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Excess Skin and Weight Loss

Posted by admin in Plastic Surgery

Dr. Patricia,

I have recently begun planning a healthier lifestyle and am aiming to lose a rather large amount of weight to do so. My question is what will happen to my skin? Will it shrink along with my body mass? I have heard some say that skin will not shrink down when you lose weight, and you have to have plastic surgery to remove the excess skin. Is this true? I have done an extensive amount of research on the subject, and I have found almost nothing. I am not concerned with a bit of saggy skin, but when I do reach my weight goal, I don’t want to look like an old, lumpy sack of potatoes. Please help!

Does this sound familiar? This is an actual question emailed to us from a customer that comes in for regular skin spa treatments. I get many emails from patients curious about what happens to their skin during weight loss and it seems like skin is the one organ in our body that people know the least about. Sure we know if we scrape it, it bleeds, if its dry, we moisturize, but there is so much more into knowing how your skin works to realize the affects our daily lives have on it. So the quick answer to the question is not really quick at all, it is a Yes and No. Yes, your skin will shrink down to an extent. No, it will not tighten completely. Yes, if the amount of excess skin is disruptive, you will want (not need) to have it removed. If excess skin is causing health issues then it must be removed.  Excess skin can be a serious medical problem but so is obesity, although excess skin is troublesome, your health should be the first and foremost concern.

Skin 101

Skin is our largest organ in our body and it is our first line of defense against the environment. This makes it very important for us as humans to take care of our skin through sun protection and nutrition. Your skin is made of a protein called collagen; collagen allows for elasticity but it also has its limits. When you pinch your skin you know it is not solid, we’ve all seen those crazy creepy YouTube videos of people stretching their eyelids and ear lobes or whatnot. In order to understand what happens to our skin during weight gain or weight loss, we should first understand what happens to our fat when we lose weight. When we lose mass by burning fat, the fat doesn’t just disappear as we would like it to, instead our fat changes form. When we eat, glucose and sugar are harnessed from the carbohydrates we consume, which are our bodies’ first fuel source. The liver then stores the glucose in the form of glycogen and released into the bloodstream as necessary. Once our bodies run out of glucose for energy then fat takes over in what is called ketosis. During ketosis, our hormones activate an enzyme in fat tissue called lipase. The lipase ignites fat cells to release macromolecules called triglycerides. Once they are released they are signaled to break into three components of glycerol and three fatty acid chains in a process called lipolysis. They liver then absorbs the glycerol for energy and the fatty acids move to the muscles for energy. Because the fat tissue is removed of some of its components, it shrinks and so does the skin but as stated before only to an extent.

Skin stretches because rapid weight gain or growth (ex. pregnancy) outpaces collagen production in your skin which causes areas to overstretch. Just as plastic will tear when stretched too far, so will skin in terms of stretch marks. In cases of massive weight loss, where individuals lose 80 lbs. and over, folds of extra skin remains because the skin had become so outstretched that it hangs from the thinner body like a rubber band that has lost its elasticity. In cases of moderate weight loss, skin can certainly shrink back to fit the body’s new size because of its elasticity. However, collagen fibers weaken with age and a few other factors thus resulting in wrinkles. The factors that determine your skins elasticity is dependent upon the individual and include whether the individual smokes, their race, sun damage, genetics, and even how often their weight has fluctuated greatly.

Excess Skin Problems

Having excess lose skin is detrimental for those who have gone through a massive weight loss or weight loss surgery. Instead of the fit and slim gorgeous body they were hoping for after putting so much work into weight loss, they have a thinner yet disfigured body image because of the excess skin. Many who go through weight loss surgery either do not realize that the surgeon does not remove the excess skin after the surgery or was not told resulting in a poor body image because of the remaining skin. Excess skin can even cause the body distressing problems that many individuals wouldn’t know about until they have the loose skin. Folds of skin from a massive weight loss can result in psychological and physical problems. A 2013 study published in the North American Journal of Medical Sciences observed 64 patients following a massive weight loss. The patients were then polled on their “Quality of Life” post weight loss and had these results: Dermatitis and itching in 28%, Difficulty finding clothes that fit properly 26%, Difficulty performing physical activity 34% (N Am J Med Sci. 2013 April; 5(4): 301–305). They were also polled on their satisfaction with their appearance in which most rated their satisfaction in terms of specific body parts as “dissatisfied” to “very dissatisfied”. The physical problems that result from lose skin transcends into mental and emotional problems with patients as their expectations with their bodies are unsatisfactory without proper preparation beforehand. Another common medical concern that results from having excess loose apron-like skin is intertrigo—a bacterial, fungal, or viral infection that occurs often due to the difficulty in keeping these folds of excess skin clean and dry. The skin can also cause back pains and ulcerations.

