Dec. 6, 2022 – Rosalina Finelli from Deerfield Beach, FL, lost 216 pounds after weight loss surgery in November 2019. While she wanted to celebrate her achievement, the procedure left her with excess skin on her arms, back, chest, belly, and upper thighs.
Finelli says she constantly felt pressure from the hanging skin on her back, stomach, and knees.
“From the pain I felt from the weight pulling on my nerves to looking at myself in the mirror, wanting to celebrate the weight loss, but not loving what I saw, it was a daily struggle,” she says.
The nearly 2 years she lived with the excess skin were physically, mentally, and emotionally painful, Finelli says. She eventually found relief through a series of plastic surgeries referred to as “body contouring,” which removes excess skin from the body.
In 2020, almost 200,000 Americans had bariatric surgery, according to the American Society for Metabolic and Bariatric Surgery. While the procedure can help people with obesity lose a significant amount of weight and lead to improved health and quality of life, an unpleasant side effect is the loose, excessive skin that once held the now-lost weight. And excess skin can cause serious health issues.
Why Does Loose Skin Occur After Bariatric Surgery?
While skin is flexible, quickly losing a lot of weight doesn’t give the organ time to shrink and contract, in part because the more skin is stretched, the less elastic it is.
“When a person is significantly overweight, they have a thick layer of fat that stretches all the skin out,” explains Robert Gilman, MD, a clinical associate professor of plastic surgery at Michigan Medicine in Ann Arbor. “When people lose a great deal of weight, the thickness of tissue decreases, but the skin has limited capacity to accommodate for that, so it results in extra skin.”
After Brenda Langford, 46, had weight loss surgery in 2018, the excess skin that hung down from her belly reached halfway to her knees.
She is from Queensland, Australia, a country where the number of people having weight loss surgery has more than doubled in recent years. She says the effect of excess skin on her mental health was “profound.” She also had painful rashes where her skin folds rubbed against each other, a common complication that can lead to skin infections.
“I couldn't exercise or walk properly, I could barely fit into clothing, as none of it is made for the anatomical anomalies that I was experiencing, and I was finding the ability to work arduous,” Langford says.
What Body Contouring Entails
During body contouring procedures, the patient is put under general anesthesia, and a surgeon trims excess skin and fat. Remaining skin is sutured together.
“These surgeries can really be done from head to toe,” says Peter Rubin, MD, chair of plastic surgery at the University of Pittsburgh Medical Center.
Surgeons focus on areas of the body that patients find most bothersome. Rubin says one of the most common contouring procedures is a panniculectomy, also called an abdominoplasty or tummy tuck.
People must meet certain clinical criteria before they get body contouring, including maintaining their goal weight for at least 6 months.
“You don't want to take someone to the operating room who's actively losing weight,” Rubin says.
Generally, a plastic surgeon will perform these procedures only 12 to 18 months after bariatric surgery.
The cost can range between $5,000 and $10,000 per procedure, Rubin says. Sometimes, insurance companies cover the bill, depending on the state and individual plans.
Gilman notes that while many companies tout creams, lotions, and laser treatments for skin tightening, they will not give patients significant benefit when it comes to loose skin after bariatric surgery. Neither will diet or exercise.
“You cannot exercise extra skin away,” he says. “If you’ve lost a significant amount of weight and you have a significant amount of loose skin, surgery is the only thing you can do.”
Recovery and Risks
"After undergoing body contouring procedures, people should expect to be out of work for 2 to 4 weeks, and hold off on strenuous activities for at least 6 weeks,” Rubin says.
Risks from body contouring procedures are the same as with any major surgery, and include fluid buildup, infections, and bleeding.
Another thing to consider is that skin removal surgeries leave scars, which vary from person to person but can be extensive.
Finelli has a 15-inch scar on each arm, two 360-degree scars – one around her breast and upper back, and another around her lower abdomen – and a 10-inch vertical scar down her stomach.
“Some days, I joke around that I look like Frankenstein, but I would do it all over again," she says.
She’s also not afraid to show off her scars, saying they’re “part of the journey.”
Langford endured long recoveries, needing to take about 2 months off work for each set of her surgeries, and she dealt with swelling for months after. She agrees the payoff was worth it.
“I spent decades loathing my body,” she says. "And now, at age 46, I'm finally free of that torment.”