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Body Image and Issues after Weight Loss Including discussions about excess skin and reconstructive surgery

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Old 01-31-2004, 08:58 AM   #1
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Default Weight Loss And Skin FAQs

Weight Loss And Skin FAQs

Frequently, questions are asked in the different forums here at 3FC about what happens to our skin as we lose weight and what can be done about it after we reach our goal weights. The following FAQs have been put together to try to answer some of the most common questions. If you have a question that isn’t listed here, post it in the Maintainers Forum and we’ll see if anyone can answer. Please note: I’m not a doctor, nor is anyone else who has contributed to these FAQs, but we all have first-hand experiences with excess skin after weight loss and can try to answer based on our own personal knowledge, opinions, and experiences.

1. What will my skin look like when I reach my target weight? The most important thing to remember about weight loss and your skin is that no one — not even a doctor— can tell in advance what your skin will look like when your reach your goal weight. Every person’s skin will react differently to weight loss.

However, many people who lose a significant amount of weight are unpleasantly surprised to find that their skin looks worse and worse as the pounds drop off. Fat cells themselves never go away entirely; they empty out but their structure remains behind. As the fat from the cells and inches melt away, there’s less support for the overlying skin and it starts to look deflated — collapsed and wrinkled — like a balloon that was blown up and popped. Since the underlying fat layer to which the skin was attached is now gone, it flops around loosely.

There are some common variables that affect how your skin will react to and look after weight loss:

* How old are you? — the younger you are, the more elastic your skin is.
* How long were you overweight? — skin that has been stretched for many years is less elastic than skin that was only stretched for a brief time.
* What are your skin genetics? — some people are genetically blessed with elastic skin.
* Do/did you smoke? — smoking negative affects the skin’s ability to tighten up.
* How much weight did you lose and how quickly did you lose it? — the more weight you lose, the more likely it is that you’ll have excess skin. Extremely rapid weight loss (e.g. loss as a result of gastric bypass surgery) can also cause loose skin to occur.
* Are/were you a sun worshipper? — sun damages skin.
* Were you ever pregnant? — a large pregnancy can permanently damage the underlying fibers of the skin and permanently separate the ab muscles that keep your stomach flat.

From Joseph F. Capella, MD:
… following massive weight loss ... with few exceptions, individuals following significant weight loss develop generalized or focal areas of excess skin.

The primary cause of excess skin following weight loss is relatively simple. Similar to pregnancy where the muscles, skin and other tissues of the abdominal wall expand to accommodate the fetus, a similar process occurs with the accumulation of fat in the body. There are important differences however. The process of fat accumulation in morbidly obese individuals often begins during childhood or adolescence, prolonging the period of tension on the skin. In addition, the area of tissue expansion in obesity is generalized rather than limited for the most part to the abdomen.

With weight loss and following the delivery of a baby, the affected tissues tend to retract. When the tissues do not return to their previous state it is because they have been permanently damaged. In the case of skin, the elastic fibers have been broken. This can give the appearance of striae, a condition often seen on the breasts and abdomen following pregnancy. How closely the skin and other tissues of the body resemble their appearance prior to pregnancy or obesity depends on similar factors.

Probably the most important determinant of how much loose skin an individual will have following weight loss is age. Younger patients tend to have less loose skin. The next most important factor is the amount of weight loss. An individual who loses 250 lbs. is likely to have more excess skin than somebody losing 80 lbs. Other less important variables include complexion, amount of sun exposure received over a lifetime, heredity and whether somebody is a smoker. Fair skinned people in general tend to develop more loose skin than darker individuals. Sun worshippers tend to sustain more tissue damage over the years and consequently more loose skin following weight loss. Some people tend to have " better" skin than others of similar complexion and lifestyle. This may be the result of hereditary factors that are not readily apparent. Finally, smoking breaks down collagen, a major component of skin and other structural components of the body. Smokers develop more loose skin than their non-smoking counterparts.

Exercise that includes increasing muscle tone can tighten connective tissue between muscles and overlying skin. A regular exercise regimen is helpful to maintain ones weight following bariatric procedures and can serve to tighten loose skin to some degree.
2. Will exercise affect the way my skin looks when I reach my target weight? Exercise alone can’t make your skin tighten up; however, building muscle as you lose weight and afterwards can help to fill up some of the loose skin. There’s an interesting discussion of exercise and its effect on skin here: Why do some people just shrink?

