The ins and outs of bariatric skin removal surgery

Bariatric surgery can be a very effective way for people who are obese and have failed traditional weight loss tactics to lose large amounts of weight. Combined with a commitment to healthy living, this can be a life changing and even life saving process.

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

“Loose, sagging skin can be a functional problem,” said Matthew Ranzer, MD, FACS, an OSF HealthCare surgeon who specializes in plastic surgery. “Your clothes don’t fit well and rubbing your skin can cause irritation, pain and discomfort. We can remove the excess skin that is causing unwanted problems and restore your normal contour. “

People considering bariatric surgery and skin surgery should educate themselves before looking for treatment options to ensure they are treating their weight loss as safely as possible, understanding the requirements for success, and having reasonable expectations for their results.

“Surgery is not a magic wand,” said Dr. Ranzer. “We cannot undo what happened to your body through weight gain and weight loss. We can restore the normal contours of your body, but it will require an operation that means risks and scars. Most patients are doing very well and complications are rare, but they do occur. “


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

Dr. Ranzer doesn’t perform skin surgery until a person’s weight loss journey is complete, which usually 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 will not do skin surgery on someone with a higher BMI because of the increased risk of complications and because I do my best work and get the best aesthetic results by removing mostly skin, not skin and fat,” said Dr, said Ranzer.

“There are two reasons we are waiting for a stable weight,” he said. “First, when you are still in the midst of weight loss, you may develop more sagging skin. Instead of doing multiple surgeries in the same place, I’d rather do one surgery the correct way. The second reason is that patients lose weight by essentially being deliberately malnourished. Hence, the body needs to normalize food levels to support proper recovery. “

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

Some of the procedures can be covered by insurance, but to get coverage you will usually need to demonstrate a functional impairment and that your attempts to treat the impairment with other methods have been unsuccessful. Many insurance providers require a person to have reached their plateau weight for at least six months prior to surgery.

And the insurance still cannot cover some parts of the procedure for some parts of the body. It may not cover moving your belly button or tensing your abs, it can only cover removing loose skin.

Common skin surgical procedures

In order from most common to less common:

  1. Abdominal contouring – removal of excess skin and tightening of the core muscles. Sometimes this is only for the stomach, but sometimes it is also for the back.
  2. Breast Reduction or Lifting – This procedure may involve enlargement to restore volume if the breasts appear deflated from weight loss.
  3. Arm lifts and thigh lifts

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

What to Expect

As soon as the financial or insurance approval is available, the operations are performed under general anesthesia and usually on an outpatient basis, with the patient going home the same day.

“We don’t usually treat a person’s whole body in one operation,” said Dr. Ranzer. “We’ll prioritize the area that bothers them the most and come back at a later time to do the next phase of the operation. If someone has sagging skin on multiple parts of their body, over time they may need two to four surgeries to remove all of the excess skin. “

What else can a skin surgery patient expect from the procedure? Here are some of the findings from Dr. Ranzer for recovery:

  • Typically, for most procedures, the surgeon injects short- and long-acting anesthetic drugs to keep patients comfortable after the operation.
  • Depending on the type of surgery, drainage tubes may come out of your body, which will be removed after one to three weeks.
  • Half of the patients only need acetaminophen or ibuprofen to manage pain after surgery, and the other half may need some prescription medication for about a week.
  • All patients are expected to get up and walk on the day of surgery.
  • Most are able to do normal activities such as getting dressed, cooking, cleaning, and leaving the house on the day of surgery.
  • Most are allowed to shower the day after the operation.
  • Most find that they feel good within a week or two of having a desk job.
  • All patients must avoid lifting more than 10 pounds for about six weeks after surgery.
  • The restrictions on light duty can usually be resumed about two weeks after the operation.
  • Most procedures require wearing post-operative compression garments for six weeks.


With any surgery, there is a risk of stroke, blood clots, bleeding, and infection. Once you are done losing weight, these risks will be reduced. You will therefore need the approval of your family doctor in order to keep the risks as low as possible.

The most common negative consequences are asymmetries in body shape when weight loss has not been uniform and scars related to surgery. There’s no way you can remove skin without scarring, said Dr. Ranzer. So you’re trading sagging skin for scars, but improved body contours can be more beneficial than scars are negative. The danger with scars is that they can reopen and may need a second surgery to improve their appearance and firmness.

“You need to commit to lifestyle changes,” said Dr. Ranzer. “There is no shortcut. You have to get it right or you risk complications. I care for many patients who sought advice for skin removal surgery without weight loss, left the country to find someone to do so, and came back with life-threatening complications. You shouldn’t risk your health. You should do it right. “

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