Dr. Pane weighs the potential benefits and drawbacks of cosmetic surgery after rapid weight loss.
The Question
One of the more common questions we receive at Atlantic Coast Aesthetics deals with excess skin after rapid weight loss. There are numerous reasons people may lose weight quickly: during illness, after childbirth, finding a diet and exercise regimen that works and after bariatric surgery, just to name a few. This can result in loose, floppy skin around the arms, abdomen, buttocks, thighs and upper legs. One example is the subject of this week’s Ask Dr. Pane segment, coming to us all the way from New Orleans! The patient asks: I’ve went down from 315lbs since last October to 175lbs now. I feel so sloppy EVERYWHERE! I would love to know what procedures are suggested for me. I do have Medicaid and they will pay for excess skin removal on my entire body but I know that’s probably not all that I need.
The Case
Dr. Pane evaluated the photographs the patient included and noted that the primary area of concern for this particular patient is the abdomen. Another consideration is whether the patient’s insurance will cover a full body lift or simply an extended tummy tuck, or abdominoplasty. While many insurers will cover abdominoplasty after rapid weight loss, it is less likely that they will cover skin lifts on the thighs, even less so for the arms and almost never for the breasts, absent a pressing medical need which is very rare to actually have present.
Dr. Pane’s Opinion
When a person gains a lot of weight and then loses it rapidly, it is common for the person’s skin to stretch to accommodate the additional weight and then lose elasticity as it stretches. However, as the weight is lost, the skin remains in that stretched-out state. In many cases, cosmetic surgery may be the only practical option to effectively remove the excess skin and restore at least some elasticity to the skin that remains.
In this case, given the patient’s photos and stated medical history, Dr. Pane says an extended abdominoplasty would be the optimum starting point. Many patients find they get better results throughout the body with a single procedure, which is obviously less invasive than a number of smaller procedures at various specific points. In some cases, a vertical incision may be necessary to optimize the results and remove more excess skin than a standard lateral abdominoplasty, but if the patient is particularly self-conscious about showing scars, this may not be an ideal option.
Other Considerations
Evaluating a patient solely from a description and photographs is very difficult, especially in cases like these, because it is hard to properly determine where the major problem areas as perceived by the patient lie. In addition, skin elasticity and laxity, a detailed medical history and any potential complicating factors lie outside the scope of a brief review. For best results, the patient should undergo a comprehensive in-person clinical examination to help craft a treatment plan that best meets the patient’s needs and requirements.
Depending on the patient’s physical and emotional needs, a “body lift,” where the scar goes most of the way around the body and terminates at the back, may be a better choice. However, for this specific situation, Dr. Pane feels the extended abdominoplasty would be of most immediate and obvious benefit. The first reason for this is that when the skin of the abdomen is pulled tight, especially along the vertical axis, the skin in other areas will perforce “migrate” a little, making the overall result more apparent and dramatic. Second, doing the extended abdominoplasty instead of a full body lift targets the effort in a single area, making the procedure less lengthy and reducing the risk of potential complications that may otherwise arise.
If you have a question regarding any facet of cosmetic surgery for any part of the body, Dr. Pane and the staff of ACA are always happy to answer any questions, comments or concerns you may have! Simply follow us on Twitter and Facebook, email us at https://acplasticsurg.com or call us at (561) 422-4116. Your question may even be selected as the focus of an upcoming Ask Dr. Pane segment, which means the doctor will address your question live in a Google Hangout. It’s a great way to help us inform others while getting the answers you need. Remember, at ACA we believe the only bad question is the one you don’t ask!