3. Are there any creams or lotions that I can rub on my skin that will make it tighten up? Will 'brushing' my excess skin make it go away? No, but it certainly never hurts to moisturize.

4. Are there any vitamins or supplements that I can take that will make my skin tighten up? No.

5. Is it true that if I lose weight ‘the right way’ that my skin will tighten up and I won’t have any loose or excess skin? There are myths, misinformation and outright lies floating around the Internet about skin and weight loss. The Big Lie is that if you lose weight ‘the right way’ you won’t have any problems with your skin — that it will shrink to fit your new body. The ‘right way’ is commonly held out to be through healthy eating, exercising and lifting weights, drinking lots of water, using lotions of various types, losing slowly, and taking various supplements and oils. Often whoever is espousing the ‘right way to lose weight’ is selling something: a book, lotion, supplement, or weight loss plan. Or that person is simply misinformed and has never personally lost enough weight to get to the point where excess skin is an issue. In any event, they’re wrong. You can lose weight 'the right way' and have a lot of excess skin.

6. Am I a failure if I lose weight ‘the right way’ and still have a problem with excess skin? No! The Big Lie perpetrates the myth that we've done something wrong if we reach our goal weights and don't have magically shrinking skin. Many people have lost weight the right way and have problems with excess skin. You’re a success for losing the weight! Don’t let ignorant people make you feel like you're a failure.

7. Why do I see pictures and read stories in magazines, books, and on the Internet about people who say that they have lost a lot of weight but have tight skin with no excess skin problems? Everyone is different and there may be a few lucky souls who can lose large amounts of weight with no excess skin problems. Those folks would probably be ones who lost their weight at a young age, hadn’t been overweight for very long, and/or were genetically blessed with elastic skin. Unfortunately, however, sometimes people just aren’t honest about their skin problems because they are selling products or services or trying to make a name for themselves. So you have to consider the source: does this person, magazine, company, or book stand to profit from giving the illusion that you can lose weight without having any problems with excess skin? Keep in mind that photos can be airbrushed and that lighting, posture, makeup, and hair styles make a huge difference in before and after photos. Sometimes excess skin is tucked into clothing, even skimpy posing suits, to make it ‘disappear’.

In other words, be cautious about believing all that you may ‘see’ and ‘hear’ about weight loss without excess skin problems. Especially if it involves your money!

8. When will I be able to tell whether my skin will tighten up after weight loss? Try not to worry prematurely about potential skin problems before you reach your goal weight. Many body changes happen as you lose the last ten or twenty pounds. Most plastic surgeons tell you to wait at least six months after you reach your goal weight and stabilize there to see how your skin reacts to your weight loss. However, not much is likely to change after a year.

Remember, if you decide that your skin looked better before you lost weight, you can always gain the weight back again – but we bet you won’t!

9. I’ve reached my goal weight and waited six months and still have a problem with excess skin. What can I do? At this point, it comes down to two choices: live with the skin or have it surgically removed. Excess skin problems can usually be camouflaged under clothing quite nicely. If you don't want to live with the skin, you can schedule a consultation with a plastic surgeon to discuss surgical options. You might want to consider talking to a doctor just to find out what all your options are even if you don’t think that you would consider surgery.

10. What kind of doctor would I see? A plastic surgeon.

11. How do I find a plastic surgeon? Look for a board-certified plastic surgeon: American Society of Plastic Surgeons Talk to friends about their experiences and recommendations. Plastic surgery is becoming common today and you may know quite a few people who have had surgery. Get referrals from your GP or gynecologist since they are likely to have seen the results of various surgeons’ work and know their reputations.

Visit several doctors to be sure that you find one who you are compatible with and feel like you can work with as a partner. More than any other medical specialty, plastic surgery is an art and you want to have total confidence that your doctor understands your wants and needs and can get you the results that you expect.

12. How much does a consultation cost? Ask when you call for an appointment. Some may be free, some may be between $50 and 150, depending on where you live. Some doctors will waive the fee if you end up doing the surgery with them.

13. What happens at a consultation? You will need to undress and show the doctor what’s bothering you. After a large weight loss, the skin problems are frequently all over our bodies, so you might as well forget about modesty. Often the doctor will take photographs. He/she will discuss treatment options and their costs.

14. What should I ask a plastic surgeon? It’s a good idea to go in with a written-out list of questions. There’s an excellent list of suggested questions at TuckThatTummy.com. You might not want or need to ask all of them but it’s a good place to start thinking about your own questions.

