STORY BYLatricia Frank struggled most of her life with her weight. It didn't matter how much she exercised or dieted. The bulges just weren't budging and her health was in jeopardy.
Gastric bypass surgery helped her lose the fat, but not the flesh that had been stretched by more than two decades of being morbidly obese.
Her now slim figure was hidden under layers of excess skin, especially around her abdomen. The folds would get pinched in her clothes, and the skin often bled and oozed. This wasn't how she had envisioned herself after losing half her body weight. Frank sought out a reputable plastic surgeon to help her with the last step toward a healthier, better-looking body.
Dr. David Wainwright, associate professor in the Division of Plastic Surgery at The University of Texas Medical School at Houston, says that extra skin is often an unpleasant and unexpected byproduct of weight loss after bariatric surgery.
“They go through this surgery to improve their health and body image, and although they've made great strides with their weight loss, it's not complete,” Wainwright says. “This is not how they want to see themselves.”
Aesthetics aside, the superfluous skin can cause medical complications, including rashes, skin irritation, infections, back strain and pain. The folds of skin also can cause odor.
“They have to use pillows, paper towels and even hair dryers to keep the skin dry,” Wainwright says. “They can't exercise because all of this extra skin is shifting and slapping. I have one patient whose extra skin of the upper arms would get in the way – especially in the kitchen when she was working around the stove. She would accidentally burn herself. The extra skin makes it impossible for patients to carry on normal activities of daily living.”
It may also cause psychological issues. “They have lost all this weight, and they still aren't where they want to be,” Wainwright says. “It can be very depressing for them.”
There are a number of reconstructive procedures that plastic surgeons can perform to rid a patient of unwanted, unnecessary skin and help improve their lifestyle and body image.
The abdominal area is where doctors see the most problems with redundant, hanging skin. For that, Wainwright recommends a modification of a standard abdominoplasty, also known as a tummy tuck. He removes the lower apron of excess skin and repositions the naval. He may suggest limited liposuction to remove stubborn fat and do muscle tightening at the same time.
Because Frank had reached her maximum weight loss, Wainwright recommended she have the modified abdominoplasty. Wainwright removed five pounds of excess skin.
“I immediately went from a size 12 to a size 10,” Frank says. “It was amazing. Before I lost the weight, I had a 54-inch waistline. That skin had nowhere to go but down, and the more weight I lost, the more it hung.”
The thighs are another problem area for excess skin, and removing it is often a two-step process. “The thighs are one of those areas that seem to be resistant to weight loss,” Wainwright explains. “To reduce the risk of problems following surgery, we want to reduce as much weight in the thigh as possible by performing fat removal first by suction lipectomy. This will create even more skin.
“Three or four months later we do a thigh lift,” he says. “It's like pulling up the excess slack in stockings.”
To do the lift, surgeons must make an incision in the groin and between the legs. Because of the location of the incision, there is a greater risk of infection than other areas of the body where excess skin is removed, Wainwright says.
Loose, extra skin on the arms may also require a two-stage approach. Depending on the thickness of the arm, Wainwright may recommend liposuction first, then a skin excision. The excision will create a scar from just above the elbow to the arm pit on the inner aspect of the arm. “It will be a noticeable scar, but it will be acceptable, and it can easily be covered with short sleeves,” Wainwright says.
Other procedures to eliminate redundant skin include breast lifts and a modified facelift to tighten skin under the chin and on the neck. For patients who have excess skin on their upper backs, surgeons can do an excision there, as well. The cut is at the bra line, so for women, the scar is relatively easy to hide.
Some patients who have lost weight after gastric bypass surgery may develop a redundant roll of skin all the way around their bodies. For that, Wainwright does what is called a body lift. He combines abdominoplasty with removal of skin on the lower back.
“I usually limit that to patients who have lost a lot of weight and have very little residual body fat,” he says.
For patients who have excessive skin on various parts of their bodies, depending on the recommendation, surgeons may be able to do multiple procedures at the same time. For instance, Wainwright explains, abdominoplasty and suction of the thighs can be safely done together. Breast lifts and abdominoplasty are not recommended combinations.
Before patients even make an appointment for a consultation, there are a few issues they need to consider.
They should find a board-certified plastic surgeon, such as Wainwright, who is experienced with these major procedures.
Cost is another factor to consider. If excess skin is causing medical complications, insurance may cover it. However, if approval is denied, patients must pay for it out of pocket.
Once they have found a reputable surgeon and have the finances worked out, Wainwright says, patients need to have a good understanding of the planned procedure and what they can expect in the post-operative phase. They also need to assess the risks and have realistic expectations.
As with any surgery, complications can occur. Patients are at risk for undesirable scarring, infection and bleeding. Because surgeons are lifting up skin and separating it from the tissue underneath and its nourishing blood supply, there is a risk that edges of the skin could die, resulting in another surgery.
Recovery time depends on the procedure. “Abdominal and thigh surgeries are substantial operations,” Wainwright says. “You can expect to be in the hospital for a few days. Afterward, you will be required to wear compression garments for six weeks.”
The compression garments provide comfort, support and help reduce swelling, as well as stress and strain on the incision. The garments, which are worn under the patients' clothes, also help eliminate the pocket underneath the skin by pushing the raw surfaces together so the area will heal better.
For six to eight weeks after surgery, patients can expect some activity restrictions. Frank says she wasn't able to lift, pull or push anything for two months.
“It was worth it,” Frank says. “When I lost the weight, I felt better, and then I made the decision that I wanted to look better. It was a pleasant recovery. Now I feel like I have a new lease on life.”
Wainwright says that after the compression garments come off, there shouldn't be any major restrictions. “Patients should be able to go about their lives and hopefully enjoy more activities than they've ever been able to before.”
UPDATED: 3-22-2005
Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us
©2000-2006 Office of Institutional Advancement, UT-Houston
Dr. David Wainwright is an associate professor of surgery at the UT Medical School.
See Dr. Wainwright also at:
Men: Pay Attention
to Your Bicycle Seat
Men who bike more than three hours a week should be aware that standard bicycle seats, ridden for extended periods, can cause temporary numbness and, in some, more serious problems, such as erectile dysfunction.
Such problems are caused by compression of an artery and a nerve connected to the penis. New seat designs to minimize compression are now available.
Other preventive measures you can incorporate:
