Excess Skin after Weight Loss Surgery
A common concern of many bariatric patients after weight loss surgery is excess skin. While most of the changes that accompany weight loss are positive, loose skin is a concern for many patients. Loose or hanging skin can affect both comfort and self-confidence and can be a daily reminder of past obesity. In this article we are going to discuss some ways and solutions to help correct or prevent those skin changes.
Let’s first discuss some facts about skin. The skin is actually the largest organ of the body, with a total area of about 22 square feet. The skin protects us from injury and infection, regulates body temperature, and stores water, fat, and vitamin D. There are three main layers of skin, the Epidermis, Dermis, & Subcutaneous tissue. The first layer of skin, the epidermis, is the outermost skin layer which provides a water proof barrier and creates our skin tone. The dermis is beneath the epidermis and contains tough connective tissue, hair follicles, and sweat glands and then there is the subcutaneous tissue layer which is made of fat and connective tissue.
Predicting who is going to have problems with hanging skin after weight loss is hard to determine. The way your body looks after weight loss is directly related to the ability of your skin to shrink down over the new foundation, which we call elasticity. The more elastic your skin is, the better it is able to conform to the new body shape. In general, skin in regions of your body that are most stretched from the weight gain tend to be less elastic. Elasticity also decreases with age, sun exposure, cigarette smoking, and is also affected by genetic factors. Exercise, adequate protein intake to help build muscle, adequate amounts of fluid intake to keep the skin and body hydrated, avoiding sun exposure, quitting smoking, and losing weight through a longer period of time are all ways to help recoil the skin. By following these instructions, the skin in some cases can recoil. Unfortunately, the elastic qualities of the skin are not perfect and the skin does not completely recoil and in those cases, plastic surgery may be required to remove the excess skin. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds, such as recurrent infections that are not well treated with medications.
A patient is usually a good candidate for skin removal surgery when they meet the following the criteria. Their weight has been stable for a year with no further weight loss expected, have overall good health, a well-balanced healthy diet because problems with protein or vitamin deficiencies can affect healing, and be smoke free, smoking can also delay healing and increase serious complications during or after surgery. If you feel you meet this criteria for skin removal talk to your surgeon, he or she can let you know if are a good candidate and if so provide you a referral to see a plastic surgeon to be evaluated for skin removal surgery.