After trying countless diets, Suzanne Ryan finally tried an eating approach that worked well for her — and that shift kicked off some rapid weight loss. Very rapid. At her heaviest, she was 315 pounds and lost 146 pounds in just over a year. Although she was thrilled to see the weight go, it wasn’t so pleasant to see what was left behind.
Ryan had loose skin in her upper arms, stomach, back and thighs. The effect tamped down some of the enthusiasm she felt about the weight loss, she says.
“The extra skin was very frustrating for me in many ways, from discomfort when running to discomfort sleeping, the occasional rash and skin irritation,” she notes. “It also affected me mentally in some ways because I felt frustrated that after losing so much weight, I was still left with a body that was uncomfortable and that I felt the need to cover up.”
The excess skin reminded her of ways she’d mistreated her body, she adds. As a gift to herself, she decided on surgical removal since no amount of working out would “stretch” the skin back into place.
Ryan is far from alone in feeling conflicted about her weight-loss progress, according to Dr. Peter LePort, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at the California-based Orange Coast Medical Center.
How much excess skin someone gets after weight loss depends on a number of factors, Dr. LePort notes. Genetics plays a big part, as does the rate of weight loss and the amount of muscle building.
“Anyone who’s lost enough weight to have extra skin as a considerable issue will probably consider surgery at some point,” he says. “It’s not for everyone, but it’s worth researching if you think it might be helpful for you.”
With that in mind, here are some pros and cons to kick off that research:
For Ryan, her excess skin felt like a constant reminder of her past — rather than proof of how far she’d come in meeting her weight-loss goals. “It was like baggage from a really difficult period in my life,” she recalls.
Getting over mental obstacles on the way to your goal weight is tough enough without a memento of your past dragging you down. The sense of momentum and progress were some of Ryan’s favorite results from going forward with her surgeries.
One of the major sticking points for most people is the surgical cost, especially since insurance doesn’t usually cover the procedures. Dr. LePort notes that his office, like many others that do this type of surgery, offers financial counseling to evaluate all the options.
“What we’ve found is that insurance might cover something like 10% of the costs, unless it’s deemed medically necessary,” he says. “Even then, you may have to appeal to the insurance company to cover more.” Some of his patients spend about a year or two saving for the procedures they want, he says.
One of the most common areas for excess skin is around the abdomen, which Dr. LePort says makes sense, since that’s the part of the body that’s often significantly affected by being overweight. There’s only so much the skin on the arms and legs can be stretched, he notes, but the abdomen has an amazing capacity for expansion.
Because of that, the “apron” that’s left can become a problem for walking, he says. One of his patients had to hold up that portion of skin simply to walk at all. While that’s an extreme case, Dr. LePort says it’s common for patients to feel hindered by skin when they’re trying to exercise.
Particularly in the abdomen, surgery can affect pain fibers, and that may lead to a more difficult recovery when it comes to pain management, Dr. LePort says.
Many other surgical techniques have advanced toward being less invasive, which greatly reduces the amount of post-op pain. But excess skin surgery still relies on the traditional strategy of cutting a large area, and that can turn recovery into a long process.
Excess skin can be challenging when it comes to feeling confident, and if your activity level is impacted, that can be even more of a problem, says Dr. LePort.
“There’s a large psychological effect that comes with this kind of excess skin,” he notes. “That might cause someone to isolate themselves more, and that’s not good. Part of health is being social and connecting with others.”
Even if you want surgery, a procedure may not be appropriate, according to Dr. Eugene Elliott, cosmetic and reconstructive surgeon at MemorialCare Orange Coast Medical Center. That could be because of chronic health issues such as hypertension, diabetes, heart problems or other concerns.
Also, surgeons may feel a patient needs to lose more weight to get better results, Dr. Elliott says. Expectations also play a part, he adds.
“There might be patients who are good health-wise, but they’re unrealistic,” he says. “They think they’ll wake up with a perfectly flat stomach or that their lives will be very different as a result. We need to make sure they are good psychologically — and they have a good understanding about what surgery can and can’t do.”
MAKING THE DECISION
At this point, Ryan has had excess skin removed from her stomach and breasts and plans on surgically correcting her thighs as well. She says the result isn’t just better for her appearance, but it’s also reduced strain on her neck and back, improved her posture and helped her move forward emotionally.
“I feel more confident in my body and movements,” she says. “Having skin removal for sure didn’t magically make everything better, as I still struggle with repairing my self esteem. But I feel more comfortable in my body without the pressure of excessive, sagging skin.”