that the title should better reflect both methods of significant weight loss. We have revised the title to include both bariatric surgery and pharmacological treatments to provide a more comprehensive description of the review’s focus.

Comment:  3Table 1 is very well constructed and summarize the whole review.

Response: Thank you for your positive feedback on Table 1. We are glad that the table effectively summarizes the key points of the review.

Comment:  4Please comment on post bariatric anaemia especially iron deficiency anaemia.

Response: Thank you for raising this important point. We have expanded our discussion on post-bariatric anemia, with a specific focus on iron deficiency anemia, in the revised manuscript. We have also included relevant references to highlight the impact of bariatric surgery on iron absorption and the need for proactive management of anemia in these patients.

Comment: Comment on the need of blood transfusion especially in combined post bariatric surgeries

Response: We appreciate your suggestion to address the need for blood transfusions in post-bariatric surgery patients, particularly following combined procedures. In response, we have added a section discussing the indications for blood transfusion in these cases, emphasizing the importance of perioperative management, the risk of anemia, and the role of transfusions in optimizing surgical outcomes. Please see the Discussion section, lines 400-412.

Reviewer 3 Report

Comments and Suggestions for Authors

• The topic is very relevant given the increasing use of drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro), and the manuscript successfully integrates existing literature and clinical practice.
• Recomended: Minor  Revision
• Suggested Interventions: Linguistic and stylistic correction of the entire manuscript. Reduction of repetitive parts. More precise search methodology. Stronger conclusion with emphasis on implications for practice.

Comments on the Quality of English Language

Linguistic and stylistic correction of the entire manuscript.

Author Response

Comment 1: The topic is very relevant given the increasing use of drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro), and the manuscript successfully integrates existing literature and clinical practice.

Recomended: Minor  Revision

Response: We sincerely thank the reviewer for the positive feedback and thoughtful assessment of our manuscript. We appreciate your recognition of the topic’s clinical relevance and the integration of literature with practical considerations. In response to the minor revision recommendation, we have carefully reviewed the manuscript and made minor clarifications and language improvements to enhance clarity and precision throughout. All changes have been marked in the revised version for your convenience.

 

Comment 2: Suggested Interventions:

• Linguistic and stylistic correction of the entire manuscript.
• Reduction of repetitive parts.
• More precise search methodology.
• Stronger conclusion with emphasis on implications for practice.

Response:

Thank you very much for your revisions. We have extensively revised the English language throughout the article and reduced the repetitive parts.

We clarified with a more precise search methodology, please see lines 73 to 81.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

 I could see that you have implemented my previous suggestions. But, this revised version still has errors. Needs further refinement.

Additional suggestions:

Rephrase:
Post-weight-loss patients face an increased thromboembolic risk, particularly in body contouring surgeries. Surgical planning 

should align with patient priorities, set realistic expectations, and strategically stage procedures.

I request the authors to meticulously, correct and rewrite this line in the abstract "As medication-assisted weight loss becomes more common, surgical strategies must evolve to accommodate this patient population".

The above sentences trigger so many questions. I simply, don't want to get into that. Instead of listing those questions and making you to prepare responses, we can come up with better expression of what needs to be said in that part of the abstract.

Replacing "accommodate" with a suitable word will preserve the intent and outcome of your study. 

Check the usage of these words "this patient population" in that sentence.

Line - 354: should this be weight loss here? "Weight gain can lead to the stretching of facial skin and soft tissues."

Replace the word resolution here: "Although weight loss can improve comorbid conditions to some extent, complete resolution may"

Add limitations of your review work.

Please, check whether your title reflects your work.

 

 

Comments on the Quality of English Language

Still needs editing

Author Response

We sincerely thank you for your thoughtful and constructive feedback on our manuscript. We appreciate the time and effort you have taken to review our work. Below, we provide our point-by-point responses and indicate the changes made in the revised manuscript.

 

1. Reviewer Comment:

I could see that you have implemented my previous suggestions. But,this revised version still has errors. Needs further refinement.

Additional suggestions:

Rephrase:

Post-weight-loss patients face an increased thromboembolic risk, particularly in body contouring surgeries. Surgical planning should align with patient priorities, set realistic expectations, and strategically stage procedures.

Response:

Thank you for the suggestion. We have rephrased this section for clarity and precision. The revised sentence now reads:

“Patients who have undergone significant weight loss are at increased risk of thromboembolic events, particularly after body contouring procedures. Surgical planning should be patient-centered, setting realistic expectations and employing a strategic, staged approach when necessary to optimize outcomes.” Please see the Abstract section.

 

2. Reviewer Comment:

I request the authors to meticulously, correct and rewrite this line in the abstract "As medication-assisted weight loss becomes more common, surgical strategies must evolve to accommodate this patient population".

The above sentences trigger so many questions. I simply, don't want to get into that. Instead of listing those questions and making you to prepare responses, we can come up with better expression of what needs to be said in that part of the abstract.

Replacing "accommodate" with a suitable word will preserve the intent and outcome of your study.

Check the usage of these words "this patient population" in that sentence.

Response:

We appreciate your concern regarding the vagueness of this sentence. We have revised it to be more specific and accurate. The new version reads:

“With the increasing prevalence of medication-assisted weight loss, surgical strategies must adapt to address the distinct anatomical and physiological features of these patients”

We also revised the phrase “this patient population” to enhance clarity.

 

3. Reviewer Comment:

Line - 354: should this be weight loss here? "Weight gain can lead to the stretching of facial skin and soft tissues."

Response:

Thank you for pointing this out. You are correct—the sentence should refer to weight loss. We have corrected this in the manuscript.

 

4. Reviewer Comment:

Replace the word resolution here: "Although weight loss can improve comorbid conditions to some extent, complete resolution may"

Response:

We agree that “resolution” may overstate the impact. The sentence now reads:

“Although weight loss can improve comorbid conditions to some extent, complete remission may not always be achieved.”

 

5. Reviewer Comment:

“Add limitations of your review work.”

Response:

We have added a dedicated “Limitations” section at the end of the discussion. This section addresses the scope of the literature reviewed, potential publication bias, and the evolving nature of weight-loss interventions.

 

6. Reviewer Comment:

“Please check whether your title reflects your work.”

Response:

Thank you for the suggestion. We reviewed our title and revised it to better reflect the scope and findings of our manuscript. The new title is:

“Evolving Body Contouring Strategies for Patients After Massive Weight Loss: Insights from Bariatric and Pharmacologic Interventions”

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

You have improved your work by incorporating the suggested modifications.

All the best.