15. What kinds of plastic surgeries are done for excess skin? Here are the names of some of the various procedures:

* Arms: arm lift or brachioplasty
* Thighs: thigh lift or lower body lift
* Face/neck: face lift
* Breasts: breast lift, mastopexy
* Butt: butt lift, lower body lift
* Entire lower body (abdomen, butt, thighs): lower body lift, belt lipectomy

Many of the above can be combined with lipo to remove excess fat. Frequently multiple procedures are done together to save on expenses.

16. Does plastic surgery leave scars? Yes. Unfortunately it’s a trade-off between scars and excess skin. Most scars can be camouflaged by clothing or a bathing suit or underwear, although those on the arms and knees and other exposed areas are more visible. Scars go through a maturation process as they heal, starting off as red and raised, and fading to thin white lines over the course of a year. Your doctor will suggest products and techniques (like massage) to minimize scarring. You need to avoid tanning and sun exposure on your scars for a year.

You may discover people telling you horror stories about scarring in an effort to scare you off from surgery (my aunt's best friends daughter had surgery ... blah blah blah). Do yourself a favor - talk to doctors, look at photographs, and make up your own mind about what is acceptable to you.

17. How much does all this excess skin weigh — will I lose weight if I get rid of the skin? “Dry skin” (skin drained of all its fluids) doesn’t weigh much at all (they drain it back into your body in the OR before they cut it off). Frequently, however, some fat is removed along with excess skin and that adds some weight to what’s removed. The total weight can range from just a pound or two to twenty or more pounds, depending on the amount of excess skin and attached fat that you have. Everyone’s experience will be different — a plastic surgeon would have examine you in order to answer that question for you.

18. How much does plastic surgery cost?

2006 Average Surgeons Fees (these do not include operating room, hospital, anesthesia, or miscellaneous expenses) from the American Society of Plastic Surgeons:

Abdominoplasty: $5063
Brachioplasty: $3513
Thigh lift: $3885
Face lift: $4856
Mastopexy: $4220
Butt lift: $4527
Lower body lift: $7578
Breast augmentation: $3600

Total average costs of the various procedures (surgeon’s fee, anesthesia fee, operating room fee, and implant fee (if applicable)) from InfoPlasticSurgery.com:

Arm lift (brachioplasty): $5000 – 6500
Abdominoplasty: $6000 - 8000
Face lift: $7000 - 9000
Mastopexy: $5000 - 6000
Breast augmentation: $5000 - 6500

The cost will vary depending on the doctor, where you live, and whether you are combining procedures but these numbers give you a ballpark idea of the costs.

19. Does insurance cover plastic surgery to remove excess skin? You will have to check your own medical insurance to answer this question for sure. Typically, skin removal, even after massive weight loss, is considered to be cosmetic and not covered unless you can show that it is causes a medical problem, like rashes or back pain. Keep in mind that your insurance company is only interested in medical problems caused by the excess skin after you reach your stable goal weight. They don’t need information about any problems with rashes, backaches, or pain that you had while you were overweight, so don’t be concerned if you didn’t document problems that you previously had. If your skin is causing you problems once you’re at goal, take photos and visit your PCP for treatment.

On a practical level, it’s unlikely that insurance will cover any surgery unless you previously had weight loss surgery -- WLS patients seem to have better results with insurance coverage than non-WLS patients. Cosmetic surgery is not deductible as a medical expense for tax purposes.

20. Can I finance the surgery? Some plastic surgeons offer financing plans, either themselves or through various companies. Check with your doctor. Tip: many surgeons give cash discounts. Be aware that the interest rates offered by cosmetic loan companies can be rather high. Shop around – you might save money on both surgery fees AND interest rates if you can use, say, a home equity loan or 401(k) loan at a lower interest rate, and pay your surgeon cash (i.e. certified or personal check).

21. Will a hospital pay for my skin removal if I agree to donate the skin to help burn victims? No. This is an urban legend that’s frequently passed around the Internet. Hospitals use cadaver or synthetic skin for skin grafts.

22. Can you recommend any web sites for more information?
When researching a plastic surgeon, your first stop should be the American Society of Plastic Surgeons website (of course, if you’re outside the U.S. you’ll need to find the certification board in your country. It IS imperative that you research your surgeon carefully).

