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Congratulations you are almost at your goal weight! After successively losing a large amount of weight many people find they have a lot of loose and sagging skin that can cause physical and emotional problems. Excess skin can make it difficult to find properly fitting clothes and can deter you from doing certain activities and exercises. Some physical issues that can arise from excess skin are rashes and painful skin breakdowns. Many people do not see the success of their bariatric surgery because of issues with excess skin.
Weight loss in the initial months after bariatric surgery can be dramatic. Eventually, the body will reach a plateau. When this happens loose skin may be hanging from sections of your body such as your chest, arms, stomach, thighs, and buttocks.
The sections of skin that are sagging are prone to chafing, irritation, and rashes. A typical example is an overhanging panniculus. This is the excess skin that hangs from the stomach covering both the pubis and groin. Thankfully, plastic surgery procedures can easily correct these issues and lead to reduced rashes and increased mobility.
Most surgeries are performed 12 – 18 months after a bariatric procedure to limit the risks of complications while ensuring that the body has had time to heal from the initial surgery. This timeframe also gives the body ample time to adjust to the weight loss changes and you have been at a steady weight for several months. Most board-certified plastic surgeons require patients to be as close as possible to their ideal weight before they will perform surgery.
How To Get the Best Results
- Achieve a Healthy Weight: After massive weight loss, you may require major reconstructive surgery and your body must be as healthy as possible. To prevent complications and have good results, it is important to be as close to your goal weight as you can be. Having a good scale is a good way to keep track of your weight. I recommend the RENPHO Body Fat Scale. It tracks your weight and sends it to your phone so you can keep track of how you are doing.
- Eat Right and Exercise: Healthy eating habits and exercise are great ways to prepare yourself for surgery and recovery. Patients who have undergone bariatric surgery are more prone to have anemia or other nutritional issues. If your levels are too low, that may prevent you from having reconstructive surgery done or may increase your healing time.
- Follow Your Doctor’s Instructions: Your doctor is an expert and knows best what you should do. The smartest thing you can do for yourself is to listen to your doctor and follow their recommendations. Normally, patients who do not follow their doctors’ recommendations have more complications.
- Be Realistic: Don’t expect to see final results the day after surgery, or a week after, or a month after. Post-weight loss procedures are more invasive and extensive and will take a longer time to heal. You should expect to have more swelling, pain, or discomfort due to the extent of the procedures. It can, and usually does, take three months to see close to the final results.
What Kind of Plastic Surgery?
There are six main types of plastic surgery that are common after bariatric surgery. Some can be combined depending on the results that you are trying to achieve.
The lower body lift is one of the most extensive procedures after massive weight loss. An incision is made entirely around the lower body and excess skin and fat from the abdomen, hips, and buttocks are removed. Normally, there are 30 to 40 inches of the incision that will need to heal.
An inner thigh lift removes a crescent of skin in the upper inner thigh and hides the incision in the groin crease, the area where the upper inner thigh meets the groin and buttocks. This surgery can also include a vertical extension, creating a “T” shaped incision, which can be extended as far down your leg as necessary to tighten up extra skin all around the thigh. I have had an inner thigh lift. I was having to swing my leg to get around the excess skin when I walked, and it was causing hip problems. This is one of the surgeries that had the most impact on my increased mobility.
During an arm lift, also called a Brachioplasty, your surgeon will make a cut on the inside of your arm and remove extra folds of skin and fat. They will then sew the tissue that is left back together. Sometimes you will also have liposuction of the area during the surgery to help with the contour. I have had one arm lift and am hoping to have another in the future. Mine was done early on in my weight loss journey due to bruises that I was getting from the excess skin hanging from my arms, so I was not at my full weight loss goal. The doctor removed 13 inches of hanging skin taken from each arm. I am still not comfortable with showing my arms because I still have a lot of hanging skin.
A breast lift or mastopexy is another common surgery after massive weight loss. There are several types of breast lifts, ranging from a mini-lift to the full mastopexy, depending upon the degree of excess skin around the breasts. The mini-lift involves making an incision around the areola, removing some of the excess skin, and tightening the envelope, which brings the nipple position upward. In the full mastopexy, an incision is made around the areola and extended downward from the nipple to the breast crease. Many people also choose to have implants put in to fill out the excess skin instead of removing it.
A tummy tuck (Abdominoplasty) after weight loss is a great option for patients who want to remove some excess skin following weight loss but do not have a large amount of skin hanging down. If you do have a lot of excess skin, you would be looking at having a Panniculectomy. Once the skin has been stretched, it loses its natural elasticity and will not tighten back up. One of the main differences between Abdominoplasty and Panniculectomy is the amount of excess skin, and that insurance usually covers Panniculectomies.
A panniculectomy removes the excess skin and tissue that hangs down over the genitals and/or thighs. Get to a stable weight that they can maintain for three months and then skin removal surgery is a good option. Remember that you will have an additional loss from the removal of the skin. My first Panniculectomy removed over 20 pounds and my second took an additional 9 of excess skin. I had two because of trouble walking about a year after my bariatric surgery. I had my inner thigh lift with my second Panniculectomy. An important thing to know is that you will end up with a new belly button with each surgery. My second belly button was pulled tight and almost looked like an outie before I lost more weight and the skin loosened up. If you had laparoscopic bariatric surgery, the umbilicus may be scarred or deformed, as it is often used as an entry site for the largest surgical tool.
While you are waiting for surgery, a good compression garment can help keep everything in place and help with any mobility issues. I have used SPANX Shapewear and was really impressed with how well it held my sagging skin up, even my stomach, which was hanging down almost to my knees. Remember to celebrate your successes along the way. I know it can be hard to see your success when you are so focused on the skin hanging down blocking your progress but you will get there. Keep living a healthy life!