Body Sculpting After Bariatric Surgery

For some obese people, bariatric (weight loss) surgery is just the first step in reclaiming their health and restoring their body image. According to data collected since 2003 by the American Society of Plastic Surgeons, about one third (around 55,000 per year) of people who have weight loss surgery go on to have one or more cosmetic surgery procedures to correct damage to skin and muscle tissues created by carrying 100 pounds or more of excess weight for many years.

Not every bariatric surgery patient will need plastic surgery to remove excess skin. Age, genetics, and the degree of obesity before weight loss surgery are deciding factors. Plastic surgeons familiar with the process report that older and/or heavier patients, defined as patients over age 40 and those who weighed 400 pounds or more are, more likely to be candidates for surgery than are younger and more moderately overweight individuals. Some people who have lost weight with bariatric surgery will have a large amount of loose skin in one or two areas. Others however, will have excess skin from head to ankle.

Patients who lose a significant amount of weight through diet alone may encounter similar problems with skin and muscle tissue damage and be candidates for plastic surgery.

Not a Matter of Vanity

Getting a skin tuck is not just a matter of vanity. It is often necessary because folds of excess skin can cause hygiene problems, are prone to developing rashes and infections, and contribute to ongoing body image issues. Hanging skin in the abdominal area and legs can also make exercise difficult. On a practical level, excess skin can make it difficult to get clothes to fit properly. For example, excess skin on arms and legs does not fit into sleeves and pant legs. A panniculus (the apron of skin and underlying fat hanging from the abdominal area) can reach to the mid-thigh or knees in people who were 200 pounds or more overweight, making it difficult to fit into anything but a super-sized shift.

For some people who were once morbidly obese, damage from the overstretching of their tissues is more than skin deep. Overstretched muscle tissue will not hold organs in place properly and may have developed tears that need to be repaired to prevent hernias from forming.

People who were morbidly obese before bariatric surgery may be carrying up to 100 pounds of excess skin

A tummy tuck, more properly known as an abdominoplasty, is the plastic surgery procedure most often requested by bariatric surgery patients. This operation removes the “apron” of skin hanging from the stomach. A lower body lift, buttocks lift, breast lift, arm reduction, neck- and face- lifts are also common. Some patients have so much loose skin that they require a procedure known as a torsoplasty or body lift. Surgeons describe it as pulling up the loose skin from the legs on up, almost as if you were pulling on a pair of pants.

Often, patients seeking skin tucks, also need muscles repaired and tightened. And, because weight loss is not always lost evenly, some require liposuction for spot reduction. Some patients have numerous procedures, which are generally performed over the course of several surgeries to control risks and costs.

Plastic surgery procedures following bariatric surgery fall into two broad categories- body sculpting procedures that tighten skin and muscle and remove some fat, and procedures such as liposuction that remove only fat for spot reducing.

Most of the skin-lifting procedures are performed one to one and a half years after bariatric surgery. This allows the patient to lose sufficient weight and for their weight to stabilize. Each plastic surgeon’s approach to bariatric body contouring differs, but to ensure the best results, many require patients to have maintained a stable weight for three months before they will perform any type of body lift procedure.

Cost and Insurance

Individual procedures run between $5,000 and $10,000. Cost varies depending on the area of the country in which the person lives, the degree of body sculpting they require, and their overall health. Patients who require several different procedures can spend $30,000 or more.

Insurance companies that balk at paying for the bariatric surgery are unlikely to pay for reconstructive plastic surgery because they insist it is medically unnecessary. Surgeons, however, report that some insurance companies will pay for plastics procedures they believe have health benefits such as an abdominoplasty or panniculoplasty because they see these procedures as improving skin health, but refuse to pay for a neck and face lift because they view these surgeries as purely cosmetic.

Media coverage regarding bariatric surgery, including TV shows like Big Medicine on the Discovery channel, have helped people seeking bariatric surgery recognize that it is acceptable to seek additional procedures to achieve a normal-looking body.

Risks

Body lifts and liposuction are not without the potential for side effects such as infection, fluid build-up under the skin at the surgical site, and adverse reactions to anesthesia. Bariatric surgery patients who have heart trouble due to their weight may be at particular risk from anesthesia. Long incisions take time to heal. Patents may need to be out of work for 6 weeks, which adds to the cost of the procedure, and they often must refrain from exercising for up to 8 weeks.

In theory, any plastic surgeon has the basic training necessary to perform these body sculpting procedures. However, it is best for bariatric patients to find an accredited overnight facility and seek a doctor who has experience with other weight-loss patients. If you are interested in body contouring procedures, ask your bariatric surgeon to recommend a qualified plastic surgeon.

Benefits

Improvements in skin health, ability to exercise, and body image following body contouring surgery often outweigh the negatives of cost and pain for many bariatric surgery patients. Psychologists who specialize in obesity issues say that body contouring procedures can do as much to heal a patient as the bariatric procedure itself.