When author Frances Kuffel reached her goal weight -- after losing more than200 pounds -- she didn't even realize how far she'd come.
"I kept thinking 'I'm still fat; I still look awful.' Someone else hadto point out that my problem was no longer fat -- it was skin, all this excessskin from losing so much weight," says Kuffel, author of Passing forThin.
As weight loss surgery becomes more popular, weight losses of 100 pounds ormore are becoming common. But, experts say, the result can be at once rewardingand cruel, as layers of excess skin replace lost layers of fat.
"People who lose 100 pounds or more feel healthier, they know they arehealthier, they can do things they could not do before. But when they look attheir body, it's a constant reminder of where they were – and it can sometimesmake it difficult to move on with their life," says J. Peter Rubin, MD,director of the Life After Weight Loss Surgery Center at the University ofPittsburgh School of Medicine.
A relatively new medical subspecialty, body-contouring plastic surgery wasdeveloped to address the aesthetic concerns of those who have lost largeamounts of weight -- whether through dieting alone or with the help of weightloss (bariatric) surgery.
"Very often, it's that final step in achieving the body that many peopleenvisioned they would have when they signed on for weight loss surgery,"says Stephen Colon, MD, chief of plastic surgery at Hackensack UniversityMedical Center in New Jersey.
According to the American Society of Plastic Surgeons, in 2005 more than68,000 people opted for body-contouring surgery following weight loss – anincrease of 22% over 2004.
Types of Body-Contouring Surgery
While operations like the tummy tuck and breast lift have been around fordecades, what makes body-contouring surgery different is both the amount ofskin that is removed and the fact that procedures usually cover more than onearea of the body.
"The most popular [procedure] in our center is the lower body lift,which includes the tummy, outer thighs, and the area around themidsection," says Rubin.
Other choices include an upper body lift, which focuses on the breasts andback, as well as lifts for the arms, inner thighs, and the face and neck.
Because some of these operations can be lengthy, one of the newestapproaches is to use two or more surgeons working simultaneously on a singlepatient, Colon says. This helps reduce the amount of time spent underanesthesia, and that, in turn, may speed recovery, he says.
But even with a surgical team, Rubin says, a multiprocedure involving theabdomen, a lower body lift, breast lift and arms -- a common combination --could last eight or more hours.
How Safe Is It?
Among problems that have been cited are wound infection, reopening of woundsneeding surgical drainage, and excess bleeding requiring a second surgery,Rubin says. Blood transfusions are also needed about 15% of the time. In rareinstances, patients have developed fatal blood clots.
While some of these problems still occur (notably the need fortransfusions), experts say it's on a much smaller scale in the last few years.In a study presented in 2003 at an American Society of Plastic Surgeonsconference in San Diego, researchers found that many such complications couldbe avoided if patients allowed more time to elapse between weight loss surgeryand plastic surgery.
The research reported that patients who underwent bariatric surgery (weightloss surgery on the stomach and/or intestines) who waited about a year beforeundergoing body-contouring surgery saw a reduction in the complication rate --and ended up with shorter hospital stays. The researchers also reported thatwaiting allowed the death rate to drop dramatically, from 14% for those who hadbody-contouring surgery soon after losing the weight, to 0% for those whowaited.
Today, Colon says, most patients are advised to wait at least one year afterbariatric surgery.
But even when patients do wait, problems can still occur -- including adramatic loosening of the newly tightened skin that sometimes requires a secondround of surgery, Rubin says.
"We can't predict who will be affected and we don't know why it happens,but it does. Some people actually need more surgery," says Rubin.
Body Contouring: Is It For You?
Not everyone who loses a lot of weight needs body-contouring surgery.Moreover, experts say, not everyone needs it for the entire body.
"A lot depends on your age, your genetics, level of sun exposure, howevenly the weight was distributed, and, more importantly, how you feel when youlook in the mirror," says Colon. "If you're not unhappy about the wayyou look, you shouldn't be made to feel you need body- contouringsurgery."
Those least likely to want or need the procedure, he says, are usually underage 40. "The majority of the patients I see for this surgery are over 40.It's pretty hard to avoid the slackening effect of the skin after thatage," says Colon.
What can also make a difference, however, is where you lose theweight. While a loss of 50 pounds that was concentrated in your midsectionmight leave you with a lot of loose skin in that area, a 100-pound loss thatwas more evenly distributed on your body may have less of an effect onskin.
If you do end up with droopy, sagging skin and think there's some other wayaround it, experts say, forget it.
"Short of surgery, there is really nothing that can help. Exercise won'ttighten it, and skin creams and lotions won't do a thing to help," saysNolan Karp, MD, associate professor of plastic surgery at New York UniversityMedical Center.
But body contouring doesn't come cheap. The average price of a full-bodylift is around $30,000. Arm surgery runs in the range of $8,000, while innerthighs cost about $10,000 a pair. A breast lift and upper back surgery will setyou back about $15,000, and a neck and face lift would add another $15,000 tothe bill. (As you probably already guessed, insurance rarely covers any ofit.)
When you add to this the need for four to six weeks of at-home recovery, formany, spandex can seem like the only viable option.
In an attempt to make things easier, many doctors use finance companies tohelp patients work out a kind of "plastic surgery mortgage" -- apayment plan that allows you to reduce the size of your midsection withoutpaying an arm and a leg up front.
Doctors say they also help patients rationalize the expenditure, frequentlycomparing it to the purchase of a new car.
"Many people wouldn't hesitate to spend $30,000 for a new car. So I askthem, after all that hard work losing the weight, aren't you worth the same$30,000 to look the way you want to look?" says Karp.
7 Things to Do Before Having Surgery
If you are considering body-contouring surgery, here's what experts wetalked to said you should do first:
- Stabilize your weight -- at your goal -- for at least three months, and besure to correct all nutritional deficiencies (which are common after weightloss surgery).
- Establish a reliable support network of family and friends to help youduring recovery.
- Make sure you can get enough time off from work to recover. It will take4-6 weeks depending on the procedure.
- Understand that everything is a trade-off between removing skin, getting acontour, and having a scar. Scars are permanent. They do get lighter, but don'tdisappear over time.
- Prioritize your body according to the area that bothers you the most, andconcentrate your surgery there first. You may find you don't need additionalprocedures.
- Prior to surgery, stop smoking (to reduce complications) and increase yourprotein intake to 50 to 70 grams per day to speed healing.
- Choose a surgeon who is board-certified in plastic and reconstructivesurgery -- not just a board-certified doctor.