Excess skin after significant weight loss is not just a cosmetic issue. Sure, when patients lose more than 100 pounds, they would like their body to reflect the change they feel inside. But excess skin can also limit mobility, cause medical and hygiene problems, and make daily chores difficult. It can make physical activity uncomfortable due chaffing and rashes, which can discourage patients from adopting healthy changes to their lifestyles.

Dr. Mitchel Krieger, a board certified plastic surgeon in Fairfax, Virginia, uses body contouring procedures, such as liposuction, tummy tucks and breast lifts, to help weight loss patients return to a normal life after such a dramatic physical change.

Dr. Krieger says up until about five years ago, nearly all his patients were coming in after open gastric bypass surgery, having lost around 100 to 200 pounds in about nine to 12 months. “From a surgical standpoint, these patients were the easiest to treat, because it was all loose skin,” he says.

However, today more patients are having the less invasive Lap-Band procedure, which means slower, more steady weight loss over a longer period of time. “Many of these patients, because they haven’t lost all their excess weight, may still have some residual fat or residual weight in their extremities,” Dr. Krieger explains. “And so their arms and legs sometimes require liposuction as an initial staging procedure before we can go in there and remove the excess skin.”

Patients need to have a realistic concept of what they will look like after weight loss surgery. Although the change will be dramatic, Dr. Krieger stresses that different people have different starting points before the procedure, and therefore will come out at different sizes after surgery.

“In an ideal world, we’d like to see patients have a BMI of under 30, but sometimes we see patients who are in that [over 30] range,” he says, “and as a result they have to temper their expectations that you can’t generate as thin a contour as you could in a patient who had started off at a lower weight.”

Using lasers for the purpose of skin resurfacing began nearly 20 years ago, when the first CO2 laser was used to get rid of wrinkles, scarring, pigmentation problems and more. The treatment was extremely effective, but recovery took up to 14 days, and the red complexion associated with the procedure took nearly four months to return to normal. Over time, techniques have been developed using the fractional laser to achieve matching results, with almost no downtime.

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“Initially, CO2 lasers were used to resurface the skin. They would mainly vaporize or burn the surface of the skin in a very controlled fashion,” explains Dr. Mitchel Krieger, a board certified plastic surgeon in Fairfax, Virginia.

While CO2 lasers were effectual, patients’ demands for a shorter recovery time led the gradual transition to Erbium laser treatments, which were more precise in treating the skin.

“The advantage of the Erbium laser was that because of that precision you didn’t get the heat transferred to the skin and you didn’t have the downtime, or the prolonged recovery,” notes Dr. Krieger.

On the flip side, CO2 treatments offered more dramatic improvement of visible wrinkles and lines than the Erbium laser, which worked better for younger patients with softer wrinkles, notes Dr. Krieger.

The quest for tools to improve wrinkles without any downtime continued. Thermage, ReFirme, and other non-ablative technologies were developed. These heat up the tissues beneath the surface of the skin without burning the skin’s surface. The results eventually show improved tightening and firmness in the skin, but the results are still subtle.

Fractional lasers were the next step in skin resurfacing technology development. This procedure improved on the original idea by only penetrating small areas of the skin completely, in what looks like a grid of pinholes. Using this method, skin heals within six to eight hours, and total recovery is achieved in as little as three to four days. This means the patient can take a long weekend and return to work with no residual evidence of the treatment other than refreshed skin.

The only requirement for fractional laser skin resurfacing is general good health. Fractional lasers produce good results on any skin type for most skin issues, such as scars, wrinkles, and pigmentation problems. However, it is important to note that fractional lasers produce improved skin–not perfect skin.