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Life After Massive Weight Loss: Skin removal surgery

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Own Your New Life

Congratulations! No matter what type of weight loss surgery you’ve chosen (gastric bypass, gastric sleeve, or maybe you’ve dieted and worked out only…), you have taken a serious step toward a healthier and more fulfilling life. No type of weight loss is easy. Some suggest that diet and exercise is the most difficult type of weight loss, but that isn’t necessarily true. No matter the method of weight loss, it is a lifestyle change that needs to be maintained and you will have to adjust to the new you.

A new you, and a new challenge

Many people that undergo weight loss surgery, or any form of rapid massive weight loss, are unaware that their bodies will change rapidly. While you expect to be thinner and to feel better, sometimes the skin doesn’t shrink as much as you would like. This varies for different people. The important thing to realize is that you are not alone. Recently, there have been massive weight loss patients that have shown their extra skin on videos, such as those on YouTube. This is great in that it helps to break down the stigma of extra skin.

During your weight loss period, you will need to begin to understand your new body. Many patients are shocked to find that they traded one problem for another. The most common thing noticed is that there is extra skin around the lower abdomen that can sometimes hang like an “apron.” This can make it difficult to keep clean and to exercise. I have had patients tell me they would rather gain the weight back than to have the hanging skin because it is embarrassing. It is difficult for a patient to have been judged or to have felt insecure previously about his/her body to now have a different and new insecurity. I always tell patients to see this stage as a transitional stage rather than the “final” stage of their bodies. It’s important to focus on good nutrition and staying healthy during this time period.

You are not alone!

Another important aspect in accepting your body’s transition during the time of weight loss is to know that you are not alone. So many other people have gone through this same phenomenon, and reaching out through groups on the internet through sites like Facebook, Instagram, and other blogs can really help.

When you are going through the weight loss process alone, it is important to have support. If you don’t have someone in your life that can offer that, that’s okay. You can find others on the sites mentioned above, and I always recommend a daily morning ritual of inspiration. This can be something as simple as a quote book or a daily inspirational quote calendar. While some patients find this a laughable thing to do, it can really help start your day off. Focusing on a positive message can help you when you have those struggle days. And you will have those days. One little trick is to either write down a quote or inspirational message on a notecard or tear a sheet off your inspirational calendar and tape it to your bathroom mirror before going to bed each night. That way, you can focus on the positive message as you’re getting ready the next morning. Just give it a try 

Focus on Health and Nutrition

You will find that no matter the weight loss surgery route you chose, you will be eating much smaller portions. Different types of surgeries also can contribute to difficulties absorbing certain vitamins and minerals. For this reason, you will at least want to be on a multi-vitamin and you will need to talk with your bariatric surgeon about supplements that you should be taking.

Even though you have had weight loss surgery, you will want to focus on foods that are healthy. Usually, when you start to lose weight, you will be inspired to live a healthier lifestyle. There is no need to be on a strict diet, but you will want to focus on eating healthy foods, such as vegetables and lean meats like chicken and fish. If you base your daily foods around these healthy items you will find that you feel better.

Get to the gym

This can be one of the hardest things to do for patients losing weight. Most patients that have been heavy feel very self-conscious in the gym, so let’s really hash out those feelings:

Be honest with yourself

The first step in resolving an issue, such as feeling self-conscious is to recognize the feeling. There’s no use in ignoring it, so go ahead and admit to yourself that going to the gym makes you feel intimidated or self-conscious.

Realize that you are not alone

Pretty much everyone has these feelings. Here’s a little secret: There will always be someone smarter, more fit, better looking etc. than any one person. I don’t care if you are the beautified incarnation of Brad Pitt and Angelina Jolie, you will still be able to find someone who is better or more accomplished. Understand that even the fittest people in the gym have insecurities.

What others think doesn’t matter

Realize that it doesn’t matter if someone else judges you. You must relinquish the things that you have no control over. You cannot control other people’s thoughts. You can only control your own. You cannot control other people’s actions. You can only control your own. Accept that what other people see, think, or interpret is out of your control. Once you have done that, it will be easier for you to stop caring what others think about you.

Get out of your own head!

