10 Things to Know About Cosmetic Surgery After Weight Loss Surgery
Weight loss (bariatric) surgery can have a tremendously beneficial effect on overall health and wellbeing. For many patients, it is even lifesaving.
However, patients typically don’t anticipate what will happen to their skin after they go through the type of large weight loss that comes after successful bariatric surgery. It is important to understand that skin tissue will not magically shrink back into place after the weight is lost. This extra skin may look unsightly and can even become a health and hygiene issue if moisture trapped in the folds of skin causes recurring rashes and skin infections.
Fortunately, there are safe and effective cosmetic surgery procedures that can remove the excess skin left behind after significant weight loss. In our practice, we see many patients who have gone through weight loss surgery and now have problems with excess skin. Here are 10 things we encourage patients to know about cosmetic surgery after weight loss surgery.
1. Weight loss surgery can do many things, but don’t expect it to make you look exactly like you did before you lost the weight.
It is important to note that weight loss surgery is done for reasons of health, not appearance. Studies have shown that it can help reduce the risk of many serious obesity-related diseases, such as diabetes, heart disease and sleep apnea. Weight loss surgery patients who come to us for help with excess skin are almost always happy with the health results of their bariatric surgery. However, many are frustrated that they now have excess skin problems they didn’t expect to have. Patients need to go into their bariatric surgery understanding that there is a very good chance that they are going to need some type of skin-removal procedure down the road to get back to looking like they did before they gained the weight.
2. Insurance companies typically cover weight loss surgery, but they don’t always cover cosmetic surgery to remove excess skin after weight loss surgery.
Insurance companies are still trying to figure out where these procedures fall on the spectrum of cosmetic vs. reconstruction, so what they cover can change from month to month.
3. Even if insurers don’t cover all cosmetic surgeries to remove excess skin after weight loss surgery, it can still be worthwhile to make a case for coverage with your insurer.
Essentially what insurance companies want to see documented is that you have a real medical issue—typically recurring rashes and skin infections due to moisture trapped in folds of excess skin—and that you and your primary care provider have spent months trying non-surgical treatments, such as anti-fungal creams, to resolve these issues but the condition keeps coming back no matter what you do.
4. The skin-removal surgeries most likely to be covered by a health plan are those for excess abdominal skin. The surgeries least likely to be covered are for extra skin on the arms.
The back area has less success in getting insurance coverage than the abdomen, but again, if you can show that you have recurrent rashes and infections, at least you have a chance.
Even if the insurance company agrees to cover just a portion of the procedures needed, it can lower the overall cost. Our office helps patients create a documented timeline showing that they’ve done all they can do to take care of skin issues themselves and it just hasn’t worked.
5. Patients have many options in how to treat problems with excess skin after weight loss surgery, and their cosmetic surgeon can help guide them in creating a surgical plan that makes the most sense for them.
The biggest choice may be whether to have multiple surgeries at once, or to space them out over time. This decision usually hinges on the type of job the patient has and how much time he or she can take off, as well as what kind of activity the patient needs to get back to doing.
The most common procedure we do is a circumferential body lift. As the name implies, it involves removing skin all the way around the body. We make an incision in the front like a tummy tuck, but then extend it onto the back and the upper buttocks area to help remove a lot of the skin and fat from the abdomen, the hips, the sides and onto the buttocks area as well. This flattens the tummy and gets rid of the spare tire a lot of people have from loose skin.
While just doing a tummy tuck is possible, it typically will not deliver the results patients want, because when the tummy is nice and flat, everything else will look even more loose and sagging in comparison.
We often do thigh lifts and breast lifts at the same time as we do a circumferential body lift. Combining a few different procedures at the same time limits the total number of operations someone is going to need to have, and also limits the number of recoveries someone has to go through.
You can combine the surgeries any way you want. Often what we will do is schedule two of these surgeries a week or two apart. This limits the length of time in the operating room for each surgery, while still combining the recoveries so that patients don’t have to take time off from work for two completely separate recovery periods.
6. Doing several procedures at once generally does not make a big difference in recovery time or increase risk.
It takes about four to six weeks for incisions to heal safely for normal activities. This amount of healing time will be the same regardless of whether you have one incision or multiple incisions.
One thing that does make somewhat of a difference in recovery time is the overall time spent in surgery. Patients whose surgeries combine several procedures are under anesthesia longer and receive more anesthesia medicines. This can leave them feeling a bit more run down, with a longer "anesthesia hangover" after the surgery.
All surgeries have risks, but when performed by a highly trained board-certified cosmetic surgeon on a young and healthy patient, these surgeries are extremely low risk. Combining procedures is not necessarily any riskier than spacing them out, because the primary risk of any surgery is being under anesthesia.
7. To be a good candidate for surgery to correct excess skin left by a big weight loss, you should be in good health and your weight needs to have stabilized.
You will not have optimal results if you lose significantly more weight after removal of the excess skin because then the problems of loose skin will recur. Indeed, those insurers who do cover cosmetic surgery after weight loss surgery generally want to see that your weight has been stable for a certain time period, typically 3 to 6 months, and that at least 12 or even 18 months have passed since your original weight loss surgery.
8. Recovery from your cosmetic surgery will be different than recovery from your weight loss surgery.
Oftentimes, patients will remark how much easier the recovery from weight loss surgery was, compared to what they had expected. The situation is reversed in cosmetic surgery to remove excess skin. That’s because the incisions are longer, the amount of tissue removed is greater, and the skin is very sensitive with lots of nerve endings.
People's responses to pain medications vary, so we work hard to find the right regimen that will control their pain. We also counsel them on what to do if side effects from the medication become an issue.
9. Being inactive during recovery from surgery will generally not lead to weight gain.
One thing that is hard for weight loss surgery patients during recovery is the change in routine, because they typically have a very disciplined diet and exercise routine and may fear putting the weight back on while they are recuperating. It is important to realize that few people put any weight back on during the downtime of recovery, even if they can’t exercise. First of all, patients rarely feel much like eating in the weeks immediately following surgery. Second, patients typically can and should get up and moving as soon after their surgeries as possible, because it helps in healing and reducing pain from tightness. Many are up walking around the same day as the surgery, and while it may be four to six weeks before it is safe to go back to the gym, gentle walks as long as several miles are typically fine.
10. Tummy tucks, breast lifts and other lift procedures done after bariatric surgery will generally not help you reach a final weight loss goal.
Although some fat is removed along with the extra skin, it is rare for a patient to lose 20 to 25 pounds through these procedures, as they are not really weight loss procedures, they are body contouring procedures. Typical weight loss is more like 5 to 10 pounds from these types of cosmetic surgeries.