The Question

One thing many people do not fully appreciate, even with the most detailed and comprehensive medical overview, is just how bariatric surgery will alter their appearance, or the impact it may have on their lives afterward. At Atlantic Coast Aesthetics, we receive many questions about options for post-bariatric surgery and why and how they work. In this week’s Ask Dr. Pane segment, our founder and Chief Medical Officer, Dr. Thomas A Pane, discusses the options patients who have been through bariatric surgery have and some crucial facts they need to know.

The Answer

Through periods of extended weight gain and plateauing, the skin stretches out and loses elasticity and resilience. This results in stretch marks, “bat wings” and pronounced sagging. When the weight melts off, either as a result of bariatric surgery or intensive diet and exercise, all these effects can be significantly amplified, leading to excess skin hanging down around the thighs, upper arms, torso and elsewhere. For obvious reasons, this can leave patients feeling healthier, but far less physically attractive and comfortable in their own skins.

In most cases, insurance companies do not pay for post-bariatric surgical intervention without a compelling medical reason. For this reason, many patients find themselves paying out of pocket for these sorts of procedures, which are considered cosmetic and not medically necessary in general cases. Depending upon the individual patient’s situation, there are a number of financing options available both through ACA and other channels. In a few cases, an insurance company may be persuaded to approve post-bariatric corrective procedures, but these cases almost universally carry very stringent and narrow criteria. This does not mean it will not happen in your specific case, but having alternative payment strategies in place beforehand will offer additional peace of mind if the insurance company does deny the claim.

Currently, no reliable nonsurgical corrective procedures for excess skin exist, and skin cannot be exercised back into shape. This is because when the skin is stretched for long periods of time, the collagen, a chemical lattice which lends the skin its elasticity and ability to return to its original shape, begins to break down. Since collagen cannot be regenerated with current medical knowledge, the only option which assures permanent results is surgical intervention.

Depending on the location and severity of the excess skin, a number of individual procedures may be considered, on their own or in conjunction with other corrective surgeries. These include procedures such as neck, breast, arm, thigh and body lifts, as well as tummy tucks. All of these procedures function mostly the same way from a practical standpoint, their primary differences arising from the vulnerability, complexity and visibility of the areas in question.

In all these cases, incisions are made to remove the worn-out skin. The surgeon then stretches and attaches the remaining, healthy skin to healthy skin. How and where these incisions are made will be largely impacted by the available options for concealing the scars surgery inevitably leaves, the amount and location of the damaged skin and how much healthy skin will be available after the damaged skin is excised. Ideally, the incisions will be made in areas such as the creases of the inner thighs and under the breasts, because these areas lend themselves to concealing the scars or at least reducing their visibility.

Decisions about post-bariatric or any other cosmetic surgical procedure should always be made by the patient and surgeon, working together to determine the treatment path most likely to deliver optimal results. By establishing and maintaining realistic expectations concerning the outcome of the procedure as well as a relationship predicated on trust, openness and free communication, the odds of a successful outcome and a satisfied patient increase vastly. In addition, compliance with postoperative directions and immediate reporting of any suspected problems can help prevent difficulties before they have a chance to begin.

At Atlantic Coast Aesthetics, we believe passionately in the importance of patient education. Because of this, we make it a point to be available to address questions, concerns and points of interest on all things related to cosmetic surgery. You can contact us through ACA’s website at https://acplasticsurg.com, by phone at (561) 442-4116 or by following us on Twitter and Facebook. It’s even possible your question may be selected as the focus of an upcoming Ask Dr. Pane segment, answering your question live in a Google Hangout and helping others who may share your interests and concerns. Remember, at ACA we believe the only bad question is the one you don’t ask!