Dealing with Sagging Skin

Jeri Chrysong of Huntington Beach, California, had every reason to feel proud of herself. At 50 some years of age, she’d lost 150 pounds with 2 years of rigorous diet and exercise. But instead of feeling joy when she looked at her new image in the mirror, she was haunted by a lingering reminder of her once ample body – loose, sagging skin. “I had so much sagging skin in my stomach, it hung to mid thigh,” she remembers. “It was like having a 10-pound medicine ball hanging from my stomach. It was awful.”

People who lose large amounts of weight, whether with diet and exercise like Jeri, or through bariatric surgery, often experience loose, hanging skin in many areas of their bodies. “If you lose between 50 and 200 pounds, there’s going to be sagging skin,” says Semira Bayati, MD, FACS, a female plastic and cosmetic surgeon based in Newport Beach, California. “During weight gain, your skin expands as you gain body fat. Over time, your skin can lose elasticity and may not shrink with the rest of the body as you
lose weight.”

According to Bayati, the amount of excess skin varies according to how many pounds were lost, and how rapidly the weight came off. It also differs depending upon your age (skin loses elasticity as you age), ethnicity and also your genetics. Whatever the amount of sagging skin, for some, it can be a real source of shame. “It’s so sad after all the effort to lose weight, you’re still not proud of your body,” says Bayati.

Loose skin is more than a cosmetic problem, though, she adds. “In some cases, excess skin causes health problems such as chafing that can lead to skin infections. And many people experience increased discomfort during exercise due to excess skin, to the point where they can no longer exercise effectively.”

While there’s nothing you can do to prevent sagging skin – other than to avoid gaining weight in the first place – there are solutions. “Fortunately, it’s fixable,” says Bayati, who addresses sagging skin with one or more of the following body contouring surgical procedures:

Central body lift (belt lipectomy): A face-lift for the trunk, a central body lift focuses on the midsection, thighs and buttocks, removing excess skin and fat and lifting and pulling taut the remaining skin for a smoother, more toned appearance.

Tummy tuck (abdominoplasty): This procedure removes excess skin and fat in the abdominal area, lifting the remaining skin, resulting in a flatter appearance of the stomach.

Medial thigh lift: Removes excess fat in the upper and inner thigh, tightening the skin for improved appearance of the thigh; helps to reduce friction of thighs while walking.

Arm lift (brachioplasty): Hanging skin is removed from under the arm.

Breast lift (mastopexy): A breast lift raises and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the breast. Depending upon the amount of weight lost, it may be necessary to use implants to restore the proper shape and volume to the breast.

How risky is body contouring surgery? Even for relatively safe procedures, no surgery is without risks and side effects, says Steven L. Garner, MD, FACS, board certified plastic surgeon practicing in Santa Cruz, California. Like all surgical procedures, you can experience infection, bleeding, scarring or even blood clots, especially if you have chronic health conditions or you’re a smoker. “But scarring is most common,” he explains.

Sun protection of the scar as well as the use of silicone gels used post surgically can minimize any unsightliness, but you’ll still have a scar, says Garner. “People who have had to endure sagging skin are more able to accept some scarring than the average person,” he adds. “Of course you don’t want a scar, but you’d trade that (sagging) skin for a scar.”

For Jeri, scarring was a small price to pay for her new body. After having body contouring surgery combined with a needed hernia repair, she had to remain in a 45-degree angle sitting position for a week. But she remembers the day that she returned to Dr. Bayati for her post surgical follow up. “After one week, I stood up,” Jeri says. “And for the first time in 20 years I could see my feet. Now I can go horseback riding and hiking again, and I can be an active grandma. It was the best decision I’ve ever made.” MS&F

Q: How soon after weight loss can I have body contouring surgery?
A: Most docs agree that you should wait until your weight has stabilized for about 3 to 6 months before having surgery (often as much as 2 years from the start point of your weight loss). If you continue to lose weight, you’ll likely develop more sagging skin.

Q: Can more than one surgery be done at a time?
A: In less severe cases of sagging skin, surgeons may combine two or more procedures. But many times, body contouring is done in stages to minimize complications. Your doctor will help you to decide the best surgical approach to use for your particular situation.

Q: Will my health insurance pay for body contouring?
A: Most insurance companies consider this surgery to be cosmetic, so they won’t pay for it. But if there is a medical complication that has resulted from excess skin (such as severe, repeated infections in skin folds), they may pay for a part of the surgery.

After massive weight loss, the face often looks gaunt and unhealthy, says Sherry Hasty, RN, Clinical Nurse Injector at Bloom Medical Spa in Dallas, Texas. “The main area of facial fat loss is in the cheek area,” she explains. “The cheeks flatten down toward the bone.”

While severe cases of facial weight loss may require fat grafting procedures, “The days of surgical facelift are going by the wayside,” claims Hasty. “Research has produced many more non-surgical options.”

Some techniques used for increasing the fullness of the face and tightening the skin include the following:

Restylane is an injectable filler that includes hyaluronic acid, a natural substance found in the body. It acts as a magnet for water, plumping up the volume of the skin, helping to reshape cheek contours and bolster elasticity. The treatment, consisting of one or more syringes, is done in one visit and effects last from 3 to 9 months, depending upon the person.

Juvederm is a popular injectable filler that is similar to Restylane. The results last anywhere from 6 to 9 months, depending upon
the person.

Sculptra is an injectable filler of Poly-L-lactic acid, which stimulates the body to produce collagen (a fibrous protein that supports body tissues) and increases the thickness of the skin. It provides up to 80 percent improvement in revolumizing cheeks, areas around the eyes and chin. Treatment is done in a series of three appointments about six weeks apart. Results last up to two years.

ArteFill is an injectable gel filler that consists of millions of “beads” suspended in animal collagen. As the collagen is absorbed by the body, the beads stimulate your body to produce its own collagen, plumping up the skin in the treated areas. ArteFill is done in one to two treatments and is the only “permanent” dermal filler approved in the United States.

Thermage is a skin tightening laser treatment that stimulates the body to produce collagen. It’s done in one treatment and results can be seen immediately, although facial tightening continues to improve over the course of about six months. Results last for as long as 7 to 8 years.

Ultherapy is a new nonsurgical face and neck treatment that uses ultrasound to trigger the body to produce collagen, tightening and lifting the skin. Ultherapy is done in one treatment, but takes about 6 months to achieve the full effect. Treatment lasts about 1 to 2 years.

Note: Prices for non-surgical facial procedures vary depending upon the geographical location. Many places that offer these treatments have payment plans.

By Linda Hepler, BSN, RN