Other useful sites:

Medline Plus on Plastic and Cosmetic Surgery
Tuck That Tummy and its sister websites Liposuction4You, Beauty After Pregnancy, and Breast Lift 4 You
Plastic Surgery 4 U: detailed information on a variety of procedures, with photographs
Dr.Foley.com has videos of lipo and a breast lift
InfoPlasticSurgery.com: info from Dr. Jean Loftus, whose book is cited below.
Also check out the Discovery Health website for some informative articles and the TV listings – they have some interesting (if somewhat sensationalized) shows about plastic surgery.

If you know of any great sites, please post them!

23. Can you recommend any books for more information?
Karen (MrsJim)’s favorite book on the subject is “Two Girlfriends Get Real About Cosmetic Surgery” by Susan J. Collini and Charlee Ganny. This book manages to be both informative AND a fun read as well!
Another book Karen recommends is “The Smart Woman’s Guide to Plastic Surgery: Essential Information from a female plastic surgeon” by Jean M. Loftus, M.D. Not as much fun to read but packed with good info. Check ‘em out.

24. Are there 3FC members who have personal experience with weight loss and excess skin? Have any of them had plastic surgery for skin removal?
I’ve had several surgeries for skin removal and will tell my story in a separate post, below. Others with personal experiences, pre- or post-surgery, are invited to post also.
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Old 01-31-2004, 09:55 AM   #2
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HI Meg

Wow what a great job you have done here. This must have taken a lot of work. I just want you to know that I appreciate what you have done here. It has been a great help for me to be able to read this.


Have a great Saturday.

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Old 01-31-2004, 11:47 AM   #3
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Default My experience with plastic surgery...in a nutshell

I've posted about this before but most of my post-op posts got torched during the Big Crash. So here ya go again...

In November 2002, I came to the conclusion (after talking with Meg - see the huge Loose Skin thread which has been moved to this forum) that:
  • My loose skin and saddlebags were NOT going to go away by themselves, no matter how clean I ate, how much water I drank or what kind of supplements and lotions I used; and
  • They bugged the crap out of me!

So that's when I decided to research it further. I went on a couple of consults - the first one was with a major university hospital - I was trying to save money initially and had read about teaching hospitals doing the surgery at a discount (a medical student in training, supervised by a 'real' surgeon). It only took the consult to find out that was NOT the way I wanted to do it. Meg's said in the past that a plastic surgeon is an artist - just like if you were having your portrait painted, or your home redecorated/remodeled, you would want to have a good rapport with the surgeon who works on you - KWIM? (besides, the money I would have saved wouldn't have amounted to much anyway...and they did admit they had a waiting list).

My second (and last) consult was with the PS who did my mother's breast reconstruction after her double masectomy. She's highly regarded here in the Bay Area (and that's really saying something since we have a plethora of PS's here!) and we just hit it off right away. Like I said...rapport.

So I had two problem areas that were bugging me:

1) Even at a size 4/6, I had 'thunder thighs' including saddlebags that never went away...remember that Meg said once fat cells develop, they're there to stay unless you have them removed surgically (liposuction).

2) My hangy tummy.

I didn't have the 'fundage' to do both procedures at once so I basically picked the area that was bugging me the most - at the time it was my thighs. In February, I had 5000 cc's of fat cells removed from my thighs via liposuction. While I was delighted with the results, I could see immediately that my stomach now looked MUCH worse - more prominent since the saddlebags and all were history.

On December 8th, I went into the surgery center and had a full tummy tuck with muscle repair (where the abs are sewn back together like a corset). The surgery took 3 1/2 hours and I went home the same day (for both procedures actually).

For the liposuction, I took a week off work; for the TT, I took two weeks off.

Pain? Actually I would call it for the most part, more of 'discomfort'. Of course you have to remember that I was on DRUGS. At least for the first 3-4 days post op. After that, an occasional Valium or Tylenol PM was fine. I am a major pain weenie (my dentist has to give me a Valium to calm me down before she injects the novocaine!) but aside from a couple of times where I was reading/watching TV and something funny would come on (warning: do NOT watch "South Park" during TT recovery!) I was okay. Except for the fact that I couldn't run, jog, lift weights or horseback ride for six weeks following the surgery - but it was well worth it. (for the lipo I was on the DL for four weeks).