Stop that negative thought reel that keeps playing through your head! Replace those negative thoughts with positive thoughts, even if you don’t yet believe those thoughts. This is where having a daily quote calendar or something inspirational for every day can really help. Focus on a positive message about yourself. Again, even if you don’t believe it, repeat it when you feel self-conscious. While such intimidation is most commonly felt in places such as the gym, you can feel intimidated or self-conscious at work or at the store. Train yourself to combat those feelings with positive messages.

Start small.

The gym can be an over-whelming place for many. There are machines everywhere, many or all of them that you have never used. Trying to figure out how to even use a machine can be a challenge. There are a million treadmills with complex buttons offering all sorts of different workouts and all you want to do is to quietly slip onto one and jog. Again, take a deep breath, and realize that you are not alone. The best way to get started with fitness is to start small. If you haven’t walked a mile in years, then start walking outside. Once you’ve conquered a mile or whatever your first goal is, then start timing yourself and speed up that walking until you can jog a mile. Don’t focus on some long-term feat, such as running 3 miles. Focus on the short term goals. Once you are ready to go to the gym, sign up for a few personal training sessions. Many gyms offer a free introductory personal training session. A few of these will help you get oriented with the layout of the gym, how to use most of the equipment, and can provide you with a few basic workouts. It’s so much better to go to the gym with a plan that you can execute, rather than milling about trying to decide what you should do. A few training sessions are well worth the cost.

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Skin Removal Surgery

Many patients that undergo major weight loss wonder if they are candidates for skin removal surgery. If you watch shows like “The Biggest Loser,” you’ll notice that after contestants have lost large amounts of weight, they will often visit a doctor for an evaluation for skin removal surgeries. They go in with anticipation to see if they are a “candidate” for the surgery.

Are you a candidate?

In order to be a candidate, most plastic surgeons will require that your weight has been stable for at least 3 months, and most will require 6 months of stable weight. Beyond that, you should be in good health, meaning that any medical problems like high blood pressure are at least well controlled with medications, and that you are fit enough to walk one flight of stairs without stopping for a breath. Other considerations, such as your nutrition status, whether you have a history of blood clots or breathing problems will be considered, as well. However, most patients after massive weight loss are much healthier than they were prior to weight loss, so most are surgical candidates.

Selecting a Surgeon

It can seem overwhelming to find a surgeon to perform your surgeries. Often patients begin by asking friends that have been through the process or by using the internet to search for surgeons that specialize in “body-contouring after massive weight loss” near their city. One thing to evaluate when finding a surgeon is whether he/she was trained to do plastic surgery. There are many surgeons that practice “plastic surgery” but they did not do a residency or training program in “plastic and reconstructive surgery” and they are not candidates to be board certified by the American Board of Plastic Surgery. You can read more about board certification on the American Board of Plastic Surgery website, but this is an important thing to ask your doctor.

Should I travel for my surgery?

Some patients may wish to travel to another city for their surgery. This can be because they live in an area with very limited access to plastic surgery or because they found a price or surgeon elsewhere. You want to be cautious in doing this. In general, it is probably better to find a qualified surgeon near your home for recovery purposes. If you are going to travel for surgery, ask you surgeon what he/she recommends. At a minimum, you will want a week (5-7 days) near your surgeon so that you can be monitored those first few days after surgery. For surgeons that have “fly-in” programs, they may be able to offer you a package for staying nearby. 5-7 days is usually the minimum amount of post-surgery recovery time before flying, though the exact time you are okay to fly after long surgeries hasn’t been well defined. Find out more about recovery below.

What are my options for skin removal?

Abdomen

The abdomen is the place that most weight loss patients report as their biggest “problem area.” Many refer to having an “apron” that causes them emotional and physical discomfort. The abdomen skin is usually the area that patients want to first address. In addressing this region, it often gives patients a boost of confidence to continue with a healthy lifestyle and many patients lose more weight after addressing the abdomen because they are able to do more physical activity.

Abdominal contouring options

Panniculectomy

The most fundamental or basic option is what’s called a “panniculectomy.” The “pannus” is the medical term for that apron of skin that hangs down over your pubic bone. This skin can get very irritated as it hangs on top of other skin and can be difficult to keep clean. It can also get in the way of wearing clothes that fit the rest of your body and can certainly get in the way of exercise. To have this apron or pannus removed and the skin edges sutured back together is a “panniculectomy.” This does nothing to move or improve the appearance of the belly button, and it does not tighten your abdominal muscles or address any extra on the sides(“love handle” region).

