(show aired 2/15/14)


Let’s start by defining just what is Bariatric Surgery. This is the field of medicine that treats obesity and issues related to it. One aspect that is quite common  deals with surgical intervention to help people who are severely overweight or obese – whether that is through gastric bypass, lap band, the vertical sleeve, etc. – to lose weight.

Typically these patients  are at risk for obesity-related illnesses like diabetes, hypertension, sleep apnea. If considered morbidly obese, their condition can become life threatening. Have you ever thought about what happens to all that skin that might not shrink back? Skin has the remarkable ability to stretch during pregnancy.  For some, after childbirth they look great but for others they never seem to be able to lose the extra spare tire around the midsection. That’s true – now  with massive weight gain, the skin is similarly stretched and may not always contract – especially if the weight loss is 100 pounds or  more and done so very quickly?

The option  for surgical intervention to achieve massive weight loss is available. In the United States alone.  A majority of cases, patients will be left with excessive, sagging skin in many areas of the body.  Plastic surgeons are then needed to perform a number of reconstructive procedures following massive weight loss.  These procedures are grouped under the term post bariatric reconstructive surgery or in laymen’s terms, simply body contouring.  Today we are going to explore the very painful side of this subject people rarely talk about.

I’ve seen people lose well over 150 pounds and not need anything done – they look as if they never had an issue with weight.  But there are many factors that are at work – to mention two:
  1. the skin’s age
  2. the ability of the skin to stretch or the amount of elasticity left in the skin

Again, think of any garment that has an elastic waistband – after so many washes the elastic needs to be replaced – it just doesn’t work; with the skin – the more significant the stretch, the less likely it will come back completely.  The more weight lost, the more likely the person may need reconstructive plastic surgery.


Over the 30 plus years, I’ve seen literally hundreds of men and women who lost 80, 100, 150 pounds or more.  Imagine that as  a result, you now had a large apron of skin that literally hangs down to just above your knees.  I’m not exaggerating here. Many people actually have to face this battle everyday of their lives. We never consider that they are physically impaired and have limitations the rest of the population take for granted.  It’s a subject we don’t talk about – we avoid it. Even minor amounts of excess skin can become moist and harbor bacteria which can lead to chronic skin infections that are impossible to eradicate.  With constant skin on skin contact – its difficult to keep the area clean. Some people dealing with this issue become severely depressed and I think we as a society need to be more compassionate when it comes to how we treat this and how we talk about it.

Procedures Related to Skin Removal Surgery: 

  1. Lower Body Lift – (Circumferential) a complete lower body lift is a major surgery following massive weight loss;  includes removing pockets of remaining fat and loose, redundant or sagging skin in  the abdomen, buttoks, waist, hips and thighs in one surgery.  An incision is placed in the lower abdomen, across the hips and onto the buttocks. The abdominal muscles are tightened,  excess skin and fat are permanently removed from these areas; depending on the patient, some liposuction may be needed to further contour the body. Results can be seen immediately.  Final results take time to develop because it will be affected by diet, exercise and lifestyle  (may not be seen for 1 to 2 years).  
  2. Breast Lift – Mastopexy – is designed to lift the breast by re-positioning the nipple and areola to a higher position on the chest wall; depending on the patient, may need to add breast  implants for fullness, shape and size.  If there is enough breast tissue after weight loss it may not be needed. 
  3. Arm Lift – (Brachioplasty) surgical procedure used to reshape the underside of the arm from the area beginning near the armpit down to the elbow.  Removes excessive sagging skin.  Can leave an unsightly scar so be careful the view before and after pics. Exercise may improve the underlying muscle tone but does not address skin that likely has lost elasticity.  Ask your doctor about the scar and how the area heal; in other words, though the initial  incision is thin, what are the chances the scar will widen during the healing process.
  1. Thigh Lift  – This procedure gets a mixed bag of reviews – either you will love it or hate it. YOU DEFINITELY NEED TO HAVE A TRUSTED RESOURCE FOR THIS PROCEDURE.   The incision for a inner thigh lift is from the groin area down in most cases.  Newer techniques that include liposuction are also available.

Other singular procedures:

  1. Abdominoplasty
  2. Panniculectomy
  3. Liposuction

Insurance and Post Bariatric Plastic Surgery

Even our healthcare system can be dismissive when it comes to treating post bariatric patients.  We still have to fight to get their surgeries covered – it takes a compassionate surgeon to become the voice for this group of patients.   It is unthinkable that insurance companies that provide health care often cannot see the medical necessity.  Even some medical professionals/doctors continue to  think of this type of surgery as cosmetic. When you recognize the discrimination that goes on in our industry someone has to be the voice for the patient.   If the doctor doesn’t care to follow up and help the patient establish a case, then the patient is out of luck.  EVERYTHING REQUIRES VERY SPECIFIC DOCUMENTATION AND EVEN WHEN YOU PROVIDE THAT, YOU CAN BE DENIED COVERAGE.  It takes a lot to meet criteria and submit it according to the guidelines.

All of these cases should be considered reconstructive in nature because post bariatric patients not only have redundant, hanging tissue but under the skin when it is lifted they deal with macerated skin, sometimes even ulcers can form under the skin.  Along with that comes the embarrassing body odor, sweating, itching.  In the summer months it’s worse because the area stays wet.  You cannot imagine the relief they feel once that is surgically removed.  In most cases insurance covers the costs but even that is a process they have to deal with.  Most doctors offices should have an insurance specialist to go through a predetermination process to get this approved for patients who are suffering this way.

Skin Donation After Post Bariatric Plastic Surgery

Did you know that skin can be donated and used for a worthy cause? Skin can be donated following massive weight loss- usually it is discarded.   If you have lost 100 or more pounds and have the skin surgically removed you can donate it to help others.  Certain medical criteria must be met.

Some donor patients include:

  1. Breast cancer patients to reconstruct the breast after a mastectomy
  2. Those who suffer from urinary incontinence may need pelvic floor reconstruction
  3. Used to repair an abdominal wall  in the case of hernias or trauma
  4. People with skin defects secondary to an injury or birth defect

 Your generous donation is made possible through the Musculoskeletal Transplant Foundation – they are a non profit service organization dedicated to providing quality tissue to improve outcomes of transplant surgery.

Don’t just look at before and after photos when choosing a plastic surgeon. Make sure the surgeon is board certified in the specialty you are seeking. Click here to get questions to ask your surgeon for post bariatric plastic surgery.