Am I happy I did it? was it worth the $$ and time off, etc? ABSOLUTELY!
Mrs. Jim
Highest weight: 265 pounds, size 24/26 (May 1990)
May 1991: 174 pounds (-91 lbs)
September 1996: 155 pounds (-110 lbs)
*LIVING at: 145-149 pounds, size 4/6 (-116/120 lbs)

*Maintenance = LIVING.
Posts by members, moderators and admins are not considered medical advice and no guarantee is made against accuracy. Please see your physician before taking advice found on the internet.

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Old 01-31-2004, 12:29 PM   #4
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Thanks for the excellent job, gals.

5'5.5" ~248# Mar1 03/cw: 192#


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Old 01-31-2004, 04:41 PM   #5
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Default My Plastic Surgery Experiences

My story: when I weighed 257 pounds, I had a picture of my dream body in my mind — what I thought I’d look like after I lost all the weight. It wasn’t a model’s body or anything unrealistic; it was just a normal body that could wear bathing suits and shorts and all the clothes that you’re self-conscious about wearing when you're overweight. As I got close to my goal weight, things were actually looking worse (wrinkly and cellulite-y), rather than lean and tight. After I reached my goal weight, I was so disappointed in how my body looked, especially my legs, stomach, and butt. This is where I had carried most of my weight (I ended up losing 22 inches off my hips and 13.5 off my waist). My upper body had tightened up pretty well except for that arm flap and the skin where I used to have boobs.

I really felt like I had failed in some way at weight loss. Sure, I’d reached my goal weight and was down to a low body fat %, but I couldn’t wear shorts or a bathing suit. I’d read lots on the Internet about how losing weight ‘the right way’ would prevent saggy skin after weight loss and so I concluded that I must have done something wrong. All that work and I still screwed it up! The problem was that I was down to around 13% body fat, which is about as low as I felt I should go. What to do?

I made an appointment with a plastic surgeon for a consultation and stood in front of him, stark naked, and asked him what was going on — was it fat or skin or celluite or what? He told me that there was very little fat left on my body but that there was an "enormous quantity” of skin that, spread out, would “cover yards”. He said that it would not go away on its own regardless of how hard I worked in the gym or how well I ate — there was just too much of it. It gave me so much relief to know that I had done everything that I could to make the skin go away and that I hadn’t failed at weight loss.

He recommended a lower body lift — it’s like a tummy tuck that goes all the way around your lower body. We also discussed my floppy chest and the loose skin under my arms and my “turkey neck” and jowls on my face, all resulting from the weight loss.

In January, 2003, I had the lower body lift and some work done on my face. The surgery took 7 1/2 hours: three for the abdomen, two for the butt, and two and a half for the face. Basically what my doctor did for my lower body was the classic tummy tuck in front and pulling up and getting rid of all the excess skin on my butt and thighs. He said that he built me a new butt! All my stretch marks and C-section scars are gone. I also have a new navel. At my hip, the incision splits into two and one line goes up above my butt but below my waist and the other goes down following the line below my butt where it meets my thigh and curves around to my inner thigh. All the scars are covered by my underwear.

I spent two nights in the hospital (though I had only planned on one) because I ended up needing blood transfusions because of the amount of blood that I lost during surgery (rare, but it happens). This is major surgery, but really not very painful surgery because they are not cutting into organs or joints, just skin.

I actually recovered faster than anticipated. I woke up from surgery with four drains (removed after a week) and in a knee-length girdle-type thing that I wore 24/7 for the first two weeks. At first, it was difficult to move because my skin was stretched very tightly. I took Percocets for the first four days, then Tylenol for two days, and at the end of the first week, I didn't need anything for pain. I really never was in pain — I would describe it rather as an uncomfortable, tight, pressured feeling. The worst was the fact that I had a butt full of surgical staples, so that sitting (and going to the bathroom) were uncomfortable. The staples were removed after two weeks.

I snuck back into the gym for light cardio and upper body weights after two weeks. By the third week, I was back working out at a low intensity and worked my way back to an hour of cardio per day. By the fifth week post-op, I was back doing the same workouts at the same intensity as before surgery, though with slightly lighter weights because I lost a little strength while I was off.

It took a full year for all the swelling to go away, though the worst was gone in four months. It was about four months before I could sleep on my stomach. I lost inches after the surgery, though my weight is the same as before surgery (probably because I didn’t have a lot of fat attached to the extra skin; my doctor estimated that he only took off 2-3 pounds of skin). Now, a year after surgery, my scars are flat and faded though still visible.