So, because a panniculectomy is strictly removing the skin that may get irritated, have sores, or be difficult for movements and exercises, it is covered by insurance. Often the results of a panniculectomy are less appealing than those of a tummy tuck, but if you are unable to afford a tummy tuck it can be a good step to keep you moving and feeling better.

The Tummy Tuck

The standard tummy tuck or “abdominoplasty” also removes the apron or pannus of skin but it goes beyond that. It tapers in the sides to some degree, making the hips look a little better. The two key things it also provides are that it 1.) Gives you a new belly button and 2.) tightens your abdominal muscles.

#
p<>{color:#000;}. The Belly Button

Let’s talk about the first thing (the new belly button). Many people take a nice belly button for granted. But a youthful “healthy” belly button is one of the most important parts of having a nice abdomen. You can have a really flat and well-contoured abdomen, but if the belly button hangs or looks odd, the abdomen doesn’t look quite normal. Most people that have lost large amounts of weight have excess skin and tissue above their belly buttons. We sometimes refer to this as “hooding” of the belly button. This is taken care of with a tummy tuck.

#
p<>{color:#000;}. Abdominal Muscle Tightening

Now, let’s talk about the second main advantage of a tummy tuck: tightening the abdominal muscles. First of all, lets define what is meant by the term “abdominal muscles.” The abdominal muscles, for the purpose of a tummy tuck, refer to your rectus abdominus or “abs.” You may laugh and state that you don’t have abs, but actually you do. In fact, everyone has “abs” but most of us have some fat over our abs so that they don’t show up like a fitness model. The rectus abdominus muscles (there are two), should sit side-by-side. However, after you’ve expanded your abdomen with things like weight gain or pregnancy, these get stretched so that they are no longer side-by-side in the midline of your abdomen, but sitting out to the sides. This allows the stuff behind your muscles (your intestines and organs) to be lax and appear “slouchy.” The medical term for this is “rectus diastasis.” By tightening these two muscles and bringing them back together down the center of your abdomen, it’s like a corset effect for your middle body. This is one of the main advantages to a tummy tuck, but it’s also one of the reasons that a tummy tuck is painful. Tightening the muscles doesn’t feel good right away, but it will give you a much better result, and doing so allows your plastic surgeon to remove a little bit more skin off your tummy.

 

The image above shows the gap between the abdominal muscles that is then repaired during a tummy tuck.

The image above demonstrates the standard tummy tuck. Red arrows indicate the skin that is removed between the belly button and the pubic bone area. The green area indicates the skin that is raised off of the abdominal muscles to then be pulled down to create the new abdomen. The blue marks indicate the final scar.

The Fluer-de-lis Tummy Tuck

Now, there are extensions of that basic tummy tuck we just discussed. One extension of it is called a fleur-de-lis tummy tuck. This involves taking skin not only below your belly button in that “apron” area, but also up and down (vertically) on your abdomen so that it cinches in your waist more. Most massive weight loss patients have extra skin hanging off their waists or sides, and by removing skin up and down in the center of the abdomen, it allows this to be pulled in. Imagine what a corset does for the waist, and that’s similar to what the fleur-de-lis accomplishes. The downside to this type of tummy tuck is that it leaves a scar vertically on your abdomen. Many patients would just rather have the best contour or shape, so they are willing to have whatever scars. But, if you are very scar-conscious, this probably isn’t the tummy tuck for you. In the image below, the red arrows indicate the horizontal skin removal (like that for a regular tummy tuck) and the purple arrows indicate the vertical skin removal. Blue marks indicate the final scars.

The Belt Lipectomy

The belt lipectomy addresses the abdomen with a tummy tuck but then extends that incision around both sides and onto the back (the final scar runs around your lower waist like a belt). This operation addresses several problem areas at once, removing skin from the abdomen, the sides (love handles), the outer upper thighs, and the upper buttocks (a buttocks lift). See the image below to see what happens on the back during a belt lipectomy. The front is like a standard tummy tuck. This is often the go-to procedure for massive weight loss patients looking to remove the most skin from the trunk in one operation. In the image below, the red marks indicate skin removed off the upper buttock region and the blue marks are the final scar along the border of the upper buttock and lower back.

