The Unexpected Surgery Many People Need After Losing Weight
Super losers who shed 100 or more pounds often end up with another problem they didn’t expect and definitely don’t want: Folds of loose skin hanging off their arms, legs, stomach, and breasts. Not only does this get in the way of living the good life they had imagined, it can also lead to rashes, infections, ulcers, back strain, and balance issues.
Although the “bat wings” under your arms and other unwanted skin can also be a remnant of losing weight the old-fashioned way (diet and exercise), it’s becoming more common as bariatric surgery allows people to lose even more weight and keep it off.
“The majority [of patients having bariatric surgery] end up with a lot of excess skin,” says Jennifer Capla, MD, a plastic surgeon at Lenox Hill Hospital in New York City.
The solution? Skin-removal or body-contouring surgery to get rid of the extra skin and tighten your bod. It’s really a (much) more complicated version of the tummy tuck a woman might get after having children, says W. Thomas Lawrence, MD, chief of plastic surgery at University of Iowa Hospitals and Clinics in Iowa City.
Skin removal surgery is actually many different surgeries depending on the parts of the body involved: the face or neck, breasts, stomach, legs, buttocks, or arms. Each area is a separate operation, a process called staging; and each operation can last three to six or eight hours under general anesthesia.
The procedures follow the same basic principle: Incisions are made, extra skin is cut away, the remaining skin (and underlying structures) reshaped, then all sewn back together. Certain areas, like the breasts, may be reconstructed.
Full recovery can take up to two years, though you will see results right away. And the results are usually permanent, though you won’t be spared the usual ravages of aging.
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“Things tend to sag,” says Dr. Lawrence. “That’s still going to happen but it’s much less extreme.”
And your skin can also stretch out again if you regain the weight, says Seth Thaller, MD, chief of plastic surgery at the University of Miami Miller School of Medicine. The number of people getting bariatric surgery has skyrocketed in the last several years, says Dr. Capla. And re-contouring surgeries are following suit, with about 45,000 people electing to have them done in 2014.
Meanwhile, not everyone is a good candidate.
“We like to see that their weight has plateaued for a minimum of six months,” says Dr. Capla. (Body weight is more likely to stay off after weight-loss surgery.)
And that there are no vitamin or mineral deficiencies, which can be a real problem after some weight-loss surgeries.
As long as there are no complications from surgery (like bleeding or infection), the main trade-off for a firmer body is scars from the incisions, says Dr. Capla.
Health insurance likely won’t cover body-contouring surgery unless there are medical problems (like skin rashes). When coverage is granted, it’s usually only for abdominal surgery, which is also the most common type of skin-removing surgery, says Dr. Lawrence.
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Out-of-pocket, each surgery could cost $20,000, give or take, says Dr. Capla.
But for many it’s worth it.
“There’s a huge emotional component. For many people, this is end of their journey,” says Dr. Capla. “They never really [understood] that when they lost weight, their bodies would look the way they do. ... It’s incredibly emotional. In one operation you can take away what’s been tormenting them since they lost the weight.”
Can you wear a skimpy bathing suit again? It all depends—on how how much weight you lost, how many surgeries you have, where the incisions are and how long. And how many surgeries you end up getting depends a lot on cost.
“It’s a trade off,” says Dr. Lawrence. “You can get more tissue and more waist definition for some people but when we do that it does generate an additional scar.”
And people carry the skin differently. “You would think that having lost 100 to 150 pounds people would look pretty similar but as a matter of fact they don’t,” says Dr. Lawrence. “Some people will have a huge amount of redundant tissue around their legs, some have multiple rolls.”
Appearance also depends on how fit you keep yourself. “Weight management and physical conditioning play a role in how you look and how your body is shaped,” says Dr. Lawrence.
The reality is, you will have some noticeable scars. How noticeable depends on how you started out, and what you had done.