In August, 2003, I had a second surgery. The plan was to take off the loose skin under my arms, do a breast lift and an inner thigh/knee lift. It turned out that there was a lot more excess skin on my arms that we anticipated and my doctor couldn't do the breast lift at that time (he says that you can’t pull in two directions at once). I was in surgery for five and half hours this time and spent one night in the hospital.

I have a lot of scars from this surgery. They travel up my arm from the elbow, up through my armpit, down to boob level. The thigh scars are at the tops of my thighs and extend down the inside of the thigh for about six inches. I also have scars around my knees. These scars will be more visible than the ones from the lower body lift.

My recovery experience was similar to the first surgery, though the arm incisions were fairly painful at times. My doctor encouraged me to walk after ten days to reduce the swelling in my legs, so I was walking 2-3 miles a day from that point on. I was able to use the elliptical and start with light weights again the third week after surgery. I had surgical staples in for four weeks, due to the incisions being located in high tension areas. I developed an infection in my knee after three weeks that caused it to swell enormously (and was fairly painful) but two weeks of antibiotics took care of it.

I’m six months out from this surgery and think my legs are still swollen, especially the one that was infected. Some of the scars have healed unevenly and with puckers. There are still some areas of loose skin on the inside of my thighs.

So next up on the agenda is the “touch-up” work. With any extensive plastic surgery, touch-up work is often necessary after the initial surgery has healed. The plan is two more surgeries, neither as extensive as the first two. The first will be going over all the arm and thigh scars, pulling everything tighter and fixing any spots that didn’t heal well the first time. The second surgery will be the breast lift that we couldn’t do in August (once again I can’t do arms and the breast lift at the same time because of the problem of pulling in two directions at once). My doctor isn’t charging for any of the touch-up work, though I’ll have to pay for the surgical center and anesthesia.

Insurance didn’t cover any of this, though it did pay for the pain meds and antibiotics. We tried; my doctor wrote a wonderful and impassioned letter on my behalf, but the word we got is that if you haven’t had weight loss surgery, you’ll never get coverage of the skin removal. Despite the cost and the scars and the recovery time, I have absolutely no regrets about the surgery. It came down to a choice between scars and all that loose, floppy skin and I’m so happy that I got rid of it. I’m looking forward to being finished once and for all this year, healing, and getting on with the rest of my life in my new body.
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Old 05-29-2004, 07:44 AM   #6
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Default And another plastic surgery experience

I've been a goal weight for 2 1/2 years, and lost about 50 pounds. I carried most of my weight around my abdomen, and had had 2 very large pregnancies. During my first, I ballooned from 113 pounds (I'm 5'3") to 165 pounds in about 4 months. My dd was in a bizarre position in utero- we called her "torpedo babY" to give you an idea. After her birth, my skin was shredded, and never recovered no mater what weight I was. I gradually gained weight for the next 20 years and had 1 more full-term pregnancy, reaching my high of about 182 during the summer of 2001. I'd finally had it with the way I felt and looked. When I started losing weight, I did it for a combination of health and vanity reasons. Health to start with, but as it started coming off and I achieved a healthy weight, I wanted to look better and better. I wanted my body to reflect the hard work and exercise that I did.

I thought I lost the weight the "right" way. Good, nutritious food, cardio, and weighlifting. I was well muscled. My legs, arms, back and chest were tight and strong, but nothing seemed to help to little extra fat and saggy, droopy, stretched out skin on my abdomen. I had stretch marks almost to my breasts, and despite the strongest abs in the gym, I would never see them. I felt like a total failure, since I'd done it the RIGHT way, guzzled water, rubbed lotions on my skin, taken my EFA's, massaged my skin with all manner of creams and loofahs, and nothing helped.

In my late forties, my skin was not going to magically spring back to it's 24 year old state. Heck, it didn't do that when I was 27, why should I expect it to do that at 47? I spent two more years trying to get rid of that skin through competition diets, brutal exercise routines, and a lot of crying at mirrors. Conversations with other maintainers and a lot of reading convinced my finally that I'd done nothing wrong other than having 2 wonderful children and being overweight.

After much soul searching about vanity, cost, quality of life, and risk taking for vanity, I finally started researching plastic surgery to remove the skin and a little ab fat that wasn't moving no matter how lean I got the rest of my body. I still wasn't sure I'd go through with it, up to the point when they put the IV in my hand! The surgeon I finally picked, after interviewing 3, decided that I needed a full tummy tuck, with a lot of muscle repair. "Torpedo Baby" had stretched and torn my abs, to the point that although they were now very strong, no amount of crunches would ever give me a flat mid-section.

