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Author: Sharon McLemore
Bariatric surgery patients often ask if they will have excess skin after weight loss and if so, is plastic surgery is an option for the removal of that skin?   The presence of excess skin after rapid weight loss is dependent on several factors including age, the elasticity and condition of the skin, the speed of weight loss, and the location of the weight loss.   Elasticity is what helps the skin to bounce back into shape after being stretched. The skins elasticity decreases with age, sun exposure, cigarette smoking, and certain genetic factors.  Additionally, skin in regions of your body that are most stretched from the weight gain tend to be less elastic (like the abdomen).  So if you are older, a sun bather, smoker, heavier, or been heavy longer you are more likely you are to have excess skin.  Exercise can help with toning after weight loss, but excess skin may persist regardless of how much you exercise.  If you feel good about you and the excess skin isn’t diminishing your quality of life or self-esteem, skip the plastic surgery.  However, if the excess skin is rubbing and causing skin breakdown or rashes or if you unhappy every time you look in the mirror, then you may want to consider plastic surgery.
Not everyone is a good candidate for plastic surgery.   You are more likely to be a good candidate for plastic surgery after weight loss if:

  • Your weight has stabilized for at least six months with no further weight loss expected.  This may be 18 months or more post bariatric surgery.  Some plastic surgeons recommend you wait a full 2 years after the start of any dramatic weight-loss program before considering plastic surgery.
  • You are in good health without chronic medical conditions, such as diabetes or heart disease.
  • You don’t smoke. Smoking slows down the healing process and increases the risk of serious complications during and after surgery. Most surgeons will require you to quit smoking at least six weeks before surgery.
  • You have a positive outlook and realistic goals for results.  Plastic surgery doesn’t stop the normal aging process, so skin will continue to age and sag over time.
  • You are committed to proper nutrition (protein deficiencies can interfere with healing), fitness and an overall healthy lifestyle.

Women who are planning on getting pregnant or are pregnant should wait until after they have had children before having plastic surgeries after a weight loss.
The most typical reconstructive procedures after weight loss are:

  • Facelift – For sagging of the mid-face, jowls, and neck. Removing excess skin around the face or neck is similar to a traditional facelift, except that more skin is removed.  Incision location may need to be altered.   Typical incisions may be along the hairline, below the chin, and/or behind the ear.
  • Breast lift (mastopexy) and/or augmentation – To reconstruct sagging, flattened, uneven breasts, drooping nipples, and stretched areolas. Women who desire larger, smaller, or more rounded breasts may want to consider a breast augmentation or breast reduction along with the breast lift.  Mastopexy incisions vary, depending on the amount of excess skin and the position of the nipples.  Incisions can be made vertically down the center of the breast or, underneath the breast in the form of an upside-down “T.”
  • Male Gynecomastia – Reduction of male breast enlargement is treated with a combination of liposuction and skin removal.
  • Tummy tuck (abdominoplasty) /panniculectomy – This can range from removing the apron of skin (pannus/panniculectomy), to complete contouring of the abdomen with tightening of the abdominal muscles and moving the belly button.  Abdominoplasty involves removing excess skin and tightening of the underlying abdominal muscles. An incision is made just above the pubic area from hip to hip, occasionally extending to the back. Sometimes a vertical incision is necessary, too.   A panniculectomy removes any overhanging “apron” of skin and tissue from below the belly button.
  • Lower body lift (lipectomy) – A combined procedure for sagging of the abdomen, buttocks, inner and outer thighs.  This procedure reshapes the abdomen, waist, hips, thighs and buttocks through an incision made around the circumference of the body.   Incisions pass from the back around the hips to the front of the thighs.   Liposuction, abdominoplasty and panniculectomy are procedures related to lower body lift.
  • Medial thigh lift -For sagging of the inner thigh. Thigh lifts can either be inner, vertical, or outer lift.  Inner thigh lift involves incisions in the groin fold.  This is for those with moderate amount of skin and fat in this area.  Vertical procedure incisions start at the groin crease extending to the inner knee.  This procedure is done when there is more significant fat/skin to be removed.  The outer procedure incision extends from the groin around the hip.
  • Arm lift (brachioplasty)– For sagging of the upper arms.  Incision is made starting at the armpit and extending to the elbow.
  • Full body lift – Addresses the buttocks, abdomen, hips, thighs, arms in the same procedure. Multiple incisions are made and can also include buttock augmentation.

Plastic surgery can be expensive so start saving your money now.  A simple face lift starts at about $6500 with prices going up depending on your geographic location, surgeon, and procedure being performed.  Most plastic surgeries (with few exceptions) are not covered by insurance.  It is best to check with your insurance carrier to see what may be covered.  Plastic surgery is most commonly done under general anesthesia and may require overnight stay (or longer) in the hospital.  Other pre-testing and labs may be required.  All this may be at additional expense, so be sure and verify what your surgeon requires and the associated costs.
Some procedures require you go home with drains, special compression garments, and/ or dressings.   Recovery time can be anywhere from one to three weeks or longer depending on the surgery performed.   Pain during recovery can be intense and may require narcotic pain medication.  Like most surgeries, the first week of recovery is the worst.   Driving and lifting is usually restricted for the first week or longer depending on your surgeon and procedure.  Your initial follow up is usually five to seven days post-surgery.  Drains and sutures will be removed according to your surgeon’s protocol.    You may need to refrain from strenuous activity for up to six weeks post-surgery.
Swelling and numbness may take months to resolve. Fading and flattening of scars take three months to two years.   Some scars may remain visible at certain angles.   As with all surgical procedures, plastic surgery is not without risks.  Possible risks may include scarring, hematoma, infection, fluid accumulation, poor wound healing, skin loss, numbness or changes in skin sensation, skin discoloration, prolonged swelling, tissue necrosis, wound separation, asymmetry, recurrent looseness of the skin, persistent pain, deep vein thrombosis, persistent swelling of the legs, and the possible need for revisional surgery.
Although there may be some swelling, plastic surgery results are visible almost immediately and are permanent barring pregnancy or significant weight gain.  Normal aging will still occur and breast implants may need to be replaced after a period of time.  Check with your surgeon.
Do your homework.   Choose a surgeon that is certified by the American Board of Cosmetic Surgery.  Often surgeons certify in areas of specialty so choose one that suits the procedure you want performed.  Ask around and choose a surgeon you feel confident and comfortable with.  Although most surgeons charge an initial consult fee, it is better to get a second opinion if you’re not comfortable with the first.  Write down your questions and bring them with you to the initial consult.  Be sure to not only check out the surgeon, but also the facility where the surgery is being performed, where you will recover, and the facility and staff where your follow up visits will be done.  Avoid unpleasant surprises.  Make sure you are informed of all the associated costs including pre testing fees, surgeon fees, facility fees, recovery fees, follow up fees and any other associated costs.  Be well informed so that you have the best possible experience, avoid any unpleasant surprises, and are completely satisfied with the end result for years to come.

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