Health

After huge weight loss, sagging skin remains

March 7, 2014 at 10:30 AM ET

Image:
John Makely / NBC News
Dr. Scot Glasberg marks incision lines on Jasmin Maldonado at Lenox Hospital before her surgery to remove excess skin around her midsection. She lost 130 pounds following gastric bypass surgery and was left with sagging skin on several areas of her body.

We all carry with us reminders of the person we used to be. It’s just a lot more literal for some than others. People who lose a massive amount of weight are often surprised at how unhappy they still are with their bodies. The fat is gone, but all that skin that held it in place? It didn’t go anywhere.

It's a less explored part of extreme weight loss. The body may be lighter, but it’s now weighed down with folds of sagging skin, causing a wild amount of emotional and physical (think: chafing) pain.

More extreme weight-loss patients are choosing to remove the loose skin through cosmetic surgery, and a recent study showed that the bodies and minds of those who do end up faring much better.

“What I’ve found, it’s very interesting -- they go and get these surgeries, and then they come in and they’re still not happy,” says Dr. Steve Wallach, a cosmetic surgeon in Manhattan.“I had one patient who specifically said, "‘I’m wearing a fat suit; I feel like I’m a thin person inside wearing a body that’s twice the size of mine.’"

Clothes don't fit because of excess tissue. “So they still feel not-whole, and not-happy," says Wallach.

Where Does All That Skin Go? See For Yourself

Franklin Santana, a 29-year-old who lives in the Bronx, had gastric bypass surgery in October 2011, and before the surgery, he weighed 395 pounds. Two years later, as of late last year, he was down to 170. To the public, he seemed like a trim, even skinny, guy. But underneath the clothes, he said his sagging skin reminded him of “a deflated balloon.”

I’m wearing a fat suit; I feel like I’m a thin person inside wearing a body that’s twice the size of mine.

“To me, it looks gross,” said Santana. “You know how a pumpkin looks, at the beginning of October? And then, at the end of October, it’s all sad and saggy and deflated. I guess you could say it looks like that.”

Fantana had done his research before getting the surgery done, and he knew that he’d probably be saddled with “loose skin” after it was over.

Deborah Olmstead, who first had weight loss surgery done in 2001, knew to expect it, too; she just didn't know how awful it would make her feel.

"I was not really comfortable even looking at myself in the mirror, with all the excess flesh," said Olmstead, who lives in New York state and had cosmetic surgery in Manhattan, led by Wallach, to remove the sagging skin in 2004. "You've done all this work, you've made this big, massive change that you see on the scale, but you don't necessarily see it in your clothing, or the way you feel about yourself."

The loose skin is caused by losing a huge amount of weight – as in, 100 pounds or more – in a very short amount of time. It can happen when the weight is lost through diet and exercise, but it happens more often to weight-loss surgery patients. With a slower, more gradual weight loss, it's easier for a person’s skin elasticity to sort of snap back into place, shrinking back down as the fat is lost. But when too much is lost too fast, the skin’s elasticity doesn’t have time to catch up.

Image: Jasmin Maldonado, before and after weight loss and skin tightening surgeries
Left: Courtesy of Jasmin Maldonado / Right: John Makely / NBC News
Jasmin Maldonado shown before her gastric bypass surgery at left, and after her body contouring surgery at right.

To get rid of the loose skin, exercise helps, a little. Jasmin Maldonado, a 36-year-old living in Brooklyn who lost 130 pounds after weight-loss surgery nearly a decade ago, says a daily routine of squats, sit-ups and pull-ups has made a difference. But she’s still embarrassed about the way she looks. “Just, with my husband, I’m embarrassed to show myself. I’m always covering myself,” she said.

You've done all this work, you've made this big, massive change that you see on the scale, but you don't necessarily see it in your clothing, or the way you feel about yourself.

The most effective way to remove the excess skin is through cosmetic surgery, in one or more of an array of procedures known as body contouring. And those who do shed the extra skin generally fare better than those who don’t, both psychologically and physiologically.

People who had weight-loss surgery, and subsequently had the excess skin removed, were less likely to gain weight back than those who had the surgery but did not undergo a body contouring procedure, according to a recent study published in the journal Plastic and Reconstructive Surgery. The report followed about 100 patients who’d lost about 100 pounds after weight-loss surgery. Those who did not have any cosmetic procedures to remove the resulting excess skin ended up gaining back about 50 pounds, but those who did have body contouring done only gained back about 13 pounds.

About 100,000 bariatric procedures are performed each year in the U.S., and the study authors, led by Dr. Ali Modarressi of the University of Geneva in Switzerland, go so far as to argue that body contouring should be a routine part of bariatric surgery. (Granted, they’ve got some skin in the game, so to speak.) About 21 percent of bariatric surgery patients undergo at least one kind of body contouring procedure.

Image:  Body contouring surgery
John Makely / NBC News
Dr. Scot Glasberg and his team operate on Maldonado at Lenox Hospital.

Those who choose to have body contouring done usually pick the circumferential body lift: Doctors make an incision across the back, then around the flanks and abdomen, cutting away some of the excess skin and tightening the rest of it by suturing the incision back together. After the body contouring is done, patients routinely lose another 10 to 15 pounds of loose skin alone. People go with the body lift because it makes the biggest difference in their appearance, doctors say; plus, it’s easier to talk their insurers into covering it, because the surgery has some real physiological benefits, in addition to the psychological improvements.

On most people the loose skin tends to hang down like an apron from their lower abdomen. It chafes. And it hurts like crazy, patients say.

“It feels like it’s like an open wound, and it just doesn’t heal,” said Santana, who’s tried products like Neosporin on the sores. He had body contouring done this winter, and his insurance covered the procedure. “And that helped me sleep, and alleviated the pain, but at the end of the day it comes right back.”

Stopping the painful chafing is important, and such a relief, say people who’ve had body contouring done. But the biggest change is what they see in the mirror after the surgery.

“They feel better about themselves. How could you not? It’s pretty dramatic. It’s no wonder they feel better,” says Dr. Scot Glasberg, a cosmetic surgeon in New York and president-elect of the American Society of Plastic Surgeons. “They feel better physically, and it’s no wonder they feel better emotionally and psychologically. We’re not talking about a sort of subtle plastic surgery there; we’re talking about things that are rather dramatic.”

Franklin and Maldonado both had body lifts done by Glasberg over the holidays. Now, Franklin says he finally feels like “a normal person.” Maldonado says she feels more “confident.” The last physical reminder of who they used to be is finally gone.

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