How long should I wait to have loose skin removed after weight loss, and does OHIP cover any portion?

Question

Over the past year, I have lost 54Lbs. I still have about 20-25Lbs to go, but already my skin is very loose, in spite of losing slowly, eating well, 4L of water a day, strength training, oils, creams, wearing Spanx etc. I am in Ontario, Canada. Does the provincial health care plan cover any portion of any procedures to have the skin removed? Also, how long do I need to wait after reaching my goal weight to have the surgery/surgeries? Thank you!

J. Timothy Katzen, MD, FACS · Answer

Hi SJR81 in Toronto, ON, 
Thank you for your question about how long to wait before having loose skin removed after weight loss, and whether OHIP covers any portion.  Congratulations on your weight loss!  Great accomplishment.  Thank you for your history.  Most plastic surgeons specializing in reconstructive surgery after massive weight loss recommend you lose the weight and maintain your weight loss for at least 4 to 6 months before embarking upon reconstructive surgery.  If you have your skin removed now and lose another 25 pounds, you may need a revision.  Most plastic surgeon recommend recommend that you continue to diet and exercise.  At some point, your body weight will plateau.  At this plateau, you must continue to eat right and exercise.  Once your weight has been stable for several months, you should consult as many plastic surgeons as possible.  There are many specialists in the field of reconstructive surgery after massive weight loss.  There are many approaches to removing excess skin and fat.  Some plastic surgeons would initially suggest a 360 ° circumferential lower-body lift combined with a thigh lift, thighplasty, or thigh reduction.  These procedures would encompass the lower body.  The upper body may need a breast lift, breast reduction, breast implants, an arm lift, an arm reduction, brachioplasty, a back lift, or torsoplasty.  These upper-body procedures are usually performed during a second-stage procedure.  There are multiple variations of these two-stage procedures.  You could certainly do an extended tummy tuck and come back later for a posterior body lift.  Alternatively, you could stage the legs, the arms, or the breasts.  You may not even need all of these procedures.  These are just general guidelines and may not apply to you.  These guidelines are provided because you did not provide more information or pictures.
Regarding OHIP coverage, you will need to ask your Canadian plastic surgeons.  Hopefully, your procedures are covered.  However, your chosen plastic surgeons will be better able to answer these questions regarding coverage.  Alternatively, you can research the information on their website.  Thank you for your question.  Good luck.  I hope I’ve answered your question about how long to wait before having loose skin removed after weight loss, and whether OHIP covers any portion.  Most plastic surgeons offer free virtual or in-office physical consultations.  Therefore, explore what other plastic surgeons have to say.  If you have any more questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, thigh lift, am lift, breast lift, or belt dermolipectomy please contact an experienced plastic surgeon. Since the body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the lower body lift. Do your research.  Make sure they have performed at least 150 circumferential lower body lift surgeries and have the before-and-after pictures to prove it.  Carefully examine their before-and-after pictures and check their reviews on RealSelf.  If you cannot find an experienced plastic surgeon in your neighborhood, consider traveling out of state.  Sincerely, Dr. Katzen. ( Plastic Surgeon, President of  the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Jamil Ahmad, MD · Answer

Congratulations on all your hard work at achieving such an
incredible weight loss. It is recommended that patients reach their ideal weight
and maintain it steadily for approximately 3 months before considering a
surgical procedure to contour the body. Any further weight loss or gain will
have an impact on the results you achieve following surgery. 
In Ontario the only coverage available to remove excess
skin and fat is for the Panniculectomy. This procedure differs from the
abdominoplasty or tummy tuck because it is strictly for the removal of extra
fat and skin in the abdominal area. You will need to see your doctor to determine
if you are a candidate to for this procedure. Your doctor will refer you to a surgeon
who performs this surgery and an application to OHIP will be completed on your
behalf for review and approval.
Where the abdominoplasty differs, is that not only is the
fat and skin removed, the surgeon also tightens the muscles and takes special
care to contour the area for the best aesthetically pleasing results. 
The panniculectomy procedure is typically performed by a
general surgeon. I encourage patients to meet with more than one surgeon to find
the right fit. If you are considering an abdominoplasty or other cosmetic
surgery, always meet with surgeons who are Board Certified Plastic Surgeons. 
All the best,

Alejandro J. Quiroz, MD · Answer

There are no rules for after weigh loss.  After you start loosing your weigh normally the patient plateau and if there are less than 20 pound of close to reach the ideal weigh loss the plastic surgery can be perform and even if the patient looses some more weigh there is not going to be any effect in the result of the plastic surgery

Tarick K. Smiley, MD - Account Suspended · Answer

As long as you're reasonably satisfied with your weight (and it is within a healthy weight range), body lift via excision-based techniques such as tummy tuck, arm lift, back lift, among others, can be a great option.

The general rule is to have your weight stable 6-12 months to ensure that you can really stick to a healthy lifestyle.  Take note that significant weight fluctuations can affect if not reverse the surgery's results.

Also, the waiting period allows you to recover from malnutrition.  You may not be aware of this, but massive weight loss patients have some type of malnutrition (e.g., iron deficiency) due to the sudden change in their diet.  For this reason, surgeons typically work with their patients' bariatric doctor or primary care physician to eliminate or at least control potential risks.

In terms of insurance coverage, most issuers will only pay the cost if you are able to demonstrate that the excess skin is causing non-healing irritation, skin breakdown, and back pain due to the heavy saggy abdominal skin.  Hence, you must present medical evidence showing that your surgery is beyond cosmetic improvement.

Good luck and best wishes.

How long should I wait to have loose skin removed after weight loss, and does OHIP cover any portion?

Answers (4)

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