Today I'm 3 weeks post-op. It was not a terribly painful procedure, although I did have it done in a hospital with an overnight stay. My Doc is extremely cautious, and that was the only way he would do tummy tucks. It cost a lot, none covered by insurance. Recovery has not been a straight-line experience: some days I feel ready to take on the world, other days I just want to lie on the couch. My scar is aready looking pretty good, and my clothes fit SOOO much better without having to stuff in a roll of skin.

I went back to work after 2 weeks. I'm a personal trainer and am on my feet most of the day, and usually lifting weights all day. My clients have been wonderful about racking their own weights this week, but I do wish I'd been able to take another week off; I was exhausted, and had some days where I was painfully swollen by the evening. I've started very light or just body weight workouts for myself, but can't do abs or lift heavy for another 3 weeks.

Would I do it again? YES! resoundingly, YES! I look in the mirror and even though I'm still swollen in the ab area, I see the body I've worked for. I'm told that it takes 6 months to see the final result, so I can't wait! 4 months post-op will mark my 50th birthday, and I can't wait to see where I'll be then.

Falling down is not failure....Failure is staying down.
Save the Earth, it's the only planet with chocolate and wine.

It isn't about waiting for the storm to pass...
It's about learning to dance in the rain.

9 years at or under goal weight! Working Maintenance Everyday
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Old 07-15-2004, 09:04 AM   #7
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I am not 100% sure if I am allowed to post this, but this is an article from cbc.ca and I partially saw this news story last night.

QUEBEC CITY - A Quebec City woman is at odds with the province's health board over the cost of removing 50 pounds of excess skin on her body. Plastic surgery can remove it, but while Quebec's health insurance board paid for the weight-loss surgery, it won't pay to remove the skin. The province considers it an esthetic procedure.Quebec's health insurance board says there has to be a medical reason for it to cover the cost.

"Either physical or physiological. It doesn't matter which," said spokesperson Nathalie Pitre.

The doctor who performed Marin's surgery believes the excess skin poses a medical problem.

"Depending on the patient, you can have a medical skin problem and a social problem if you think about wiping and cleaning yourself," said Dr. Simon Biron.

Marin says she has difficulty walking and is embarrassed by her appearance.

"It sickens me. I sicken me," she said. "They started this, why won't they finish it?"

The province has approved skin-removal surgery for 209 people.

Marin says she wants her case reviewed and is prepared to take her battle to court.

Written by CBC News Online staff

It would be interesting to see how this pans out.
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Old 07-15-2004, 09:54 AM   #8
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No problem with posting the story. It's becoming more of a hot issue here in the US too since it goes hand-in-hand with the increase in WLS. My totally unscientific impression is that it can be tough for WLS patients to get coverage for skin removal, but it is possible in some cases. However, if you lost weight without WLS it seems to be virtually impossible to get insurance to pay.

But sheesh! If that poor woman has an extra fifty pounds of skin?! That definitely counts as a medical problem in my book!
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Old 07-23-2004, 05:00 PM   #9
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Question Hey Meg!

I've got a question about the arm surgery you had. How do the scars look now that itís been a while? If I ever get the chance to have mine done I'd hate to still be too self-conscious about how they look to go sleeveless. So are the scars very noticeable?

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Old 07-24-2004, 07:37 AM   #10
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Beverly -- I had the original arm surgery last August (along with inner thighs and knees). In April of this year, I had "touch up" surgery on all those areas. Even though it was called "touch up," it was pretty extensive and took another 5.5 hours. In the most recent surgery, my plastic surgeon went back over all the original arm and leg incisions in order to excise more skin and pull everything tighter. He told me that he and other PSs are finding that skin removal often has to be a two-step process for those of us who were morbidly obese -- the first time to get off most of the skin, then letting it heal, and going back a second time to pull it tighter. Apparently skin removal is the fastest growing area of plastic surgery now due to the increased popularity of WLS and they are still learning about what works best.