The Corset Trunk-Plasty

Remember that Fluer-de-lis tummy tuck? The “trunk-plasty” is like the Fleur-de-lis Turbo. So, not only do you get the skin below your belly button (apron) removed, as well as the vertical (up and down) portion of abdominal skin, but an extra removal happens horizontally under your breast fold or chest fold and toward your back, the final incision is like a large letter “I”, with your new belly button placed in the lower 1/3 of that “I”. This has a very dramatic contouring (shape) effect. For someone with lots of skin that hangs off the abdomen and the sides, this is the most effective way to remove it at once. However, as with any operation that removes maximum amounts of skin, you trade the skin removal for scars. This is perfect for the patient looking for the best shape, and who is less concerned about scarring. The abdominal muscles are tightened just like in a regular tummy tuck and in the Fleur-de-lis tummy tuck.

In a corset “trunk-plasty,” essentially all of the skin on the abdomen is removed and the back skin is pulled around to now become the abdominal skin. That may sound a little crazy, but it can really pull in the waist and smooth out the abdomen and the back. In the image below, the green arrows indicate the movement of back skin around to the front. Red marks indicate the skin that is removed from the abdomen.

 

Arms

The arms, along with the thighs, are commonly the second area that weight loss patients want addressed (after the abdomen/trunk region). Some patients don’t have too much issues with arms after weight loss, but for those that lose excess of 80 lbs, the arms are going to have extra skin on the under surface. This can be variable in severity, but the majority of patients will need what is known as a “full brachioplasty.” This involves resection of that skin along the inner surface of the arm with or without liposuction of the upper arm. The arm can be one of the places on the body more resistant to fat loss. So, even though you may have lost an extreme amount of weight, there can be both excess skin and fat in the arm. That’s where liposuction can become a useful adjunct to the skin resection. The unfortunate aspect of removing arm skin is the scar. While care is taken to keep the scar on the inner surface of the upper arm so that it is hidden when the arms are at your side, such as when walking, there is no getting around a long scar on the inner surface. These scars tend to be a little wider and redder than other scars on the body. This is likely due to the fact that the skin is pulled very tight for the closure and there is stretching of the scar due to arm movement. So, much like the more extensive abdominal and trunk contouring surgeries, a patient must be willing to trade better shape to the arms with less hanging skin for a scar that can sometimes be difficult to conceal.

Legs

Along with the arms, legs are typically addressed after the abdomen/trunk has been addressed. Like the arms, even after losing a very large amount of weight, the legs can retain some fat. This is where liposuction will typically play a role in helping to remove that. However, liposuction alone will not address the extra skin issue. The massive weight loss patient usually has excess skin hanging on the inner or “medial” thighs. This skin tends to spiral down the leg to hang off the inner, upper knee when standing. Because of this, the usual thigh lift involves removal of skin along that inner thigh, resulting in a long scar from the inner groin and down the inner leg to the knee. Fortunately, it is rare that any excess skin needs to be removed below the knees. Often, with the combination of liposuction and removal of skin on the inner thighs, the outer thighs get pulled tighter as well. Occasionally, an additional outer thigh lift will need to be performed. Sometimes, this outer thigh lifting is combined with a belt lipectomy (see above) and so the outer thigh may have already been addressed if a belt lipectomy was performed.

Face

For the younger patient that undergoes massive weight loss, the face tends to retract fairly well. However, older patients will notice more skin hanging from the face after major weight loss. Ironically, some of the fat loss in the face may not be advantageous, as we know that having fat in the right places in the face creates a youthful appearance. If there is excess skin on the face after weight loss, it tends to accumulate around the “jowls” meaning it hangs off the lower jaw and the middle neck. To address this, typically a full “facelift” is performed. The good thing about a facelift is that the incisions can usually be well hidden along the ear creases and hairline. A full facelift addresses the middle and lower face, as well as the jawline and neck. Some combine a brow/forehead lift along with this, but that isn’t necessarily a problem area associated with massive weight loss. Again, the more common area with excess skin on the face for massive weight loss patients is the area along the jaw and neck.

