Got those Loose Skin Blues?Massive weight loss is a huge decision, most of you reading have either gone through a massive weight loss or are contemplating going through a massive weight loss. One of the most common hesitations in losing weight is the resulting loose skin that occurs once your body has gone through a significant weight loss. It is common knowledge that losing weight = loose skin. Loose skin not only occurs with a massive weight loss but also with natural body occurrences such as pregnancy. This is because once your body stretches through weight gain or through pregnancy; your skin loses its elasticity. First patients come in to talk about weight-loss and bariatric surgery, how it works and your results. Many patients, however, decide they want to go the less expensive and natural way by strict diet and exercise but are concerned about the loose skin. Our doctors always tell patients to be realistic, being healthy is far more important than having loose skin. Even when you have loose skin after weight loss there are ways to remove it such as post-bariatric surgery which includes tummy tucks, breast augmentations, and thigh lifts. The loose skin, although it may not seem like it, is a proud reminder of how far you’ve come and if you take that extra step to remove the loose skin, your body will be an entire trophy dedicated to yourself. In this post, we will see why and where that extra skin came from and how to reduce or remove it.How We Burn FatAs we all know, matter cannot be created nor destroyed, so when you exercise and diet fat is not simply “disappearing” off your body. What occurs is a form change, just like water and steam. The glucose and sugar that is harnessed from carbohydrates are the first fuel sources. Once the glucose runs out, fat takes over. Your body is a constant interconnected conveyor belt that removes essential nutrients from the fat and delivers them to specific body parts. Hormones that regulate our blood sugar levels activate an enzyme in fat tissue called lipase. Lipase ignites fat cells to release triglycerides, which is what makes fat cells fat. When they receive a signal from lipase to exit the fat cells, the triglycerides break-up into glycerol and fatty acids and then enter the bloodstream for use in your body. The process of breaking down triglycerides into reusable energy is called lipolysis which is shuffled and reshuffled to produce heat, water, carbon dioxide, and ATP. Since the fat tissue has lost some of its components, the cells shrink.Why the Extra Skin?When fat tissue is worked and the cells shrink, wouldn’t it make sense that your skin would shrink as well? Yes and no. In the cases of moderate weight loss, skin can certainly shrink back to fit the body’s new size because of its elasticity due to collagen in the skin. However, collagen does have its limits. Collagen fibers weaken with age and results in wrinkles. Rapid growth or weight gain also outpaces collagen production in the skin causing areas to over-stretch, leading to stretch marks commonly seen in pregnancy and adolescents going through puberty. In cases of massive weight-loss, the skin that has been stretched has lost its collagen strength making it very difficult if not impossible for the extra skin to shrink back to its former shape. Those undergoing gastric bypass surgery or bariatric surgery feel this pain. As the number of patients going through weight loss surgery increases, so do corrective surgeries for the unwanted and uncomfortable skin. This extra skin can actually be a serious problem and can actually cause infections, rashes and even back problems.Post-Bariatric Surgery and Treatment OptionsThe most important determinant of how much loose skin an individual will have following weight loss is their age. Younger patients tend to have less loose skin than those who are older because of the strength of collagen in your skin. The next most important factor is the amount of weight loss. An individual who loses 200 lbs. is more likely to have excess skin than someone who has lost 80 lbs. There are other factors of who is more likely to have loose skin such as smoking, sun damage and skin color.- Exercise: Exercise that includes increasing muscle town can tighten connective tissue. For patients who have undergone bariatric surgery are recommended to add a regular exercise regimen that is helpful to maintain ones weight and can also serve to tighten loose skin to some extent.- Body Contouring Procedures: For those that are losing 80 lbs. to over 100 lbs. surgical procedures, known as post-bariatric surgery, are available to tighten skin and remove the extra pockets of skin that inhibit your body from being as toned and tight as the individual would like. Below are the most common procedures for massive weight loss patients.Abdomen, Thighs and Buttocks- The abdomen is usually one of the greatest concerns for individuals following massive weight loss. In both men and women, excess fat is stored both in the abdomen and beneath the skin of the abdominal wall. Consequently following weight loss in those areas, extra skin appears. Large amounts of hanging skin can lead to the collection of moisture between the skin folds resulting in a condition called intertriginous dermatitis, which leads to irritation, redness and pain. Occasionally, the skin may even breakdown, bleed and become infected. With proper documentation, many insurance companies recognize this problem and provide full coverage from surgical removal through a tummy tuck or abdominoplasty. The abdominoplasty will solely remove the excess skin from your stomach which is ideal for women following pregnancy. However, for those who have undergone weight loss surgery or a massive weight loss, excess skin is not limited to the stomach but also results in the buttocks and thighs. Because of this, surgeons will perform a procedure specifically for weight-loss patients called a body lift. This involves an abdominoplasty, thigh and buttock lift all at one time. This addresses and removes loose skin and cellulite along the thighs and buttocks as well as the abdomen. Although the resulting scar is lengthy, it is confined to the waistline and is hidden by underwear, panties, or a bikini.Breasts- Following a great weight loss, breast size and shape often change significantly in both men and women. Everyone worries about sagging breasts as we age but few know that massive weight loss greatly accelerates the process. As women advance from girls to teens to twenties and into their later years, the glandular portion of breasts is replaced by fat. The original glandular tissue is significantly more firm than fat and consequently the skin becomes unable to retract completely and produces severely ptotic or sagging breasts. This is called breast involution. There are many treatment options for women following weight loss. If a woman desires less sagging and wants to be larger, a breast lift or mastopexy is needed. Again, surgeons will tell you your options and also remind you to be realistic with or breast augmentation may be satisfactory. The problems in men are similar however treatment is slightly different. Men tend to have larger breasts when over-weight. Depending on a man’s age, degree of weight loss, and a few other factors he may result in large breasts, large and/or sagging breasts, or satisfactory breasts following weight loss. Large and/or sagging breasts in men is called gynecomastia. Here liposuction alone may be satisfactory, however this is not typical. Most men with both sagging and large breasts go through a two-staged procedure. The first stage is liposuction and is performed to remove excess fat and some glandular tissue. Over the next few months, the breast skin will retract slightly. Three to six months later, the patient will return to evaluate the situation and determine if the outcome is satisfactory. Delaying the second stage allows for significant skin retraction and if a skin tightening procedure is desired it is likely to require smaller incisions.The Bottom Line?Being healthy has far greater importance than excess skin. Although, having excess skin can lead to some serious issues there are non-surgical ways of preventing infections such as keeping your excess skin dry. For those who are able and want to remove the excess skin, post-bariatric surgery is for you. It is important to remember that these procedures should only be considered after ones weight has stabilized; especially after weight loss surgery. This can range from 7-18 months after weight loss. The most important factor in finding a plastic surgeon who can perform these procedures is that they must be board certified. If your plastic surgeon’s website or office does not advertise that they are board certified you must RUN! For everyone who has heard horror plastic surgery stories, this is probably where it started, having a surgical procedure done without a board certified surgeon. Use ASPS (The American Society of Plastic Surgery) to find a board certified surgeon near you.