Ins and outs of bariatric skin removal surgery

Obesity surgery can be a very effective way for people who are overweight and have failed by traditional weight loss tactics to lose large amounts of weight. When done in combination with a commitment to healthy lifestyle changes, it can be a life-changing and even life-saving process.

But it can also create another problem for recipients of the surgery: excess skin.

“Loose, sagging skin can be a functional problem,” said Matthew Ranzer, MD, FACS, a surgeon at OSF HealthCare who specializes in plastic surgery. “Your clothing fits poorly and skin rubbing can cause irritation, pain and discomfort. We can remove excess skin, which creates unwanted problems, and give you back your normal contour. “

People considering obesity surgery and skin surgery should educate themselves before pursuing treatment options, to ensure that they manage their weight loss in a way that is as safe as possible, to understand the requirements for success and establish reasonable expectations for their results.

“Surgery is not a magic wand,” said Dr. Ranzer. “We can not exaggerate what has happened to your body from weight gain and weight loss. We can restore the normal contours of your body, but it requires surgery, which means risk and scarring. Most patients are doing very well and complications are rare, but they do occur. ”

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The most important way to optimize patient safety and optimize the outcome is to be as healthy as you can be before surgery.

Dr. Ranzer does not perform skin surgery until a person’s weight loss journey is completed, which typically takes about a year after surgery. He waits until the weight is stable and the person has a body mass index (BMI) of 34 or less.

“I do not want to perform skin surgery on anyone with a BMI higher than that because of the increased risk of complications and because I do my best work and get the best aesthetic results when I mostly remove skin, not skin and fat,” Dr. Said Ranzer.

“There are two reasons why we are waiting for stable weight,” he said. “First, if you’re still in the middle of a weight loss, you can develop more flabby skin. Instead of doing multiple surgeries in the same area, I’d rather do one surgery the right way. The second reason is that way “whereupon patients lose weight, by being essentially malnourished. So the body needs to restore nutritional levels back to normal to help with a proper recovery.”

You are not eligible for skin surgery if you use nicotine in any form because it increases the risk of complications.

Some of the interventions may be covered by insurance, but to get coverage you usually need to demonstrate disability and that your attempts to deal with the impairment by other methods were in vain. Many insurance providers require that a person be on their plateau weight for at least six months before surgery.

And the insurance may still not cover some parts of the procedure for some parts of the body. It may not cover movement of your navel or tightening of the abdominal muscles, and may only cover removal of loose skin.

Common skin surgical procedures

In order of most common to less common:

  1. Abdominal contouring – Removal of excess skin and tightening of body muscles. Sometimes this is only for the stomach, but sometimes it also includes the back.
  2. Breast reduction or breast lift – This procedure may involve enlargement to restore volume if the breasts appear to have been emptied of weight loss.
  3. Arm lift and thigh lift

Facelifts and neck lifts are the least common procedures because insurance providers consider them to be for aesthetic purposes only, so they are never covered and not performed as often as the others due to the high cost of these cosmetic procedures.

What to expect

Once a financial or insurance approval has been obtained, surgeries are performed under general anesthesia and typically as an outpatient procedure where the patient goes home the same day.

“Typically, we do not do a person’s entire body in one operation,” said Dr. Ranzer. “We will prioritize the area that bothers them the most and return at a later stage to do the next phase of the surgery. If someone has loose skin on several parts of their body, they may need two to four surgeries over time to remove all excess skin. “

What else can a skin surgery patient expect from the process? Here are some insights from Dr. Ranzer on healing:

  • Typically for most procedures, the surgeon injects short- and long-acting anesthetic medications so that patients are comfortable after surgery.
  • Depending on the nature of the surgery, you may have drainage tubes coming out of your body, which will be removed after one to three weeks.
  • Half of the patients will only need acetaminophen or ibuprofen to deal with any pain after surgery, and the other half may need something prescription for about a week.
  • All patients are expected to be up and walking on the day of surgery.
  • Most are able to perform normal activities like dressing, cooking, cleaning and leaving the house the same day as their surgery.
  • Most are allowed to take a shower the day after surgery.
  • Most people find that within one to two weeks they feel comfortable sitting at a desk if they have a desk-like job.
  • All patients should avoid lifting more than 10 pounds for about six weeks after surgery.
  • Mild work restrictions can usually be resumed about two weeks after surgery.
  • Most procedures require a postoperative compression garment to be worn for six weeks.


With any surgery, there is a risk of stroke, blood clots, bleeding and infection. Getting rid of weight loss reduces these risks, so you need the approval of your primary care provider to help reduce risks to as little as possible.

The most common negative outcomes are asymmetries in body shape if weight loss was not uniform, and scars associated with surgery. There is no way to remove skin without scarring, said Dr. Ranzer so you replace flabby skin with scars, but improved body contours may be more beneficial than scars are negative. The danger with scars is that they may reopen and may require another operation to improve their appearance and strength.

“You have to commit to lifestyle changes,” said Dr. Ranzer. “There is no shortcut. You have to do it the right way or risk complications. I take care of a lot of patients who sought consultation for a skin removal surgery without weight loss, went out of the country to find someone to do it and came back with life-threatening complications. Your health is not something you have to take a risk with. You should do it the right way. “

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