Treatment Options

As mentioned before, a protein in the skin called elastin allows the skin to shrink back to a regular size. However, when going through weight loss, losing 20-30 pounds is very different from losing 80 lbs. or more. In cases of moderate weight loss, there are ways to reduce the amount of resulting excess skin through exercise, muscle-building, eating properly, staying hydrated and by losing the weight slowly. Exercise that includes increasing muscle tone can tighten connective tissue and help stretch the skin as it essentially acts as a filler to your skin instead of fat tissue. By consuming the proper amount of food and water every day will ensure that your skin absorbs the necessary nutrients. Water is a crucial component of maintaining skin elasticity and you should be taking in at least 2 liters each day. The two ingredients that keep skin plump and elastic are elastin and collagen, the protein to help form these is found in cottage cheese, legumes, tofu, milk, beans, seeds, nuts, and fish. In more severe cases of massive weight loss and bariatric surgery patients, other methods must be applied to eliminate the health risk with excess skin. If you’ve had a 9-month pregnancy, your skin can shrink back to pre-baby. However, if you’ve carried 50-100 extra pounds on your body for an extended period of time you will most likely need to resort to plastic surgery to tighten the loose skin and resolve the resulting health issues. There are treatment options for excessive lose skin through a body lift or post-bariatric surgery for those who have gone through bariatric or weight loss surgery. Post-bariatric surgery and body lifts involve many body areas as patients have loose skin not only on their abdomen but also through the face, neck, thighs, buttocks, arms and breast. Surgery will leave small and large noticeable scars though most patients find these acceptable and enjoy more self-confidence when wearing a bathing suit. Depending on the patient, procedures can be chosen selectively focusing on the most problematic areas. For example, a patient who has lost a moderate amount of weight but has a mild amount of loose skin can have just a tummy tuck to remove remaining fat and skin in the abdomen area. Men who have gone through a massive weight loss sometimes result in sagging or large breasts. Here  liposuction alone may be satisfactory, however, this is not typical and breast augmentation or breast reduction may be necessary. Each individual is different which is why it is crucial to first speak or have a consultation with a board certified plastic surgeon. Your surgeon will be able to identify if you are a good candidate for post-bariatric surgery and will guide you through different procedures that will ultimately give you the satisfactory body you would like to achieve. According to the same study as mentioned above, participants who had gone through post-bariatric surgery following the initial poll had improved “Quality of Life” results. 65% of patients reported an Improved Body Image, 64% reported Improved Self-confidence, 53% reported Better Fitting Clothes, 45% reported Improved Mobility, and 40% reported Improved Balance of Life. Everyone can agree that losing weight is hard, excess skin just makes it harder even though you are healthier. It takes perseverance and a community of friends for anyone to succeed through it and once you do, the results are so worth it for you and your family.

The Bottom Line?

Being healthy has far greater importance than excess skin. Although, having excess skin can lead to some serious issues there are non-surgical ways of preventing infections such as keeping your excess skin dry. For those who are able and want to remove the excess skin, it is important to remember that these procedures should only be considered after ones weight has stabilized; especially after weight loss surgery. This can range from 7-18 months after weight loss. Insurance companies have very critical guidelines as to what procedures are covered. If cosmetic, it is most likely they will not cover for post-bariatric surgery. However, if the need is medical where infections are reoccurring then it will be necessary for them to provide coverage for post-bariatric surgery.  Another important factor in finding a plastic surgeon that can perform these procedures is that they must be board certified. This Atlanta plastic surgeon provides these types of surgeries AND is board certified.  If your plastic surgeon’s website or office does not advertise that they are board certified you must RUN! For everyone who has heard horror plastic surgery stories, this is probably where it started, having a surgical procedure done without a board certified surgeon. Use ASPS (The American Society of Plastic Surgery) to find a board certified surgeon near you. 

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