 

Breasts/Chest

For women after massive weight loss, the breasts will lose volume just like the rest of the body. That’s because, give or take, about 50% of the breast is made up of fat. Like the face, this is sort of the unfortunate fat loss because it allows the remaining breast skin to hang. Many women come for a consultation in hopes that a breast lift or “mastopexy” alone will correct the abnormality. A breast lift, which involves removing skin to raise the breast position, can help but usually this is combined with placement of breast implants. This recommendation can be shocking to patients, many of whom state that they’ve always had large breasts and they think it’s odd to have lost all the weight only to now need breast implants. That is understandable. The advantage to using a breast implant is that it fills out the upper part of the breasts. With loss of fat, there is often a very hollow appearance to the upper breasts. While lifting the skin can make it so that the breast skin doesn’t hang or sit on the upper abdomen, it does very little to fill out the upper part of the breasts. That is why breast implants can be of use. However, it is certainly the patient’s decision, and if you only want the skin to be lifted that is, of course, okay. Along with the removal of excess skin in a breast lift, the areola is typically made smaller, as well as lifted to a more youthful position. Most of the scarring patterns for the breast lift (with or without implants) will be the “anchor” scar, with an incision around the areola, then straight down the lower portion of the breast and then across the breast fold (appearing like an anchor). The good thing about breast incisions is that they tend to fade well over time.

For men, the chest often hangs after massive weight loss. This can be less severe than for breasts, and sometimes men do not want the loose skin on the chest addressed. However, for the more dramatic cases or for those that would like a better contour, various amounts of skin can be removed from the chest, ranging from only the skin around the areola, which will remove skin and make the areola smaller, to more extensive skin removals that will leave more scarring on the chest.

Combining multiple surgeries

It’s common for patients to want to combine multiple surgeries. Combining surgeries at once has several advantages. Many patients seek this in order to reduce costs (see below) because combining surgeries can decrease the cost for anesthesia and for the surgical facility. Another advantage is that there is one recovery period versus waiting to recovery from one surgery and then undergoing another surgery that needs a recovery period. However, when you are going home the same day and/or having surgery in an outpatient operating center instead of a hospital, the time under anesthesia should be limited to 6-7 hours. That anesthetic limit restricts the amount that can be done at once. Also, your body can only handle so much. Typically, a tummy tuck can be combined with either breast/chest OR arm surgery. A belt lipectomy, as well as the trunk-plasty, is usually performed alone. Arms OR Breasts can be combined with thigh lifts. The best plan is to talk with your surgeon about your goals, prioritize those goals, and then have a discussion with him/her to create a plan that includes which surgeries can be combined.

Cost

Unfortunately, the only skin removal surgery usually covered by insurance is the panniculectomy (strictly removing the lower abdomen pannus or “apron”). For the others, it is an expense. How are costs for surgery calculated? Well, there is a surgeon fee (this is the amount your surgeon receives for performing the surgery), the anesthesia fee (the amount used to pay the anesthesiologist and for the medicines etc…), and the facility charge (the amount the operating room charges to use the space, surgical instruments etc…). Remember that from the surgeon’s fee, the rest of the surgical staff, including a nurse, and a surgical assistant must be paid. While costs vary from state to state by small amounts and somewhat from surgeon to surgeon, you can expect to pay around the following averages (Averages from RealSelf.com) when you are doing each surgery individually:

Tummy tuck: $8,200.00

Belt Lipectomy or Trunk-plasty: $15,100.00

Arm surgery (brachioplasty): $7,275.00

Thigh lift: $8,425.00

Breast lift with implants: $8,800.00

Facelift: $12,000.00

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Recovery

Recovery from body contouring surgery depends on which procedure you have done and whether you have multiple procedures done at once. Overall, any procedure that involves the tummy tuck, in which the abdominal muscles are tightened, is going to be fairly painful. Any time a muscle is involved in a surgery, there tends to be more pain. In general, the first 3 days after surgery are the toughest, with many patients stating that the 3rd day is the worst. For the most part, things tend to get better after 3 days. In general, incisions can get wet at around 48 hours after surgery. So, many surgeons will let patients shower after 48 hours. However, you don’t want to soak any incision (such as in a bath or hot tub or pool) for at least 4-6 weeks after surgery. Your surgeon can let you know when it’s okay for you to go back to baths and pools.

Tummy Tuck Recovery

After a tummy tuck, you will likely be in some sort of compression garment. This can range from an abdominal “binder” to a sort of body suit, depending on the type of tummy tuck, and whether you had liposuction or not. You will likely wake up flexed at the waist and the knees (sitting in a “beach chair” position). You’ll want to sleep in this position for about the next 5-7 days after surgery. Over that time period, you can slowly start to stand up straight while walking. For those first few days you’ll be a little hunched over while walking. This will be because your abdomen will feel really tight and the center will likely be the most painful region because that is where the muscle tightening occurs.

