OK. Paula, I’m back! The issue of excess skin is one that never even occurred to me when I started to lose weight — it only became an issue when I got close to my goal weight and things weren’t looking the way that I had imagined. I’m glad you are aware of it now because you will save yourself some anguish later if you are knowledgeable about what may (or may not) happen to your skin as you lose a large amount of weight.
First off, let me give you a quote from a doctor, Joseph F. Capella, MD, discussing:
Quote:
“ … changes that occur in the body 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.”
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I think that is a pretty accurate summary of what I experienced. As I posted a few months ago,
Quote:
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“The consensus seems to be that the degree to which skin will tighten up after massive weight loss (that's what they call us) depends on 1. your age, 2. your genes 3. how much you have lost, and 4. how long you were overweight (recent obesity vs. lifelong). It is an individual thing and time will tell for you.”
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My personal experience was that I carried the majority of my weight below my waist, around my hips and butt and thighs. Of course, every part of me was super-sized, but these were the worst. I noticed that, as I got close to my goal weight, my legs were actually looking worse (wrinkly and cellulite-y), rather than lean and tight. And my knees looked so fat — yet my BF readings were low. Puzzled and disappointed, I made an appointment with a plastic surgeon just to find out what was going on (fat, skin, celluite, a combination of all of these?), and when he looked at me, he told that it was skin, all skin, “an enormous quantity of skin” that, if spread out, would cover “yards.” To my relief, he said that there was very little fat left on my body. But, he then said that the skin was not going to improve or tighten up. The reason that it was looking worse as I lost most of the fat was because, when the fat disappears, you are left with muscle (yea!) and all that skin, but it is no longer anchored to anything, so it flaps and wobbles and looks like celluite or like a wrinkled-up, deflated balloon (it floated in the bathtub).
He recommended a lower body lift, which I think of as a “tummy tuck plus” because it is a basic tummy tuck that extends all the way around your body and “lifts” and eliminates the excess skin on your butt also. He also recommended facial surgery to get rid of the "turkey wattle” and jowls that I developed in my face from losing fat there and a breast lift combined with some upper arm work to take care of the triceps flap (which is not too bad but bothers me).
I did the lower body lift and the face lift in mid-January (he wouldn’t combine the three procedures, only two). Total surgery time was 7.5 hours. Total cost — about $18,000. Total covered by insurance — zero, zip, nada. My surgeon told me that the lower body lift would have been covered only if I had previous weight loss surgery. He was outraged and even wrote an impassioned letter on my behalf, talking about my weight loss and motivation and all, but it had no effect.
I spent two nights in the hospital (planned on one) because I ended up needing blood transfusions because of the amount of blood that I lost (very 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. The recovery went better than both he and I anticipated. I took my last prescription pain killer on the fifth day after surgery, took Tylenol for two days after that, and then didn’t need anything. I shoveled snow (bad me) on the tenth day and snuck back to the gym after two weeks (bad me again — well, the doctor made the mistake of telling me to listen to my body and it was saying “go go go!”) I can’t say that I was ever in pain — I would call it “uncomfortable” and “tight” and “pressured”. I was back doing squats and leg press and all by the fifth week post-surgery, though not at my previous strength.
I have to add that my doctor says that I am not typical and that I had a much better and faster recovery than most. He attributes it to me being in such good physical shape and my healthy eating habits.
Finally, I am 100% satisfied with the results. It came down to a question of whether I wanted to live with the skin or have the surgery and scars. I opted for the latter and have no regrets. I didn’t lost pounds but have lost inches (my hips are 35 1/2 inches now, down from 57 inches!) and I am tight and flat across the stomach. I am planning on Part Two later this summer, which will be the inner thighs and knees and the breast lift (with the little bit of the upper arms).
Let me know if you have other questions. I’ve posted more about this on two other threads:
http://www.3fatchicks.com/forum/show...threadid=17407 and
http://www.3fatchicks.com/forum/show...hreadid=24374.
Two last thoughts: don’t be deterred from losing weight because of skin issues (you can cover up with clothing if you don’t choose a surgical option) and weightlifting while you are losing really does help, but won’t eliminate the problem.
Good luck!
Meg
?? for those who have had skin removed
