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Plastic Surgery After Bariatric Surgery

Plastic Surgery After Bariatric Surgery

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      Extreme weight loss from bariatric surgery can prompt positive changes to the patient’s health.  For instance, some chronic health concerns like diabetes cease being issues.  At the same time, patients can experience sagging or hanging skin from one or multiple areas of the body as a result from bariatric surgery. Bariatric plastic surgery could be the answer.

      The extent of this problem depends on the individual.  For example, age, diet, exercise, smoking history, sun exposure, genetics, and total weight loss are factors that contribute towards the health of your skin.  Furthermore, the skin is most likely to be less elastic where most of the weight is carried.

      In addition to the physical discomfort of excess skin, it can also have a psychological impact that affects body image and self-confidence.  Therefore, plastic or reconstructive surgery is often an option to address this problem with post-bariatric patients.

      A woman's stomach with the words "out of order" written on them.
      Plastic surgery such as a tummy tuck can help get rid of excess belly skin from weight loss surgery.

      When should I consider plastic surgery?

      Firstly, post-bariatric patients should follow a controlled healthy, high protein, wholesome diet along with regular weight resistant exercise to help lower fat intake while building new muscle mass throughout the body.  This combination can help prevent sagging skin.  

      Additionally, all bariatric patients are made aware about the significance of vitamin supplementation.  Therefore, noncompliance to this can also affect the integrity of your skin.

      Weekly supplement container with a variety of supplements.
      Following a healthy diet, regular exercise, and taking supplements daily can help reduce the amount of sagging skin after weight loss surgery.

      However, some patients will continue to experience excess skin despite all of these personal efforts.   For this reason, the optimal time to consider reconstructive or plastic surgery is when you are close to your goal weight and when your weight has plateaued for months.  

      Otherwise, if your body continues to lose weight after plastic surgery, the outcome may not reach its potential and may even result with more sagging skin. Additionally, candidates should be non-smokers in good health.

      Regardless of the procedures you wish you have, it is important to select a board-certified plastic surgeon who has experience with bariatric patients.  Good communication between both plastic and bariatric surgeons is important to achieve safe and optimal results.

      What are the types of reconstructive procedures?

      There are many options for reconstructive surgery depending on the problem area.  Whether it is just one area or the whole body, the plastic surgeon will recommend the best and safest way to approach this next chapter of your life.  Below are common procedures:

      • Panniculectomy removes the hanging skin also known as “the apron” of skin called a pannus.  This skin hangs from below the belly button usually down to the pubic bone.  Frequently, the pannus can cause skin irritation or rash underneath the fold of the skin.  However, this procedure does not tighten any abdominal muscles.
      • Abdominoplasty also known as the tummy tuck, is different from a panniculectomy.  In addition to removing excess skin from the middle/lower abdomen, abdominal muscles are tightened.
      • A lower body lift targets the removal of excess skin from the abdomen, hips, thighs and buttocks.  Due to its extensive nature, patients may choose to complete the lower body lift in stages.
      • Breast lift, also known as mastopexy, involves the removal of excess skin while retaining as much breast tissue.  Mastopexy is often performed in conjunction with breast augmentation or reduction.
      • Brachioplasty, also known as an arm lift, removes excess skin in the upper arm.
      • Thighplasty, also known as a thigh lift, removes excess skin from both the inner and outer thighs.

      Furthermore, other areas patients may seek reconstructive surgery for include the face, neck, and or back.  Also, liposuction is often times done in conjunction with some other procedures to remove excess fat deposits and improve the contour in that area.

      Surgeon performing surgery.
      There are many reconstructive surgery options for bariatric patients who want to reduce excess skin and fat deposits. 

      How much does it cost and does insurance, including Medicare, cover plastic surgery?

      Most insurance companies including Medicare will cover or partially cover reconstructive or plastic surgery as long as it is "medically necessary." In other words, if the purpose of seeking plastic surgery is for mere cosmetic reasons, then the procedures will not be covered and will be an out-of-pocket expense.  

      However, if the outcome from extreme weight loss hinders your quality of life and causes further health concerns, then you have a stronger case.  For instance, breast reduction or panniculectomy should be covered if it will help minimize discomfort and improve overall health.  Therefore, be familiar with your insurance policies regarding reconstructive surgery.  You should know exactly what procedures and how much is covered.

      For those that have minimal or no coverage, it is still possible.  Figuring out and comparing different payment options to cover expenses is beneficial.  Not to mention, plastic surgery is not cheap.  Cost of surgery will vary based on procedure and geographic location.  

      Thus, it is important plan ahead and put together a realistic and wise strategy to pay for these costs.  The following list gives a national cost average of common plastic or reconstructive procedures bariatric patients may consider:

      Panniculectomy

      $8,000 to $15,000

      Abdominoplasty

      ~6,000

      Lower body lift

      ~$7,800

      Breast lift

      ~$5,000

      Brachioplasty

      ~$4,400

      Thighplasty

      ~$5,000

      These figures do not include facility fees such as anesthesia.

      What to expect from plastic surgery?

      Like any other procedures, there are potential risks and complications from plastic surgery such as:

      • Infection/poor healing
      • Bleeding
      • Scarring
      • Seroma (fluid accumulation)
      • Blood clot

      Depending on the type and extent of the surgery, recovery time will vary.  When planning to get surgery, it is crucial to set aside a good amount of time to heal.  For instance, if the doctor anticipates few weeks to recover, then that time needs to be blocked off your schedule.  Otherwise, you run into a higher risk of complications.  It is also important to have a support group that will help you during this process especially with recovery.

      Equally, many patients also fear of scarring.  Unfortunately, patients need to be aware the incision will leave a mark.  Some scars will be more visible than others. For example, those getting an arm or thigh lift will have a noticeable scar then those getting a breast or neck lift where the incision is more hidden.

      On the positive side, studies suggest the importance of including reconstructive surgery as part of the surgical treatments for bariatric patients.  Outcomes have shown increased aesthetic enhancements along with improved quality of life.  Therefore, do your research and ask many questions to fully comprehend all that you need to know before and after the surgery.

      Woman laying in a hospital bed.
      If you plan to undergo plastic surgery after weight loss surgery, it's important to know the risks and plan for your recovery time. 

      How to maintain good health after plastic surgery?

      In conclusion, whether you plan to get one or multiple procedures, it is key to consume adequate protein and follow up with appropriate nutrition during recovery.  A study showed post-bariatric patients receiving protein supplementation significantly showed decreased wound healing complications from an abdominoplasty.  

      Like bariatric surgery, the body needs to adapt to the new changes and heal with proper, high quality, lean, wholesome foods along with your individualized vitamin supplementation regimen.  Furthermore, regular exercise is vital for maintaining healthy skin and weight once cleared by the surgeon.  Continuously building muscle mass with a balanced diet will optimize results from plastic surgery.

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        Eun Jung Park, MS, RD

        Author

        Eun Jung Park is a registered dietitian with over 10 years experience working in various clinical settings. She graduated from New York University with an Master of Science in Nutrition and Dietetics.

        Gintas Antanavicius, MD, FACS, FASMBS

        Medical Reviewer

        Dr. G is a co-founder of BariBuilder. A US-based expert surgeon with over 10 years of bariatric experience, he regularly publishes research in medical journals like SOARD, Obesity Surgery, etc.