Got those loose skinned blues?
Massive weight loss is a big decision, most of you reading have gone through massive weight loss or are contemplating going through massive weight loss. One of the most common concerns when it comes to losing weight is the resulting loose skin that occurs once the body has gone through significant weight loss. It’s common knowledge that losing weight = loose skin. Loose skin not only occurs with massive weight loss, but also with natural events in the body, such as pregnancy. This is because once your body is stretched from weight gain or pregnancy; your skin loses its elasticity. The first patients come in to talk about weight loss and bariatric surgery, how it works and its results. Many patients, however, decide they want to go the least expensive, natural way with strict diet and exercise, but are concerned about loose skin. Our doctors always tell patients to be realistic, being healthy is much more important than having loose skin. Even when you have loose skin after losing weight, there are ways to get rid of it, such as post-bariatric surgery, including tummy tucks, breast augmentation, and thigh lifts. Loose skin, even if it doesn’t look like it, is a proud reminder of how far you’ve come and if you take that extra step to remove loose skin, your body will be a trophy dedicated to you. In this post, we will look at why and where that extra skin came from and how to reduce or eliminate it.
how we burn fat
As we all know, matter is neither created nor destroyed, so when you exercise and diet, fat doesn’t just “disappear” from your body. What occurs is a change of form, like water and steam. Glucose and sugar that are used from carbohydrates are the first sources of fuel. Once the glucose runs out, the fat takes over. Your body is a constant interconnected conveyor belt that removes essential nutrients from fat and delivers them to specific parts of the body. The hormones that regulate our blood sugar levels activate an enzyme in fat tissue called lipase. Lipase turns on fat cells to release triglycerides, which is what makes fat cells fat. When they receive a signal from lipase to leave fat cells, the triglycerides are broken down into glycerol and fatty acids and then enter the bloodstream for use in the body. The process of breaking down triglycerides into reusable energy is called lipolysis, which is mixed and rearranged to produce heat, water, carbon dioxide, and ATP. Since the adipose tissue has lost some of its components, the cells shrink.
Why the extra skin?
When adipose tissue is worked on and the cells shrink, wouldn’t it make sense that the skin would also shrink? Yes and no. In cases of moderate weight loss, the skin can certainly shrink to accommodate the new size of the body due to its elasticity due to the collagen in the skin. However, collagen has its limits. Collagen fibers weaken with age and cause wrinkles. Rapid growth or weight gain also overwhelms the production of collagen in the skin, causing areas to become overstretched, leading to stretch marks commonly seen in pregnancy and in adolescents going through puberty. In cases of massive weight loss, the skin that has been stretched has lost its collagenous strength, making it very difficult, if not impossible, for the extra skin to shrink back to its previous shape. Those who undergo gastric bypass surgery or bariatric surgery feel this pain. As the number of patients undergoing weight loss surgery increases, corrective surgeries for uncomfortable and unwanted skin are also increasing. This extra skin can actually be a serious problem and can cause infections, rashes, and even back problems.
Post-bariatric surgery and treatment options
The most important determinant of the amount of loose skin a person will have after losing weight is their age. Younger patients tend to have less loose skin than older ones due to the strength of the collagen in the skin. The next most important factor is the amount of weight loss. A person who loses 200 lbs. you are more likely to have excess skin than someone who has lost 80 lbs. There are other factors that determine who is more likely to have loose skin, such as smoking, sun damage, and skin color.
– Exercise: Exercise that includes increasing muscle mass can tighten connective tissue. For patients who have undergone bariatric surgery, it is recommended to add a regular exercise regimen which is helpful in maintaining weight and can also serve to tighten loose skin to some extent.
– Body Contouring Procedures: For those who are losing 80 lbs. to over 100 lbs. Surgical procedures, known as post-bariatric surgery, are available to tighten the skin and remove extra pockets of skin that prevent your body from being as toned and firm as you would like. Below are the most common procedures for patients with massive weight loss.
Abdomen, thighs and buttocks: the abdomen is usually one of the biggest concerns of people who follow a massive weight loss. In both men and women, excess fat is stored both in the abdomen and under the skin of the abdominal wall. Consequently, after weight loss in those areas, more skin appears. Large amounts of sagging skin can cause moisture to accumulate between skin folds, resulting in a condition called intertriginous dermatitis, which causes irritation, redness, and pain. Occasionally, the skin can even break, bleed, and become infected. With proper documentation, many insurance companies recognize this issue and provide comprehensive coverage from surgical removal to a tummy tuck or tummy tuck. The tummy tuck will only remove excess skin from your stomach, which is ideal for women after pregnancy. However, for those who have undergone weight loss surgery or massive weight loss, excess skin is not limited to the stomach, but also manifests itself on the buttocks and thighs. Because of this, surgeons will perform a specific procedure for patients who are losing weight called a body lift. This involves a tummy tuck, buttock lift, and thigh lift all at the same time. This treats and removes loose skin and cellulite along the thighs and buttocks, as well as the abdomen. Although the resulting scar is long, it is limited to the waist and is hidden by underwear, panties, or a bikini.
Breasts: After a large weight loss, the size and shape of the breasts often change significantly in both men and women. Everyone worries about sagging breasts as we age, but few know that massive weight loss greatly speeds up the process. As women progress from girls to teenagers, into their twenties and into their later years, the glandular portion of the breasts is replaced by fat. The original glandular tissue is significantly firmer than fat and consequently the skin becomes unable to fully retract, resulting in severely ptotic or sagging breasts. This is called mammary involution. There are many treatment options for women after weight loss. If a woman wants less sagging and wants to be bigger, a breast lift or mastopexy is needed. Again, the surgeons will tell her her options and also remind her to be realistic or that breast augmentation can be satisfying. The problems in men are similar, however the treatment is slightly different. Men tend to have larger breasts when they are overweight. Depending on the man’s age, the degree of weight loss and some other factors, it can result in large breasts, large and/or sagging breasts, or satisfactory breasts after weight loss. Large and/or sagging breasts in men are called gynecomastia. Here liposuction alone can be satisfactory, however this is not typical. Most men with large, sagging breasts undergo a two-stage procedure. The first stage is liposuction and is performed to remove excess fat and part of the glandular tissue. Over the next several months, the skin of the breast will retract slightly. Three to six months later, the patient will return to assess the situation and determine if the outcome is satisfactory. Delaying the second stage allows for significant skin retraction, and if a skin tightening procedure is desired, smaller incisions will likely be required.
The bottom line?
Being healthy is much more important than excess skin. Although having excess skin can lead to some serious problems, there are non-surgical ways to prevent infection, such as keeping excess skin dry. For those who can and want to remove excess skin, post-bariatric surgery is for you. It is important to remember that these procedures should only be considered after the weight has stabilized; especially after weight loss surgery. This can vary from 7 to 18 months after weight loss. The most important factor in finding a plastic surgeon who can perform these procedures is that they must be board certified. If your plastic surgeon’s website or office does not advertise that they are board certified, you need to RUN! For all of you who have heard plastic surgery horror stories, this is probably where it started, undergoing a surgical procedure without a board-certified surgeon. Use ASPS (American Society for Plastic Surgery) to find a board-certified surgeon near you.
