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Gastric Sleeve and Excess Skin:  How to Manage the Effects of Major Weight Loss

Gastric Sleeve and Excess Skin: How to Manage the Effects of Major Weight Loss

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      Gastric sleeve is a major weight loss surgery resulting with many patients having a large amount of loose skin, which may negatively affect their appearance and quality of life.  The sagging skin is a result of rapid weight loss.  Most gastric sleeve patients lose over 100 pounds that leads to excess or loose skin (Long, 2020).  

      The skin cannot revert back because the collagen and elastin fibers are damaged due to the large amount of weight gain most overweight or obese patients have accumulated.  

      Loose skin affects everyone differently.  Excess skin contributes to many physical and emotional challenges for weight loss surgery patients.  Common challenges are:

      • Physical discomfort
      • Decreased Physical Activity
      • Skin irritation
      • Poor Body Image

      Factors contributing to excess skin from weight loss surgery are:  

      • Age
      • Genetics
      • Smoking
      • Length of time spent Overweight
      • Amount of Weight Loss
      • Chronic sun exposure

      Overall, the more weight loss a person has, the higher amount of excess skin the patient is likely to have. Common problems with excessive skin are chafing, which can lead to infections.  The usual areas affected are:

      • Thighs
      • Groin
      • Underarms
      • Stomach
      • Any place with extra skin
      Shoes and dumbells.
      Bicep curls tone and aid in lessening excess skin.

      Ways to combat excess skin naturally:

      • Patience allows the body time to heal and stabilize.  With proper care and maintenance skin will tighten on its own up to a point.
      • Massage Therapy allows the skin to tighten due to increased blood flow and circulation.
      • A Sea Salt Scrub improves blood flow circulation and tightens the skin over time.  
      Woman doing crunches.
      Abdominal crunches aid in tightening stomach muscles and skin.

      According to Healthline, exercise and weight training are excellent options to improve skin elasticity.  Exercise can severely minimize and reduce the appearance of excess skin.  Building muscle mass decreases the appearance of loose skin from weight loss.  

      Excessive fat prevents the skin from shrinking with rapid weight loss.  Replacing the fat loss with muscle helps burn more calories and improves the appearance of loose skin.  

      Weight training helps in tightening skin after weight loss:

      • Biceps curls tone the muscle around the bicep area to prevent the underarm hang.
      • Planks are efficient in strengthening and toning abdominal muscles.
      • Squats tighten loose skin on the lower body by strengthening the thighs and glutes.  
      Group of people working out.
      Muscle building exercises lessen the impact of excess skin.

      Other potential alternative ways to tighten loose excessive skin is through the use of firming products.  Firming creams improving the appearance of loose skin for small to moderate weight loss patients.  Firming creams provide a temporary boost in tightening loose skin.

      Supplements and nutrients that lessen excess skin:  

      • Collagen supplements may help improve and prevent loose skin.
      • Vitamin C supplements allow the body to synthesize collagen and would lessen excess skin.
      • Gelatin is an excellent source for building collagen and improve skin elasticity.
      • Water greatly improves skin elasticity and appearance of loose skin.  
      Water being poured.
      Water helps reverse the skin losing process.

      Continual exercise and monitoring of food consumption is key for long term success after gastric sleeve surgery, but loose skin may still fail in fully retracting back due to the large amount of weight lost.  

      Common medical treatment recommended in removing loose skin is a surgical intervention.  Body contouring surgery is used after a significant amount of weight is lost to remove the excess skin.  

      With body contouring surgery, a large incision is made and excess skin and fat are removed.  The incision is sutured with fine stitches to minimize scarring.

      Surgeon at work.
      Recovery from body contouring surgery is often more painful than bariatric surgery.

      Body contouring is the most common and effective procedure to remove loose skin. Many body contouring surgeries are usually performed on different body parts over the span of one to two years after major weight loss.  There is a hospital stay of one to four days and a recovery time of typically two to four weeks.

      Common body contouring surgeries are:

      • Abdominoplasty or tummy tuck.  This is the removal of skin from the abdomen.
      • Lower-body lift is the removal of skin from the belly, buttocks, hips and thighs.
      • Upper-body lift is the removal of skin from the inner and outer thighs.
      • Brachioplasty or the arm lift.  This is the removal of skin from the upper arms.  

      Complications can arise from body contouring surgery, such as internal bleeding and infections, which may lead to longer hospital recovery time.  

      Financial complications may also arise due to the high cost of the cosmetic surgery and generally lack of insurance coverage.  Insurance normally doesn’t cover skin removal or contouring.  The procedure insurance occasionally pays for is a panniculectomy, when doctors remove a fold of skin that hangs over the patients pubic area. This procedure may fix some problems, but patients often dislike how they appear because there is no body contouring.

      Plastic surgeons try to obtain documentation of patient problems to submit to insurance for partial coverage, but insurance companies have very specific criteria in considering surgery including:

      • Lowest possible set weight achieved
      • Consult 3-6 months after a plateau
      • Diabetes and High Blood Pressure controlled
      • Overall stable and consistent health

      The main takeaway from phenomenon of loose skin resulting from weight loss surgery is the evolution of the mindset and approach to eating healthy and regular fitness.  Along with a desire to be healthy and strong.  Weight loss surgery allows for permanent changes in exchange for regaining back one’s health.  Some may call it “cheating,” or an “easy way out,” but this road to health and wellness is difficult and challenging.  Patients are faced with obstacles daily and constantly reminded of their choices.  This process of awareness and learning continues for the rest of the patient’s life.  There is no shame in having weight loss surgery or its consequence of sagging skin.  

      How one chooses to tackle their loose skin is their prerogative.  As someone who had the gastric sleeve surgery, maintaining a consistent exercise and nutrition routine is essential.  I also have had conversations with my bariatric doctors and nurses regarding my loose and sagging skin.  There is only so much exercise and firming creams I can use before there is only one option remaining.

      Body contouring surgery is something I am currently considering to remove my loose skin.  I was aware of the possibility my skin would only be able to retract only to a specific point.  I currently do not possess the appearance of a “melted candle,” but reaching a point of complete satisfaction with my appearance is a continuous journey I endure daily.  

      At my first bariatric doctor appointment I was told the success of my weight loss journey was based off one thing, “I am giving you a tool.  It’s a tool that can help you lose and keep the weight off, but it’s only a tool to help you.  You still have to do the work.”  Hearing this statement allowed me to face the truth of my own my choices.  Understanding that the process of weight loss is a continual journey, loose skin and all.  

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        Kelsey Renae Schulze


        Kelsey is a post-op bariatric patient who had sleeve surgery in 2018. She is a writer, focusing on a variety of topics given her background in legal studies and criminal justice.