Do All Post-Bariatric Patients Need Plastic Surgery?

Everyone has her own body shape, both before and after weight loss.  Some women have more loose skin on their abdomen after weight loss, while others end up with more loose skin on their legs.  Still others have loose skin everywhere. It's exceedingly rare to have no loose skin after massive weight loss--and it does NOT matter how slowly or quickly you lose weight. The skin damage is done with the weight gain, not the weight loss.  Weight loss just unmasks it. 

You may want to consider starting to save for your anticipated cosmetic procedures now--if you end not needing the surgery, at least you'll have a nice little savings account started.

Based on your level of obesity, it is very unlikely that your skin will "bounce back" into place after bariatric surgery. As a post-bariatric plastic surgery specialist, I have worked with countless post-bariatric clients, all of whom were left with sagging skin. That being said, it is your choice whether or not you choose a cosmetic procedure to improve your body contour after weight loss. Plastic surgery is by no means mandatory but the excess folds of skin can interfere with daily activities and make it difficult to find clothing that fits properly. If the excess skin causes chafing, rashes, or other medical problems, insurance will sometimes pay for part or all of the corrective surgery.

If you do decide to save up for plastic surgery, it's important that you select a board-certified plastic surgeon who has many years of experience with post-bariatric cases. I understand that price is a concern for you but I highly advise against choosing "bargain surgery" to save money. In the long-run, the risks and potential complications from an inexperienced surgeon could cost you much more.

After bariatric surgery, patients sometimes choose to have plastic surgery for problem areas. The likelihood of needing plastic surgery is higher when the BMI is higher and when the patient is older. Patients younger than 40 and with a BMI of less than 50 will have less excess skin than patients that are older and have a higher BMI. Patients can decrease the need for plastic surgery by exercising and improving their muscle tone. Having good muscle tone can improve the look of this skin overlying the muscle and patients may forgo plastic surgery. I would say about 40-50% of my own patients choose to get plastic surgery after their bariatric procedure.

Almost no patients with massive weight loss will be left with no excess loose skin.  The weight gain destroys the elastic fibers in the skin and these will never recover even with weight loss.  It is up to you, though, if it bothers you enough to need surgery to remove it.

Parenthetically, I am a fan of TV's Biggest Loser because I love the success stories these people have.  However, I think the show does a disservice by not addressing the issue of extra skin and by implying that diet and exercise can do it all for you.  The final images of the contestants surely have tight compression garments under their gym clothes making it look like there isn't extra skin when in reality there is.

The most common plastic surgery procedure after gastric bypass is a tummy tuck.  Probably about 50% of patients will undergo plastic surgery after massive weight loss.  Some insurance companies will cover a tummy tuck if you document recurrent intertrigo of rashes below the skin folds.

In my experience nearly all massive weight loss will demonstrate loose and redundant skin but each individual varies in the extent of where the laxity is most notable; Some show marked facial laxity while others show it in varying degrees and combinations effecting their breasts, arms, legs, backs, buttocks, etc.

Regarding: "Do All Post-Bariatric Patients Need Plastic Surgery?
My insurance will cover bariatric surgery (I'm in the morbidly obese category) but I know I'm likely to need reconstructive tummy tuck or lift after I lose the weight. I can't afford this. Do you ever have patients whose skins "spring back" and doesn't need plastic surgery?"

Respectfully, I think you skipped over the MOST important issue in the MORBID obesity discussion. Your health. MORBID comes from the Latin for unhealthy, disease causing. Your level of obesity, if allowed to continue, will kill you. The insurance companies do NOT pay for bariatric operations because they are nice guys. They pay for them because they know that people with morbid obesity get a lot of expensive diseases before they die. To save themselves the costs entailed in your future care - they are willing to pay out the cost of the surgery to get rid of that oncoming collision with these diseases.

As Plastic surgeons we are ALWAYS reminded that we should approach EACH patient thinking that we should save life before we save function and that after that, we should save function before we promote and save appearance.

In your case, as painful as your economic condition may now be, you MUST preserve your health and go ahead and have your bariatric surgery. A dead you has no future. A living you will have a chance to improve your skills and potentially earn enough to HAVE money in the future to remove all the excess skin and lift parts needing lifting. But - all that can wait!

I agree with Dr. Rand that the vast majority of massive weight loss patients do have SOME to extreme levels of sagging skin. I would like to also tell you that these people are some of my favorite patients. They are intelligent, extremely motivated and it has been a pleasure caring for them and helping them reach their goals step by step.

Dr. Peter Aldea