We all carry with us reminders of the person we used to be. It’s just much more literal for some than others. People who lose a huge amount of weight are often surprised at how unhappy they still are with their bodies. The fat is gone, but all that skin that held it in place? It didn’t go anywhere.
It is a less explored part of extreme weight loss. The body may be lighter, but now it’s weighed down with sagging folds of skin, causing excruciating emotional and physical (think: suffering) pain.
More extreme weight loss patients choose to remove loose skin through cosmetic surgery and a recent study showed that the body and mind of those who do it end up much better.
“What I found, it’s very interesting — they go and have these surgeries, and then they come back and they’re still not happy,” says Dr. Steve Wallach, a cosmetic surgeon in Manhattan. “I had a patient who specifically said, ‘I’m wearing a fat suit, I feel like I’m a skinny person inside, wearing a body twice my size.’
Clothes do not fit due to excess paper. “So they still feel not whole and not happy,” says Wallach.
Franklin Santana, a 29-year-old who lives in the Bronx, underwent gastric bypass surgery in October 2011, and before the surgery, he weighed 395 pounds. Two years later, at the end of last year, he dropped to 170. To the public, he looked like a trim, even thin, guy. But underneath the clothes, he said his loose skin reminded him of a “deflated balloon”.
I’m wearing a fat suit. I feel like I’m a skinny person inside, wearing a body twice my size.
“To me, it looks bad,” Santana said. “You know what a pumpkin looks like in early October? And then, at the end of October, it’s all sad and limp and deflated. I guess you could say it looks like that.’
Fantana had done his research before having the surgery and knew he would likely have “loose skin” after it was over.
Deborah Olmstead, who first had weight loss surgery in 2001, knew to expect it, too. she just didn’t know how awful it would make her feel.
“I didn’t really feel comfortable even looking at myself in the mirror, with all the excess flesh,” said Olmstead, who lives in upstate New York and had plastic surgery in Manhattan led by Wallach to remove the loose skin in 2004. You’ve done all this work, you’ve made this big, huge change that you see on the scale, but you don’t necessarily see it in your clothes or the way you feel about yourself.’
Loose skin is caused by losing a huge amount of weight – like 100 pounds or more – in a very short period of time. It can occur when weight is lost through diet and exercise, but it occurs more often in patients with weight loss surgery. With a slower, more gradual weight loss, it’s easier for the elasticity of a person’s skin to snap back into place, shrinking back down as fat is lost. But when too much is lost too quickly, the skin’s elasticity doesn’t have time to catch up.
To get rid of loose skin, exercise helps, a little. Jasmin Maldonado, a 36-year-old who lives in Brooklyn and lost 130 pounds after weight-loss surgery nearly a decade ago, says a daily routine of squats, sit-ups and pull-ups has made all the difference. But she is still ashamed of her appearance. “It’s just that, with my husband, I’m ashamed to show myself. I always cover up,” he said.
You’ve done all this work, you’ve made this big, huge change that you see on the scale, but you don’t necessarily see it in your clothes or the way you feel about yourself.
The most effective way to remove excess skin is through cosmetic surgery, in one or more of a series of procedures known as body contouring. And those who do shed the extra skin generally fare better than those who don’t, both psychologically and physiologically.
People who underwent weight loss surgery and then had excess skin removed were less likely to regain the weight than those who underwent surgery but did not undergo a body contouring procedure, according to a recent study published in the journal Plastic and Reconstructive. Surgery. The report followed about 100 patients who had lost about 100 pounds after weight loss surgery. Those who didn’t get cosmetic surgery to remove the resulting excess skin ended up gaining about 50 pounds, but those who got body contouring only gained 13 pounds.
About 100,000 bariatric surgeries are performed each year in the US, and the study’s authors, led by Dr. Ali Modarressi from the University of Geneva in Switzerland, go so far as to argue that body contouring should be a routine part of bariatric surgery. (Granted, they have some skin in the game, so to speak.) About 21 percent of bariatric surgery patients undergo at least one type of body contouring procedure.
Those who choose body contouring usually opt for a circumferential body lift: Doctors make an incision in the back, then around the ribs and abdomen, cutting away some of the excess skin and tightening the rest by sewing the incision back together. After body contouring is done, patients typically lose another 10 to 15 pounds of loose skin on their own. Doctors say people get body lifts because it makes the biggest difference in how they look. Plus, it’s easier to get their insurers to cover it because the surgery has some real physiological benefits in addition to the psychological improvements.
For most people loose skin tends to hang like an apron from their lower abdomen. He eats. And it hurts like crazy, patients say.
“It feels like an open wound and it just won’t heal,” said Santana, who tried products like Neosporin on the wounds. He had body contouring done this winter and his insurance covered the procedure. “And that helped me sleep and reduced the pain, but at the end of the day it comes right back.”
Stopping painful rubbing is important, and such a relief, say people who have had body contouring done. But the biggest change is what they see in the mirror after surgery.
“They feel better about themselves. How could you not? It’s pretty dramatic. No wonder they feel better,” says Dr. Scot Glasberg, a cosmetic surgeon in New York and president-elect of the American Society of Plastic Surgeons. “They feel better physically and it’s no wonder they feel better emotionally and psychologically. We’re not talking about some kind of subtle plastic surgery there. We’re talking about things that are rather dramatic.”
Franklin and Maldonado both had body lifts from Glasberg during the holidays. Now, Franklin says he finally feels like a “normal person.” Maldonado says she feels more “confident.” The last physical reminder of who they once were is finally gone.
