WATCHING shows like The Biggest Loser, you can’t help but be impressed at the astonishing weight loss some people achieve.

But you also notice a side effect of that achievement – excess skin.

Dr David Smith, director of the University of South Florida Health Division of Plastic Surgery and a specialist in post-weight-loss surgery, give the low-down on what to do with excess skin after weight loss.

 Q: How much weight do you need to lose to have a significant problem with loose skin?

A: It’s the percentage weight loss that matters, not the absolute number. If you start at 100 kilograms and lose 40 kilograms, that’s a significant percentage loss.

The important thing for people to realise is, you don’t get down to a certain weight, and then the next day you have surgery. You need to stabilise. Often this is 12 months, though that’s a difficult wait for most patients.

Q: What if a person gets excess skin removed and then regains weight?

A: If they don’t continue on their weight loss program, they will get fat again. The skin will stretch just like it did before, and if they lose the weight again, they will need surgery again. That’s one of the reasons for waiting.

Q: Do people get loose skin because they lost weight too fast, or is it just inevitable when you lose so much?

A: There are occasionally people who don’t have this problem, and there are gradations. The question is, how saggy is saggy? The skin does come back somewhat, which is another reason you don’t have this surgery immediately after weight loss. But at the end of the day, surgery is the only option for loose skin.

Q: Can you fix that without a lot of scars?

A: There is a lot of cutting and stitching in these surgeries, so there are scars. For a person with bat wings, there will be a scar either down the back of the arm, or the inside of the arm, basically elbow to armpit.

Q: Is getting excess skin removed ever a medical necessity?

A: The lower abdominal area, where you get a pannus overhang (sometimes called an `apron” of excess skin), can become a hygiene issue, a functional issue as opposed to a cosmetic issue.

Q: Can you remove excess skin from the entire body in one surgery?

A: Some try to do everything – abdomen, arms, legs, and breasts – at once, but that makes for 6 to 10 hours in surgery. I like to try to stage them. If the procedures aren’t so long, I find patients bounce back more quickly. Surgery on the legs and abdomen have a longer recovery time; arms and breasts, not so much.

Q. Are you dealing with patients with a lot of medical problems?

A. Not really. You would be astounded at what happens to these people after weight loss. There’s no more sleep apnoea, arthritis, high cholesterol. If you looked at their medical charts before and after, it’s like it’s two different people. Before, they had so many medications. After, most of them are only on vitamins and supplements.

Source: Daily Telegraph

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