The Surgeon Minute

Surgery After Massive Weight Loss

Surgery After Massive Weight Loss

According to the latest statistics from the Centers for Disease Control, 1 in 3 Americans are obese. Many insurance companies, having finally realized that treating obesity is good for their bottom line, now include bariatric surgery as part of their plan. Extremely effective bariatric surgery will leave a patient significantly thinner, but oftentimes with excess skin.

Dr. Richard Restifo of Orange, CT is a board certified plastic surgeon who routinely performs body contouring surgery for patients struggling with excess skin following massive weight loss. Below, he discusses why patients seek out surgery and what exactly to expect.

Excess Skin Is Traumatizing

Many post-bariatric surgery patients find themselves miserable after they’ve lost the weight. They’ve achieved so much, but loose skin still hangs from their now healthy body. They come to Dr. Restifo saying that, “they liked themselves better when they were heavy because they filled out their skin.”

For most obese patients, they’ve carried a significant amount of extra weight for many years, stretching out their skin. Even though they are now 80-100 pounds lighter, their skin drapes in unattractive folds that makes them extremely self-conscious naked, in a bathing suit, or in tight-fitting gym clothes. The challenge for surgeons such is these patients want to be completely, “smooth and tight”.

loose abdominal skin

They’re not looking for moderate results; they want all the skin gone.

Surgeons sometimes have to point out that there needs to be a little bit of looseness when, for instance, the patient is sitting down so that he or she can actually stand up. Every massive weight loss patient is different and may have different problem areas, so a surgeon’s expertise and skill come into play as he or she needs to know where to cut, how much to cut, and where to place the scars.“The goal is take off a lot of skin and to leave the scar in as nice, inconspicuous place as possible,” explains Restifo.

Belly, Breast & Arms Are the Top 3 Hotspots

The belly, breast, and arms are typically the top three areas where excess skin needs to be removed following massive weight loss. With the arms, the best scar location is going to be on the inside of the arm so that it’s not visible when the arm is at rest. The incision does need to be long however, so it will be visible.

surgery after weight-loss

Treating the belly in massive weight loss patients is different than treating those of women who’ve had multiple children. First of all, there’s just more skin. Second, the looseness of the skin is both vertical and horizontal, so sometimes the surgeon will need to extend the incision all the way around the torso. Following the procedure – and depending on how much needed to be accomplished – most patients are back to work within a week and back to the gym within 4-6 weeks.

Managing Expectations with Body Contouring Surgery

One of the challenges for any plastic surgery procedure is managing a patient’s expectations, but this is especially true with massive weight loss patients. Dr. Restifo handles this by talking in-depth with the patient about exactly what the surgery will entail. He discusses the realities of how much skin can safely be removed in one surgery and how if he removes the skin from one area, it may make another area look as if it has more skin, meaning there may be a need for revision surgery down the road.

One fact that all board certified plastic surgeons readily inform their patients is that plastic surgery is not a way to lose weight. The procedures are about contour and shape!

surgery after weight-loss abdomen

In general, Dr. Restifo won’t even perform a surgery post weight loss procedure until the patient has been at his or her goal weight for at least 6 months. He never wants to run the risk of doing the surgery and then having the patient lose more weight, negating all of the positive benefits from the surgery.

Weight-loss patients are often frustrated because they’ve worked really hard to lose the weight. They’ve had the surgery, they’ve watched their diet and exercised to build lean muscle, and yet, none of this can contract the excess skin that remains.

The important thing for Restifo is to just listen and let his patients know that he not only understands, but that it’s not their fault. “Stretched skin has no where to go,” he explains.. The only way to remove it is surgically.

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