One of the most common concerns that I hear from people who are about to undergo weight loss surgery is the excess skin that can accompany significant weight loss. There is no speculation about the source of the excess skin. If you have the weight equivalent of an extra adult human hanging off you in the form of fat, the skin has been stretched beyond the point where it can spring back into its original position. The most common question I get about excess skin is who will have this condition after surgery. More pointedly, “Will I have excess skin?” The short answer is I don’t know, but we do know that there are things that will increase your risk for having excess skin.
One, what do you look like before your weight loss? If you have a large, pendulous abdomen, you are very likely to develop loose skin after a significant weight loss. People with excess or disproportionate amounts of fat in certain areas seem to struggle more. Many women after childbirth already have some excess skin in the lower abdominal region due to diastasis or scarring from Cesarean sections. They commonly have lower abdominal issues after weight loss surgery.
Two, how much weight do you lose? Obviously, the more weight you lose the more likely you are to have excess skin. Someone who loses 200 pounds will have more problems than someone who loses 70 pounds. That just stands to reason.
Three, how quickly do you lose your weight? If the weight loss is rapid and extreme, the skin has little time to adjust. If the weight loss is slow and steady, the skin has a bit more time to adjust. Patients can at times have little control over the rapidity of the weight loss, but some things are within their control. Follow your surgeons directions as it relates to diet and exercise. No crash dieting or excessively brutal exercise regiments. Slow and steady wins the race
Four, how much collagen do you have? Collagen is what gives your skin the youthful, elastic, “springy,” quality to it that will allow for the skin to rebound after being stretched. Men naturally have more collagen than women. Younger people have more collagen than older people. So a 22 year-old man would be expected to have less trouble with excess skin than a 65 year-old female, all other things being equal. The “magic age” seems to be around 50. That is the time when collagen content begins to diminish more rapidly, especially in post-menopausal women.
The second question I hear a lot is, “Is there something I can do to prevent excess skin?” Yes, but very little. Some factors you have no control over- your age and gender. Some things are in your control but in the past- how much weight you have to lose. And some things are in your control, but I you may not want to control it just to limit excess skin- speed of weight loss. However, there are a few additional things that might help, but probably won’t prevent, redundant skin.
First, stay well hydrated. Water is critical to the health of your skin. How much you drink is well within your control. After your weight loss procedure, drink a minimum of 64 ounces of fluid per day. This will help keep your skin healthy and put it in a good position to respond. There are several ways to ensure you are well-hydrated. The best is to simply check your urine. I was taught in medical school that a single functional kidney is smarter than a room full of nephrologists (no insult intended towards my nephrology colleagues). If your urine is dark amber and malodorous, you need to drink more fluid. If your urine is clear, you are probably doing well. Another simple, but imperfect, test is a “pinch test.” Simply pinch the back of your hand. The speed that this returns to normal is an indication of hydration status.
Second, maintain proper nutrition. What’s good for your overall health is good for your skin’s health. Specifically, take in at least 60 grams of protein daily. Protein is critical to your body’s ability to heal itself and maintain a healthy body. Your diet should support good health and consist mainly of lean meats, vegetables, fruits, and nuts. I recommend my patients follow a diet similar to the Paleo diet. I have written about this a lot and believe it to be the healthiest diet especially for a post-op patient.
Third, make sure that you have adequate micronutrition. Take a multivitamin specifically manufactured for a surgical weight loss patient like Bariatric Fuel. Many experts recommend extra supplementation for Vitamin D, Vitamin C, and Biotin for skin health. Some also suggest that Omega 3 Fatty Acid supplementation in form of fish oil can also help.
Fourth, don’t self-sabatoge. Smoking is not only a disgusting habit and contributes to cancers and vascular disease, but also damages the collagen in your skin. Just put down the cigarettes. Excessive sun exposure also damages your skin. Some sun exposure is good for you and is critical for your body to manufacture Vitamin D. But too much sun ages the skin rapidly and increases your risk for certain kinds of skin cancer.
Lastly, proper exercise, including resistance training, is necessary. Strong muscles fill out your skin and help support the tissue. The obvious and well-documented health benefits that are associated with exercise also make you a generally healthier person that can be visably seen.
If the above fails and you have significant trouble with excess skin after your weight loss procedure, a surgeon can assist you with certain procedures that are designed to shrink the skin or remove the excess skin. New advances in laser liposuction, such as SmartLipo, will allow for skin shrinkage. But the limits of what the laser can reasonably be expected to achieve can be quickly surpassed by what occurs after weight loss surgery. Talk to someone experienced in SmartLipo techniques in order to see if you qualify.
If you clearly need a surgical procedure, be sure to speak to someone experienced in body contouring after weight loss surgery. Although I am trained to perform Corset Trunkoplasties and Abdominoplasties, I feel that these are better performed by a reconstructive surgeon. I recently visited, Dr. Alexander Moya of Geisinger’s Center for Aesthetics and Cosmetic Surgery, to see newer techniques in body contouring. He was extremely knowledgeable and proficient with these procedures. You would do well to choose someone like him for your procedure.
In closing, I would encourage you to keep things in perspective. While the excess skin is unsightly, consider it a sign of successful weight loss. Not to minimize the psychological impact of excess skin, but your improved health and improved quality of life are the most important things. I wish you continued success in your road to better health!