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Excess Skin Removal After Extreme Weight Loss

Facts on Excess Skin Removal

  • Obesity is a growing epidemic in developed countries throughout the world. Obesity causes significant public health problems, including an increase in type 2 diabetes, cardiac disease, and degenerative joint disease. A simple indicator of obesity is the body mass index (BMI), which is the weight of an individual in kilograms divided by height in meters squared.
  • Over the short term, diets can be effective for losing weight; however, only about 5% of people maintain long-term weight loss from dieting. Because of this, many people who are severely obese have turned to bariatric surgery as a more definitive treatment.
  • Bariatric surgery for weight loss in individuals who are obese is becoming a safer and more commonly performed surgery. During weight gain, the skin expands to contain the underlying fat and can often lose elasticity. If older individuals or people whose weight was excessive for many years lose weight, the skin and underlying tissue do not naturally return to their original size. A number of surgical procedures for removing excessive skin and fat are available.
  • Surgical techniques for excess skin removal began in Brazil and France more than 40 years ago but were fraught with complications, poor scarring, unnatural contours, long recovery time, and inconsistent results. Over the past 15 years, with the large increases in the number of people with excess skin, skin removal surgery has undergone several improvements. One innovation, the body lift, which was developed by Dr. Ted Lockwood in Overland Park, Kansas, has produced aesthetically pleasing results in selected patients.
  • The treatments of excessive tissue can involve extensive surgical procedures. The procedures vary from commonly performed procedures such as abdominoplasty (tummy tuck), mastopexy (breast lift), inner thigh lifts, and brachioplasty (arm lift) to the more complicated procedures such as high lateral tension abdominoplasties and lower body lifts.
  • Advantages of body lifts include improved skin quality, long-lasting results, smoother natural contours, and better control of results. Disadvantages of body lifts include more complex surgery (requiring more expertise), longer operating time, long scars, longer recovery after surgery, and increased cost.

How Do I Prepare for the Excess Skin Removal Procedure?

Preparation for the procedure involves losing weight and reaching a stable body weight prior to the procedure. This is unlike the preparation involved for liposuction. If problem areas persist, liposuction may be performed prior to the excess skin removal procedures or, if only small areas are involved, at the same time as the surgery for excess skin removal. There are inherent significant risks when liposuction is performed in areas adjacent to flap excisions required for body lifts due to the altered blood flow to the tissue, which is already compromised due to the tissue excess.

Many options are available with excess skin removal surgery. Thus, many people choose to meet with a surgeon at least twice or to seek a second opinion before embarking on such procedures. When choosing the timing of these procedures, considering the fact that people are at risk for nutritional depletion after massive weight loss is important. Discussing this issue with a primary-care doctor or bariatric surgeon may be useful. The usual preoperative health check, blood work, possible banking of one's own blood (if needed) and avoidance of any blood thinners (for example, aspirin, and ibuprofen) are all necessary and desirable for safety and a favorable outcome. Many of the procedures are performed in stages, with several months of recuperation between each stage. Additionally, many procedures are being performed by teams of plastic surgeons with at least two surgeons plus assistants in order to minimize the operative time and reduce risks to the patient.

Additional concerns of nutritional deficiency must be addressed in people who have undergone bariatric surgery. Folate, vitamin B-12, and iron deficiencies must all be corrected prior to major surgery. 

About 2-4% of patients in the population also have an antiphospholipid antibody syndrome, which is a condition of the immune system that creates an abnormal tendency toward blood clots. This should be investigated prior to surgery in those patients deemed clinically to be at risk.

The planning of multiple procedures is also important. Individuals need to decide which areas of the body bother them the most and work with the surgeon to come up with an individual surgical plan that best meets their needs. People commonly elect between one and six procedures, depending on their wishes. Excess abdominal skin is often the most bothersome and can be addressed by abdominoplasty, panniculectomy (the removal of superficial abdominal fat), or body lift. An example of a three-stage procedure is as follows:

  • First stage: body lift and, occasionally, breast lift
  • Second stage: involves the extremities and breast surgery or breast revision
  • Third stage: the face and neck areas

With potential revision surgeries, as many as six stages are possible.

For major lifts, the body is often marked for surgery the day before the surgery.

Medically Reviewed by a Doctor on 11/28/2016
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