Bariatric surgery can shrink the body faster than skin can follow. Skin that stretched over years of carrying extra weight does not shrink back on the same schedule, and many patients who lose 100 pounds or more find folds of loose skin where the weight used to be.
Plastic surgery after weight loss addresses that leftover skin. Dr. Leo Lapuerta, a triple board-certified plastic surgeon in the Houston area with more than 30 years of experience, describes the work as a combination of procedures that remove loose skin while tightening the underlying tissue and muscle. The questions below draw on his practice’s published guidance.
Who is a candidate, and when?
The practice describes the ideal candidate as someone who has lost a significant amount of weight and is left with loose, hanging skin. Candidates should no longer be trying to lose weight and should have held the same weight for somewhere between six months and a year. They should be in good overall health and have realistic expectations.
The practice advises patients who are still losing weight, or at risk of regaining it, to wait. The practice also notes one nuance: most plastic surgeons want patients at or near their goal weight, but in some cases removing loose skin helps a patient lose the final pounds, for instance when the skin gets in the way of exercise and mobility. That is a judgment call for the surgeon and patient to make together.
Is this only about appearance?
Not for many patients. According to the practice, excess skin can cause irritation, rashes, back pain and an unpleasant odor. On the abdomen, skin that hangs down and rubs against other skin can lead to rashes, irritation and even open wounds, and removing it can mean fewer skin problems afterward.
Dr. Lapuerta also reports something he sees at follow-up visits after cosmetic surgery in general. Partners who were unsure about the decision at the consultation often tell him later that they noticed more energy, a renewed interest in healthy eating and exercise, and a return of the patient’s old personality. He says some of them wish they had supported the surgery sooner.
Which areas can be treated?
The practice lists these common areas and approaches:
- Breasts: a breast lift removes excess skin and repositions the breasts; some patients add breast augmentation if they liked their pre-weight-loss size or shape.
- Abdomen: a panniculectomy removes hanging skin, sometimes with liposuction and a tummy tuck.
- Hips and buttocks: a lower body lift can remove excess skin and fat on the hips and lift the buttocks.
- Knees and inner thighs: a lower body lift can include these areas.
- Arms: hanging skin on the underside of the upper arms, often treated as part of an upper body lift.
- Neck: a neck lift removes loose skin and can include liposuction under the chin.
Can it all happen in one operation?
Often not, when several areas need work. The practice notes that most surgeons group body areas together and stage them across multiple surgeries, which helps reduce the risk of complications such as blood loss and infection. An upper body combination often includes liposuction, breast lift, tummy tuck and arm lift. A lower body combination tends to include liposuction, butt lift, thigh lift and lower body lift.
Surgery takes place under general anesthesia in an accredited surgical facility. Dr. Lapuerta owns and operates a QuadA (AAAASF) accredited facility and works with physician anesthesiologists. According to the practice, the procedure can last up to five hours, depending on which areas are treated. Surgeons may place drains to remove fluid, and liposuction may be added for stubborn pockets of fat.
What does recovery look like?
The practice calls panniculectomy recovery a slow process. Patients usually spend the night in the hospital for monitoring, and they can expect swelling, bruising and discomfort at first. Most will need help around the house for the first few days and can return to work after about a week.
Exercise and strenuous activity should wait for at least a few weeks, and a full recovery takes about 2 to 3 months, according to the practice. Scarring comes with this surgery, and like any operation it carries risks that a surgeon should explain in person. Regaining weight can reverse the result.
On cost, the practice’s answer to the insurance question is direct: in most cases insurers consider this surgery cosmetic and do not cover it, though individual cases differ, and its billing coordinator checks each patient’s benefits.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.