The results are really good but I won't kid you -- the scars are quite visible at this point. Scars go through a maturation process over the first year and they peak in redness about 3 - 4 months out from surgery, which is where I am right now. So my arm scars are reddish-purple and somewhat raised. They start at chest level and travel up through my arm pits and down the inside of my arms to my elbows. The original incisions didn't go all the way to my elbows, but that left me with toned upper arms with a big flap of skin by my elbows, which looked terrible. So my doctor extended the incisions to get all that floppy skin.

I expect that the scars will improve tremendously over the next year. I had the lower body lift 18 months ago and those scars are really smooth and faded now. I imagine that I'll always have some visible pale scars on my inner arms but think that a little self-tanner will work wonders in covering them (I can't use it now in the healing stage). I have the same problem with noticeable scars on my legs but tend to wear pants or capris so it's not as much of an issue.

But I wear short-sleeved and sleeveless now, despite the arm scars, after being quite self-conscious at first. I've always known that it's a trade-off between the excess skin and scars -- that I couldn't get rid of one without the other. I've never regretted my choice to get rid of the skin, even though I sure did get the scars. I simply refuse to let the scars embarrass me now. They're part of me and my story -- I'm not trying to pretend that I didn't spend most of my life as a obese woman. Iím certainly not flaunting the scars and am not proud of being fat -- but they're part of who I am now. I spent way too many years being inhibited from living because of my fat and I'm just not going to let the scars affect me the same way. So I've reached the point that I don't care any more if someone sees them and wonders what they're all about.

Of course, all of this involves a lot of personal decisions that everyone has to make for themselves. Trust me, plenty of people will be happy to give you their uninformed opinions about what to do about excess skin after weight loss (hey, they saw this show on TV all about skin or read about someone on the Internet, etc). Don't be surprised to find that some people are quite opposed to this kind of surgery for a variety of reasons (ranging from a generalized opposition to plastic surgery as being motivated by vanity to some who think that we did something "wrong" if we have excess skin after weight loss). We put together these FAQs simply to try to get accurate info and personal experiences out there so people can evaluate their choices and decide what's right for them.

Good luck to you, Beverly, and feel free to ask any other questions you may have.
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Old 08-21-2004, 11:48 AM   #11
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I'm needle phobic, so surgery frightens me (says this former open heart patient). But if someone dropped the kinda dough in my lap it'd take, I'm thinking I'd jump at the chance for something around the abs and buttocks. It's not bad unless I bend forward. I concentrate on that area in exercise. But now:

3. Are there any creams or lotions that I can rub on my skin that will make it tighten up? No.
Guess I can throw out my firming cream and cocoa butter. LOL

I use lotions morning and night and do lots of situps, crunches, leg lifts and the like on a daily basis. I've been overweight since about 1985, over 200 pounds since about 1989/90. I keep hoping I can tighten it up some more, cause it doesn't look like my rich uncle will be getting out of the poorhouse anytime soon.

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Old 10-18-2004, 11:28 PM   #12
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Red face Meg

Congrats on your weight loss! Where did you have your surgery done & who was your surgeon? Thanks.
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Old 10-19-2004, 05:22 AM   #13
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Wecome to 3FC, Square Dancer! My plastic surgeon is Dr. J. William Futrell and I had my surgeries done at Magee Hospital here in Pittsburgh.
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Old 10-26-2004, 06:46 AM   #14
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Do you know how long I have been looking for this exact info??? I have just lost 167 pounds thru diet and exercise. I am now at 155 and let me tell you. My arms are what bother me the most. I don't care about the tummy or the non-existant boobs but the arms is what I want taken care of, it's awful. It makes me feel like all of the work I have done was for nothing because I don't know what looked worse. I know that it's not a matter of looking perfect but feeling healthy and that's what I am reveling in now. I have never felt so good in my life. I'm 32 and have 2 boys 4 and 1 yr old and live in NW Pennsylvania.
Thank you!!!!!!!!!!!!!
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Old 11-17-2004, 03:45 PM   #15
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I don't know if any of you caught it, but last weekend there was a show on Discovery Health about plastic surgery after massive weight loss. Usually I don't watch those shows, but this one seemed pretty well informed. It reminded me of this thread, actually. One lady had lost a couple hundred pounds after a gastric bypass and had a whole-body tuck; another lady had had a very large pregnancy and had a tummy tuck, and another guy was in the process of losing a lot of weight and had an 'apron' of skin and fat removed.

Let me tell you, it made me admire those of you that have had these things done even more! I completely understand how frustrating it must be to lose this huge amount of weight and then have these problems which are only solved by major surgery. Holy cow.
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