Body Contouring
Your New Body
Bariatric surgery and the weight loss that follows is truly a life changing event. You look better and feel better. You are probably doing things that you may not have thought possible in the past. Every activity, from clothes shopping to sitting in a movie theater, is a different experience. While most of the changes that accompany weight loss are positive, loose skin is a concern for many patients. Hanging skin can affect both comfort and self-confidence, and can be a daily reminder of past obesity.
Who has problems with skin?
It is hard to predict exactly who will have problems with hanging skin after surgery, but a majority of patients undergoing weight loss will have some complaints. How your body looks after weight loss is directly related to the ability of your skin to shrink over the new , slimmer foundation. This property of skin is known as 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, and cigarette smoking, and is affected by genetic factors. The other part of the equation is how much weight you are losing in different parts of your body. If you carried most of your weight around your middle and that part of your body changed the most during weight loss, then the skin in that region will have further to contract.
What are the symptoms and what areas are affected?
Almost all parts of the body can be affected by loose skin after weight loss. The most common area that people are concerned with is the belly. An overhanging apron, called a “pannus,” can cause a fold of skin on the front of the abdomen. In addition to preventing clothes from fitting well, a pannus can cause symptoms of rash and skin irritation. These symptoms tend to be worse in hot weather. An extremely large and heavy pannus can interfere with exercise and even normal activities, and can cause lower back pain. Less commonly, the pannus can become chronically infected and actually have areas of skin breakdown. While the belly is definitely the hot spot for problems with hanging skin, rashes and irritation can occur in folds of skin under the breasts and on the thighs and back. Excess skin on the upper arms can be bothersome to many patients. Skin rashes are less common in this area, but the hanging skin may cause discomfort during physical activity and embarrassment, especially in young women.
When is the right time to consider plastic surgery?
The best time to consider plastic surgery in when you are as close to your goal weight as possible and your weight is stable. This is usually 12 to 18 months after the gastric bypass surgery. In our Life After Weight Loss plastic surgery program at UPMC, we prefer patients to be at a stable weight for three months before having surgery. There are several reasons for this timing. First, your body is in a negative nutritional balance during rapid weight loss and is not in the best condition for healing new surgical wounds. Second, the risk of complications from the surgery decreases as body mass index (BMI) decreases. Third, the cosmetic results from the surgery (the way things look) tend to be better as you get close to your goal weight. In fact, your surgeon can usually offer more safe surgical options if you are close to your goal weight than if your BMI is still high. What if you have hit a plateau that is well above your goal weight? This is a common problem, and it is best to make a real attempt at getting past the plateau before having plastic surgery. Ask your bariatric surgeon to recommend some strategies to get your weight moving down again and give it your best effort. You may surprise yourself with the progress.