Dr. Myers, am I likely to need to have access skin removed after bariatric surgery?

This is an important question that I have asked of me often at the seminars I give several times each month. Most patients from our practice do not feel they need plastic surgery. However, as a person increases their weight their skin does not just stretch, they actually grow more skin in response to the pressure the increasing weight has on the skin. That means after weight loss there is the same amount of skin but less beneath the skin to fill out the space. Therefore most patients have some excess skin after losing their weight from bariatric surgery. For many patients this is not bothersome and they will not feel the need to have this skin removed surgically.
However, the more weight you have to loose, the more likely you will have enough excess skin that you might like to have removed. Also, aging and a history of smoking seems to correlate with the need for plastic surgery. Finally, if you carry allot of your weight around your abdomen you may want to have the extra skin removed since the fatty tissue will be gone leaving an “apron” of skin.
People have different reasons for having plastic surgery. Some patients have skin irritation or ulceration of the skin. These are medical reasons to have the excess skin removed and usually this will be covered by your health insurance plans. I suggest that you document these problems by taking photos since your plastic surgeon can use this information to request your health insurance company cover your plastic surgery operation.
Sometimes plastic surgery is primarily to look better. This is often called cosmetic surgery and the expense may not be covered by health insurance. Regardless this should be an individual decision. I suggest that my patients wait until they have lost most of the weight they expect to lose before they consult with a plastic surgeon. Usually this is at least one year following bariatric surgery.
But keep in mind that most people have bariatric surgery for their health. I have never had a patient say they wish they had not had bariatric surgery because they have excess skin.
Our program refers patients to 3 or 4 plastic surgeons. I saw Dr. John Wakelin in the operation room at Riverside Methodist Hospital today and asked him to give us his thoughts from the a prospective of a plastic surgeon. This is his response to my request:

“It's very common for people to have Plastic Surgery after losing weight. Skin normally has elasticity, which allows it to shrink back to its normal size and shape after it has been stretched small amounts. This is most noticeable in young people when you pull on their skin and watch it go back to normal. However, when skin is stretched beyond a certain point for a prolonged period, like when someone is overweight, it can lose its elasticity and not spring back to its normal shape.

The excess skin caused by weight loss often sags and hangs, creating an undesirable contour and/or other problems. This is most common on the abdomen. Other common areas of skin excess are the upper arms, thighs, the buttocks and back, and neck. In addition, both men and women frequently have large amounts of excess skin on the breasts after weight loss. Each of these areas can be troublesome for many people. Beyond the cosmetic effects of this excess skin, some people have difficulty with rashes and sometimes even skin infections. Most people also have difficulty managing their excess skin with clothing, since the excess skin might not fit into clothes desirably.

Thankfully there are operations that are designed to remove this excess skin and restore contour to various parts of the body affected by excess skin after weight loss. These operations can remove skin and reshape the abdomen (abdominoplasty), the thighs (thigh-plasty or thigh lift), the buttocks (posterior body lift), arms (brachioplasty), and breasts (mastopexy or breast lift). Some patients also find that a facelift and/or neck lift procedure can restore shape and youth to sagging skin on the face and neck.”

If you would like further information you could contact Dr. Wakelin directly.
John K. Wakelin, M.D., F.A.C.S., Columbus Aesthetic and Plastic Surgery, Inc., 614-246-6900

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