Removing Excess Skin
After Weight Loss
Many patients who have successfully managed to lose significant amounts of weight, be it through diet and exercise or bariatric surgery (such as gastric sleeve surgery) are left with loose, hanging, saggy skin, and this can occur in just about every area of the body.
This can be demoralising for patients, who’ve worked really hard at losing their weight; they are essentially left with a second problem – hanging, excess skin.
Folds of loose skin can be very uncomfortable. They can cause chafing, difficulty with exercise, and recurring skin infections (which may produce body odour). Patients may feel self-conscious wearing tighter fitter clothes and may have to “fold” their droopy skin into compression undergarments.
Post-weight loss body contouring surgery to remove the excess skin can be life changing for patients, enabling them to regain their confidence and body image, and to finally be able to leave the life they want to live.
Am I suitable to have excess skin removal surgery?
It’s important that you’ve achieved the weight loss you’ve desired and have able to maintain that weight for a few months. If you have the surgery too soon, and you continue to lose weight, you’ll be left with further loose skin, and if put weight back on, you’ll until the good work.
Keeping the weight off is about changing your relationship with food for the long-term, particularly your emotional relationship with food. Committing to regular exercise is also key.
Skin removal surgery is major surgery, so it’s vital to be in good health, and be a non-smoker.
It’s also very important to examine your expectations of what the surgery can achieve, and potential problems you may encounter during your recovery.
What kinds of skin removal surgery are possible after massive weight loss?
Excess skin will accrue in all areas of the body after weight loss, and you may also be left with poor tone or separation of the abdominal muscles.
Surgery can potentially address any area of loose skin, but it’s what’s important to you, that matters. Some patients choose to undergo more than one surgery, and it can be possible to undergo surgery to multiple areas in one go, or to have it staged over several months.
Otherwise known as a tummy tuck, this is a surgery to remove the excess skin and tighten weak or separated abdominal muscles. An incision is made that horizontally follows the lower abdomen, from hip to hip, across the pubic hair line, and if needed the underlying abdominal muscles may be repaired. The excess skin is moved, and the skin sutured. Sometimes the umbilicus (belly button) is repositioned during the procedure. In essence, this tightens the abdominal wall in one direction, downwards.
Fleur De Lys Abdominoplasty
Sometimes, if there is very considerable excess skin, a “Fleur De Lys” surgery may be recommended. This includes the traditional abdominoplasty, with the addition of a vertical incision, from the bottom of the ribs, down to the pubic area, forming an inverted, ‘T’, or “Fleur De Lys” shape. This means that not only is skin removed from top to bottom, it also enables loose skin on the sides of the abdomen to be addressed.
This is typically to move excess skin in the underarm area between the arm pit area and under arm, with the incision made along the inside (medial) side of the arm; sometimes the incision is extended onto the chest or back area.
This is a procedure to move excess skin and fat from the inner thigh. An incision is made vertically down the inner (medial) thigh, and the loose skin is removed. Sometime the incision may extend into the groin crease. Many patients choose to undergo this surgery because of thigh chafing, which can impair their ability to exercise.
Breast surgery can be an effective way to recontour the breast shape. Many women will be left with sagging or flatter breasts after weight loss, and a mastoplexy surgery (to remove excess skin and move the nipple and areola area a higher position) and / or breast augmentation with implants, may be a good choice for them. Men who’ve lost considerable weight, may have sagging skin in the male breast area, and gynaecomastia surgery (aka “Moob” surgery) may be recommended. This may involve surgery to recontour the areola area but may also involve an incision vertically down from the areola area, and under the male breast, in order to achieve sufficient skin removal.
Otherwise known as a torsoplasty, this a way of recontouring the back area, to remove “back rolls” or rolls of fat around the upper or lower back. Sometimes this will involve a vertical incision from the arm pit, vertically down the chest side (vertical torsoplasty) and it may be combined with a horizontal incision in across the back (horizontal torsoplasty), to get a good cosmetic result.
Significant weight loss can lead to saggy skin around the jawline and “jowls”. A traditional neck lift involves an incision in the hairline, just behind the ear, and sometimes an incision is also made under the chin, permitting excess skin to be removed, and if needed, tightening of the platysma muscle.
It is possible to carry out a more than one kind of surgery at a time, and many of my patients choose to do this. For example, they may wish to undergo an arm and thigh lift procedure at the same time. It is important to understand that very prolonged times on the operating table bring with it increased risks, which is why in my practice I have surgical team members assisting in the surgery, to reduce the operation time.
What I can expect after skin removal surgery?
All surgeries carry with them potential risks, which in the case of skin removal surgery can include potential infection, blood clots, bleeding, numbness, poor wound healing, seroma formation, and excessive scarring. Thankfully, good planning and surgical techniques means we can minimise, although not eliminate, these risks.
The incisions from the surgery will typically be healed after 2-3 weeks, and most patients can expect to return to exercise at around 6 weeks, and you’ll need to wear compression garments for 4-6 weeks after your surgery.
Skin removal surgery after massive weight loss is a niche area in plastic surgery, and it’s important that you “do your homework” when selecting a surgeon and ask plenty of questions.
For patients who have undergone massive weight loss, skin removal surgery is the “icing on the cake”, and many of my patients tell me it’s been life changing.