It is so amazing and rewarding to consult with a patient who has had a massive weight loss. Whether they had bariatric surgery or not, it is simply an amazing thing to have lost so much weight. The journey that these patients are on is different from the average body contouring and tummy tuck patient in so many ways, from the mental aspect of a new body image to the emotional journey to the process of coming to grips with the extra skin and how they will deal with it.
I love helping these patients on this part of the journey because it is so uplifting to help them close the chapter that was their heavier self and embark on a new chapter. But there are a lot of variables to discuss—and every patient is unique in their particular situation. Some have lost every pound they wanted to, and some are at a plateau, so we need to discuss how much more, if any, to lose before surgery. Some have genetics that allowed their skin to shrink and others are left with stretched-out and hanging folds of skin. Some need just their abdomen skin tucked, and others need all 4 extremities, the abdomen, chest, and face addressed.
For each patient, there is an amazing story of perseverance and grit as they lost the weight. Some have waited many years, and some come to see me immediately after losing the weight. Either way, it is always a pleasure to help each and every one of them.
Will Insurance Cover Loose Skin Removal After Weight Loss?
For the average weight loss patient, having lost around 100 pounds, the way we like to approach this is to try to have the insurance cover part of the abdomen. This part, the panniculectomy, is not a tummy tuck but the removal of just the flap of skin that hangs down. So we spend some time going through the insurance pre-approval process. And while it takes time, it is a good idea to save this money for the other procedures that the insurance does not cover. At Aesthetica, we do this routinely and will help you determine if you will be able to use your insurance for this part.
If appropriate, we will discuss adding the remaining aspects of the cosmetic tummy tuck to the panniculectomy. There are times I will recommend an additional aspect called the Fleur-de-Lis, which is removing skin in the vertical component as well. You can see the results we can achieve with tummy surgery after major weight loss in my patients’ before and after photos below:
Adding a Breast Lift to the Tummy Surgery
If the patient is also interested in a breast lift, it is my preference to do these two operations together. The breast lift is the smaller operation, requiring just a week to recuperate, while the tummy requires a longer recovery. Doing them together makes sense, and there is only one recuperation. Also, just a word on the post-op pain level. The breast surgery is really easy in this regard so again it makes sense to add it to the mix. In fact, the breast lift is so much easier physically, when the patients are coming in for their post-op checks, we are so focused on the tummy we can sometimes forget the breasts—and the patient will say to us “Do you want to check the breast lift too!!!?!!”
After the abdomen is done, it is a huge psychological adjustment, and this is an important aspect in the staging of the procedures. It just takes time to mentally transition to the permanently smaller body contour. It is a happy transition, but a big one.
Sometimes, patients wish to address the arm lift or thigh lift sooner than later, and that can be done. In general, the arm lift or the thigh lift can be added, but more than three areas of surgery in a single day on a patient is a lot of surgery! And there are real aspects to consider, like activities of daily living, that are impossible to do if everything has just been operated on.
And it is really hard to recuperate from this type of combination. Trust me, you will like me better if we split things into two operative days.
Do You Have To Be a Certain Weight for Body Contouring Surgery?
For the patient who has lost weight, but has about 20 or so pounds to go. Sometimes these folks initially lost it and have gained it back. Other times, it just got to a point that they were not losing anymore. There are many issues to discuss, but most of the time, we advise that the patient get all the way back to their lowest weight before proceeding. Most of the time, the patient agrees and uses the upcoming surgery to kickstart their new momentum. We encourage this because there is good research that tells us the higher the BMI, the more complications occur. And after surgery, there is a period of time when you are not able to exercise, so it is best to be at the optimal weight and fitness level before surgery.
There are times though, when a patient honestly says they have tried to lose the last 20 pounds for a long time and have been stable now for a long time. For these patients, it is possible to proceed with a realistic expectation and understanding of the increased risks and lesser cosmetic outcomes. You can learn more about how BMI affects body contouring surgery in my related blog post.
Can You Tighten Skin After Weight Loss?
A unique aspect of the human organ called skin is that it has an almost infinite ability to stretch outward. Sadly it does not possess the same ability to shrink. There are some patients where it has shrunk as the weight loss occurred, but this is the exception. So there are lots of patients who are searching for a way to make the skin shrink and look better–and surgical skin removal and tightening is usually the most effective option.
Nowadays there are fake creams and devices that say they will shrink the skin and really do not. Or worse, these heat-based devices can injure the skin even more, making the definitive surgery even more risky. So this is a cautionary message to not fall prey to things that sound too good to be true. Listen, if there was something that good, then we would all know about it and be using it already.
The Next Steps to a New You
In summary, we congratulate the patient who has been on their journey to lose a significant amount of weight. It took desire, dedication and determination. And you did it.