Typically, you will have 1-2 drains to collect any fluid from building up between your abdominal muscles and skin. The first drain often comes out at around 7 days after surgery and the 2nd at around 10-14 days. This timeline can vary so don’t be too concerned if your drains come out earlier or later. When your drains are removed is based on how much fluid is collecting in them per 24-hour period. For some tummy tucks, there will be only 1 or no drains, but this is usually based on what your surgeon determines is safest for your recovery.

You can expect swelling to your abdomen after a tummy tuck so that you will feel or look “puffy” for several months. This tends to lessen around 2-3 months and usually has resolved at around 6 months. It takes around 10-12 months for your scars to “mature.” (See scar care below)

Will I lose weight with a tummy tuck? Many patients ask this question, and many are often surprised that the weight of the removed skin isn’t more. Skin doesn’t tend to weigh too much. The average standard tummy tuck skin removal weight is around 4-5 pounds. After your surgery, if you step on the scale, you may find that you have not lost weight or that you have actually gained weight. Don’t be concerned. This weight is usually “water weight,” which is the reason you swell and are “puffy” after surgery. You will retain more water after surgery, which is one of the reasons it’s important to stay hydrated during your recovery. So, don’t obsess over your weight after skin removal surgery. You need to focus on water intake and good nutrition. The water weight will come off.

Time off work: At minimum, you will need 1 week off of work for a desk job, and I typically recommend at least 2 weeks off after a tummy tuck if you are able to take that. Heavy lifting (more than 5 lbs) will be limited for 4-6 weeks. You will also likely feel “tight” in the abdomen for several months until you get used to the new position of your abdominal muscles.

Belt Lipectomy Recovery

Recovering from a belt lipectomy is similar to that of a tummy tuck but a little more severe for most patients. While you will be slightly flexed at the waist, you will feel tight in both the front (abdomen) and the back. Remember the belt lipectomy removes skin all the way around (like a belt). The overall timeline to recovery will be similar to that for a tummy tuck, but you’ll likely have more drains (typically 2 in the front and 2 in the back).

Arm Surgery (Brachioplasty) Recovery

Most patients state that this recovery is easier than the other body contouring surgeries. Your upper arms will usually either be wrapped or placed in compression sleeves after surgery. There may be some tingling or numbness to your lower arm, but this should resolve over several days. Most patients can return to a desk job in 5-7 days. Again, like any of the procedures, lifting more than 5 lbs will be limited for 4-6 weeks, so arrange time off work and/or light duty as needed.

Thigh Lift Recovery

Thigh lift recovery is a little more challenging than the arms since it involves the legs. It’s a little more difficult to keep them from moving, and obviously they have to hold you up as you walk. Similar to the arms, the thighs will either be wrapped or placed in a compression garment. Time off work will be similar for a tummy tuck.

Breasts/Chest Recovery

A breast or chest lift recovery will be similar for that of arm surgery. If you don’t have implants placed, pain will likely be a little less (implants usually go under the pectoralis or “chest” muscles, which can be more painful).

Face Lift Recovery

Facelift recovery is likely a little easier than the rest of the contouring procedures. After surgery, you should expect your face to be very swollen, so much so that you won’t look too much like yourself. However, this will come down over the next few days. Time off work is usually more to do with patients being concerned about their appearance than any physical limitations. At any rate, I usually recommend a week off of work, and 2 weeks if the patient is able to get it off.

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Complications

The most common complication after major skin removal surgeries is a problem with wound healing. The next most common complication is an accumulation of fluid pockets called “seromas.” The reason there can be wound healing problems, meaning a part of your incision opens or is delayed in healing, is that the edges of your skin are pulled very tight in order to remove the most skin possible during surgery. Also, massive weight loss patients likely have more issues with absorption of nutrients if they have undergone a surgical procedure to lose weight, so less-than-ideal nutrition may have an effect on wound healing. Also, these incisions are often on areas of the body that move a fair amount (legs, lower abdomen, back, arms…). So, movement may pull at the incisions and contribute to healing issues.

It’s important to remember that if you do have issues healing a portion of your incision, it will be okay. Most of these areas of breakdown just take longer to heal. While it’s healing you’ll need to keep visiting your surgeon and will need to keep a bandage over the area. It can sometimes result in a less-appealing scar, but several months after the area has completely healed, it typically blends in fairly well. If not, your surgeon may be able to revise it a few months after it has healed.

