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Post-Bariatric Surgery Addresses Problem of Excess Skin: After undergoing significant weight loss, patients seek cosmetic restoration

One problem that patients who undergo bariatric surgery for weight loss encounter is excess skin.

There are few medical risks to having excess skin, but it often becomes a matter of aesthetics for post-bariatric surgery patients, said Dr. Henry Wells of Wells Plastic Surgery.

“Patients can sometimes cover up the excess skin, but that skin is still there,” he said. “Some patients are depressed because they have excess skin and they think they don’t look normal.” This is generally when they come to a plastic surgeon to address the problem.

Wells said a patient needs to be in relatively good physical condition to be a viable candidate for bariatric surgery. Patients must also be in good metabolic shape for post-bariatric surgery. “We need to make sure their albumin and their hemoglobin levels are adequate to ensure good wound healing,” Wells said.
The patient should also have been at a stable weight for at least six months. “Some bariatric patients weigh 400 pounds and they get down to 220 pounds or less,” Wells said. “That can be the stopping point.”

When performing post-bariatric surgery, Wells follows a methodical system of procedures that build on each other. “I will lay out a plan with the patient to address their issues,” he said.

The first procedure addresses the excess skin on the lower body. “This entails removing skin from the abdomen and flanks and doing lifts for the buttocks,” Wells said. The abdominal skin is tightened in this surgical phase.

The second step involves the arms and breasts. “These procedures are sometimes done separately and sometimes they are done together,” Wells said. Skin under the arm between the axilla and the elbow is removed. The surgery may leave a long scar, but Wells said it is not always noticeable. However, when the breast and the arm are done simultaneously, this might result in a longer scar.
“Typically the patients have a skin envelope that must be resected,” Wells said. “It depends on the breast lift or if I do a breast reduction or augmentation.”

The final procedure is performed on the legs, most often a leg and a thigh lift. “An incision is made from the groin to the knee to ensure adequate resection of the skin,” Wells said.

Generally, these procedures take three or five hours of operating time. Since the physician has to allow for healing between procedures, it may take as long as two years to completely finish the three different phases. “The patients sometimes feel the process is incomplete when the excess skin is still there,” Wells said.

Scarring is not always a huge concern for patients who have post-bariatric surgery. “There is a lot of scarring with all these procedures,” Wells said. “This is the trade-off when people lose all this weight. But the patients feel it’s better to have a normal-looking body with scars than to have an abnormal-looking body with excess skin.”

Exercising to tone the muscle and skin, as well as continued dietary changes and bariatric supplements, are essential for post-bariatric patients, including those who elect to have plastic surgical procedures. Regaining weight puts excess strain on tissue that has been surgically repaired.

By Tanya J. Tyler, Associate Editor

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