A couple of weeks ago I saw a delightful lady in her mid-fifties who was about to undergo a gastric bypass. She had struggled with her weight all her life and she had genuinely exhausted non surgical treatments. Much of her weight was carried around her middle, so called “visceral fat” which is the fat that substantially increases the risk of type II diabetes and heart disease. After going through the important questions regarding the procedure, Jane then asked me about the excess skin which might be left after weight loss. Specifically she wanted to know whether there would be so much skin that she might need further surgery to correct it. It’s a common question but the answer is not simple.
Patients (especially women) complain that they are losing weight from all the wrong places but this is something which is very unpredictable. Patterns of fat deposition are genetically determined, as are patterns of weight loss. In addition to genetic factors, the probability of having lax skin depends on three things; where the fat is deposited to begin with, your start weight and your age. Obviously if you are very heavy and carry fat mainly around the middle you are more likely to need corrective cosmetic surgery after losing weight. This is especially true if you already have an “apron” (or pannus) in your waist area. With regard to age, it is fairly obvious that the younger you are the more natural elasticity you will have in your skin and the more likely it is that you can remodel after weight loss. I have seen some very heavy younger women (in their twenties) lose a great deal of weight and have almost no lax skin at all, though this is exceptional.
If you are thinking about cosmetic surgery after weight loss, there are two important things to bear in mind. Firstly, you must have stable weight for a minimum of 6-12 months. If you have it done any earlier, you may well lose more weight after the cosmetic correction and this could result in a return of the lax tissue which you were so anxious to get rid of.
Secondly you must have the correction performed by a surgeon with a lot of experience in obesity cosmetic surgery. The surgery can be lengthy and complex, so don’t be tempted by cheap price deals abroad. I recently had a patient who having lost a great deal after gastric bypass was contemplating going to India for cosmetic surgery. He seemed attracted to the idea mainly because he would “be treated like a VIP” for two weeks. I told him I thought the competence and experience of the surgeon was a rather more important consideration and pointed out that if he were to develop a wound infection after his return to the UK, he may find it difficult to persuade another surgeon to look after him. I think he took the point, but probably headed to the airport anyway!
I am constantly amazed at the risks people are prepared to take with something as serious as surgery, performed in countries where the regulatory requirements are minimal and by surgeons they know nothing about. Don’t be tempted with cut-price deals and luxury accommodation. If you are thinking about cosmetic surgery for excess skin, talk to us first as we can put you in touch with good people, and have the holiday later!
Dr David Ashton
9th August 2011