What to know about skin removal surgery after rapid weight loss

Thanks to reality television shows such as TLC’s 1000-lb Sisters, the general public has a better understanding of just how difficult—both physically and emotionally—a weight loss transformation can be. It’s not fast by any means, sometimes taking an individual multiple years to get to where they want to be.

That’s because, for many patients, the journey doesn’t end after bariatric surgery or medication. Rapid weight loss typically results in excess skin, which can hinder their daily lives by limiting movement and lowering self-confidence. Take, for example, 1000-lb Sisters star Tammy Slaton. After losing 500 pounds, she underwent skin removal surgery, which freed her from 15 pounds of sagging skin around her stomach, arms and neck. Her mobility and self-image immediately improved.

While reality TV tends to exaggerate plotlines to grab viewers’ attention, the impact that skin removal surgery had on Tammy’s life wasn’t fictionalized by any means. According to Nathaniel Holzman, MD, a plastic and reconstructive surgeon at Trinity Health Mid-Atlantic’s Plastic and Reconstructive Surgery centers of Langhorne, Darby and Red Lion, this procedure allows bariatric surgery patients to fully reclaim their lives.

“They walk into the office three months, six months later, and they’re bouncing into the room. They’re so excited about what clothes they can wear, what activities they can participate in and how they really feel like they’ve reached the climax of their journey,” says Dr. Holzman. “There’s nothing more humbling as a physician and surgeon than being able to help somebody reach those goals.”

An ideal candidate for skin removal surgery is someone who’s at their goal body weight and struggling with excess skin.

“Sometimes people will come to see me after losing 20 or 30 pounds. They have excess skin, but they’re too early on in the journey. One of the most important things is they’ve reached their peak weight loss,” says Dr. Holzman. “And then typically what we expect is for that weight loss to be stable for about six months.”

He’ll also check to ensure that medical problems, such as nutritional deficiencies and diabetes, are either resolved or controlled. Additionally, skin removal patients cannot smoke or use nicotine.

“Sometimes people will come to see me after losing 20 or 30 pounds. They have excess skin, but they’re too early on in the journey. One of the most important things is they’ve reached their peak weight loss. And then typically what we expect is for that weight loss to be stable for about six months.” - Nathaniel Holzman, MD

While loose skin is often found in the stomach region, Dr. Holzman explains that it can be anywhere on the body, including the arms, legs, chest, face, neck, etc. Excess skin occurs because when people lose weight and the mass of tissue decreases, the skin can lose its elastic properties. While some patients can retain that elastic recoil in certain areas, others—typically the stomach—become troublesome.

When addressing the excess skin of the stomach in a panniculectomy or tightening the muscles in an abdominoplasty, the procedure usually lasts about 2 to 3 hours, with a recovery time of 4 to 6 weeks. As for other procedures like an arm, thigh or breast lift, recovery time is a bit shorter at 3 to 4 weeks.

The healing process from skin removal surgery is far from painless, and understandably so. However, there’s a common factor among this patient population that helps them get through it: motivation. After all, this is the final chapter of their weight loss journey. They’re at the finish line.

“These patients just want to look their best. They want to feel their best and they want to get back to everyday life,” says Dr. Holzman. “So generally, people do really well.”

For anyone who is considering starting a weight loss journey, Dr. Holzman urges them to become knowledgeable about the entire process—including skin removal surgery—so that the excess skin doesn’t come as a shock down the road.

“I encourage everybody to consider their options,” says Dr. Holzman. “Sometimes it’s helpful to simply speak about it, go to support groups and talk with people that are going through the same journey.”

For more information on plastic and reconstructive surgery at Trinity Health Mid-Atlantic, visit Plastic and Reconstructive Surgery Center Langhorne, Plastic and Reconstructive Surgery Red Lion or Plastic and Reconstructive Surgery Darby.