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Skin removal surgery: Is it right for me?

Posted on Feb. 25, 2021 ( comments)

If you’ve lost a significant amount of weight through bariatric surgery or other means, you might notice that your skin is looser than it was before. This is because as you gain weight your skin expands around your body mass, but as you lose weight it doesn’t always have enough elasticity to return to its previous shape.

Not everyone is bothered by extra skin after weight loss. But some people find that it gets in the way of exercising, causes rashes or prevents them from fitting into clothes the way they’d like, and begin looking into ways to reestablish a more proportional body contour.

As the most effective method of body contouring, plastic surgery has many benefits. But it’s important to carefully consider whether it’s right for you based on what you hope to accomplish, your risk factors and the recovery period involved.

Joshua Elston, MD, board-certified plastic and reconstructive surgeon with MultiCare, presented at a recent support group for the Center for Weight Loss & Wellness. In this article he shares his answers to some of your most common questions about skin removal surgery.

What areas of the body do you typically focus on for skin removal?

I’m a head-to-toe plastic surgeon, but the two most common skin removal procedures that I perform for bariatric patients are the panniculectomy and the vertical abdominoplasty, both of which can be insurance-approved.

The panniculectomy, which most people are familiar with, involves removing skin and fat below the belly button. This is for people who have an apron of skin that hangs down below their underwear to their thighs. That overlap of skin often causes persistent rashes.

The vertical abdominoplasty is a much more powerful skin removal technique but requires more incisions and more time in surgery, and the complication rate is higher. It’s usually reserved for people who have lost 150-200 pounds and need to have skin removed from above the belly button as well.

What determines which skin removal surgery you would perform?

It depends on a lot of things, including where a patient has extra skin, how much weight they've lost and how healthy they are overall. If someone is in poor health, I can't offer them a four-hour-long surgery as it’s just too risky. If someone has excess skin mainly below the belly button, I probably wouldn't offer them a vertical abdominoplasty because they won’t get much benefit and will assume more risk. Some patients are great candidates for one surgery, but they don't want the extra incisions—they just want the quickest recovery. So, it's a mutual discussion.

Will my insurance pay for the procedure?

Some insurance companies are stricter than others, but for the most part they look at whether your weight has stabilized and if you have a documented history of your extra skin affecting your well-being or ability to perform the activities of daily living.

Another thing that helps is for patients to show that they have meticulous hygiene, meaning we can document that you're spending hours a day keeping areas dry or applying creams to keep the skin healthy.

The MultiCare Plastic & Reconstructive Surgery team is skilled at working with patients and insurance companies for approval of both the panniculectomy and vertical abdominoplasty, but procedures to other parts of the body are usually classified as cosmetic in nature and not approved for insurance coverage.

How much weight should I lose before getting skin removal surgery?

I’d say once you’ve lost somewhere between 40 and 70 pounds that starts putting you in a surgical category for us. Obviously if you’ve lost a lot more weight, like 150 or 200 pounds, you’ll see more dramatic results, but anyone with excess skin can benefit.  

Are there any non-surgical ways to improve loose skin?

I think it’s hard to get surgical results with a non-surgical treatment. It can be tempting to think that a cream or a laser can produce the results you want, but I wouldn’t recommend relying only on those approaches if you have a significant amount of excess skin.

What is the recovery process like?

Most people start to feel pretty good after two weeks, though still as though they’ve had a major surgery. It’s about four weeks before most people go back to work, and you need to wait six weeks before doing any heavy lifting, such as picking up your kids. It’s important to let your body heal so that you can get back to the things you love to do without any setbacks.

I usually have my abdominal patients use abdominal binders to keep pressure on and keep the swelling down for about three to four weeks after surgery, so that helps too. For the most part, people heal well. As long as you don't exercise too soon, don’t smoke and don't have poorly controlled medical problems, then most people are able to heal just fine and are happy with their results.

Ready to learn more about skin removal surgery?

If you are a candidate for skin removal surgery or would like to learn more about body contouring procedures, contact MultiCare Plastic & Reconstructive Surgery at 253-403-2120 or request a consultation.

Hear more about body contouring and skin removal surgery from Dr. Elston:

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