Procedures to Tighten Loose Skin from Massive Weight Loss?

Dear Sir:

Congratulations on your massive weight loss.  You should be commended on significantly improving your health and improving your lifestyle. 

I have many patients such as you who have lost a significant amount of weight and developed excess skin and fat in the pubic region.  Typically, male patients after massive weight loss developed significant fat above the penis and lateral to the penis above the scrotum.  When I examined patients, the excess skin and fat in this area typically looks like the letter W. 

Due to your significant weight loss, this is a very typical area to exercise or workout.  Sit ups and lunges do not significantly tighten the skin.  It is not necessarily the lack of exercise or doing the wrong exercise, it is just the skin in the area has been stretched and is unable to contract.  Surgical procedures include an abodominoplasty or a body lift  if your hips and buttocks bother you.

During my body lifts, I make the incision in the pubic region in males, very low to remove this excess skin and fat.  If your abdomen and hips are not bothering you and it is just the pubic region then I do an isolated pubic reduction.  This is done by making a vertical incision just above the penis extending towards the top of the underwear line.  By doing this, an ellipse or football-shaped skin and fat excision is done.  In addition, if the excess skin and fat is significant extending down to the scrotal region, I make an incision in a shape of an upside-down Y so the incision goes on top of the penis and then down the side of the penis onto the scrotum.  Sensation is usually always left intact and erection and fertility usually are not postoperative problems.

 

J. Timothy Katzen, MD, FACS

It's not unusual for patients to develop significant amounts of redundant abdominal tissue following massive weight loss. In patients who have lost over 100 lbs., correction of this type of problem usually always requires surgical intervention. Unfortunately, exercise will have little effect upon loose skin.In your particular case, it's difficult to make a specific recommendation without pictures or a physical examination. Despite this, your clinical history strongly suggests that you would benefit from some type of abdominal skin resection.The type of procedure chosen would depend upon your anatomic findings and aesthetic goals. This procedure would require removal of excess abdominal skin and elevation of the mons pubis. The extent of skin resection would depend upon the degree of skin sag and in some cases, may require a posterior body lift. In some cases, the underlying muscles may be weak and require tightening as well.If you're concerned about redundant abdominal tissue, it's important to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Unfortunately, no amount of diet and exercise can reverse the problem of excess skin in massive weight loss patients.  Generally, abdominoplasty is the only reliable and reproducible method to improve the problem of excess skin in the abdomen after massive weight loss.  The procedure can be tailored for each individual patient to include standard technique, extended abdominplasty, and circumferential abdominoplasty/lower body lift.  Studies have shown that removing the excess tissue can improve one's quality of life.