Surgeons try to prevent “seromas” or fluid build-ups by placing drains. However, even with drains, there can still be fluid accumulations. Sometimes these will resolve over time, but sometimes this requires drainage in clinic. So don’t pull your drains before your surgeon wants them out 

Infection is always a possibility after any surgery. While rates of infection are typically low, there are several things done to decrease this risk. You are given antibiotics through your IV just before your surgery, and sometimes your surgeon will prescribe antibiotics for after surgery. The main things to watch for after surgery are redness around the incision, fevers, or drainage from your incisions. If any of these things occur, let your doctor know.

While wound healing and seromas can be inconvenient, they typically won’t be life threatening. Blood clots in your legs are a scary, but luckily much more rare, complication. The worry is that a blood clot in your leg veins (also called a DVT for “Deep Venous Thrombosis”) is that the clot can break away and move to your lungs. So, if you have any history in your family of blood clotting problems, or if you have had such issues, let your doctor know. Also, if you experience leg swelling/pain, especially in only one leg, after surgery let your doctor know right away. Also, it’s important to do short, slow walks after your surgery to keep blood flow happening in your lower legs/calves.

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Nutrition and Scar Care After Skin Removal

Nutrition

Nutrition is extremely important in a weight loss patient. Some patients become a little obsessed with staying thin so that they drastically reduce their calories. You need to have a well balanced diet that includes protein and vegetables and fruits. Smoothies can be a great way to ensure you get protein and nutrients. When you have lots of incisions and areas of your body where tissues have been moved around, you need quality calories and nutrients to heal.

Scar Care

Patients always ask what they can do to minimize scarring. In body contouring surgery where large amounts of skin must be removed, scars are unfortunately unavoidable. However, there are some things that can be done to improve scar appearance. First, some people are genetically either good scar formers or bad scar formers. If you have scars from previous surgeries, these can be an indication of how you will scar.

Before starting any scar care regimen, you’ll want to first make sure you’re completely healed. Scars generally take about 3 weeks after surgery to be at a point that scar care can begin. However, never begin scar care on a scar that is irritated with scabbing or that is slightly open or draining. Ask your surgeon if you are ready for scar care.

Silicone: Silicone is the one substance that has been shown to improve a scar’s appearance. This means it can help flatten the scar and improve redness. Any scar cream with silicone listed as an ingredient can be used. Also, silicone strips, which are sold at drugstores and online, can be applied over scars. These are useful for scars that can have strips on them for long periods of time, like tummy tuck scars. The constant contact of the silicone sheet should help the appearance of scars.

Massage: Scar massage will help flatten scars that are raised. The general rule for scar massage is to massage the scar 3 times a day for 5 minutes at a time. When doing this, use some sort of lotion or cream so that you don’t cause skin breakdown with constant massage. One good idea is to use a scar cream with silicone for the massaging.

Sunscreen: It’s important to wear sunscreen over your scar when in the sunlight. This is especially important during the first year after surgery. Sun exposure can cause the scar to be more red.

Also, it’s worth remembering that while most people want to lessen the appearance of scars, scars serve to remind us of difficult times that we survived. Don’t hate on all your scars 

Well, you’ve likely done a lot of planning and you’ve been through quite the journey if you’ve undergone a massive weight loss. Remember, that your journey is your own, and it has made you a stronger and a better person. The great thing about skin removal surgery is that it is one of the final chapters in that journey and it’s a new door opening to the rest of your life. Go out and conquer it!


Life After Massive Weight Loss: Skin removal surgery

Patients that undergo massive weight loss, either through surgery or diet and exercise, go through a journey that is unique. Many end up with excess skin and while their new bodies are better, many find themselves with a new problem: extra skin. This skin tends to hang off the newly-smaller body and is disruptive to exercise, daily activities, and to their overall well-being and self esteem. Some patients feel they have traded one problem for another. "Life After Massive Weight Loss" is intended to educate patients about managing their post-weight loss lives and to inform them about skin removal surgery options and how they can best approach getting such care.

  • Author: Ross Blagg
  • Published: 2016-04-21 00:50:20
  • Words: 6524
Life After Massive Weight Loss: Skin removal surgery Life After Massive Weight Loss: Skin removal surgery