Body Contouring: Removing Excess Skin

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After a person loses massive amounts of weight Â? 100 to 300 pounds Â? stretched, baggy skin usually hangs on the personÂ?s body like a suit of overlarge clothes. The operation to take that skin off Â? body contouring Â? is becoming increasingly more popular, experts say.

After Maria Beal, 38, of Pittsburg, Pennsylvania, had stomach stapling and dropped 175 pounds in a year from her 352-pound, five-foot-five frame, she thought she would make a fine looking bride. After all, she went from a size 32 dress down to an eight.

What she didn’t expect: loose, hanging skin all over her body that flapped around when she moved and ruined a chance to wear newer, stylish clothes. There was so much excess skin on her upper arms – doctors call it “bat wings” – she stood no chance at all of wearing a sleeveless dress at her wedding. As it was, the excess skin made it difficult for Maria to get her arms into any sleeve of any garment.

So she took a $20,000 second mortgage on her home to undergo a surgical operation known as body shaping to remove the excess skin.

Known alternatively as a “body lift” when skin all over the body is removed, the procedure is already one of the fastest growing areas of plastic surgery as more people give up on failed diets and exercise programs and opt for the gastric bypass operation made famous by NBC’s Al Roker and other notables.

Gastric bypass – it’s also called “stomach stapling” and “stomach banding” -- creates an egg-sized pouch in the stomach so a person eats drastically less, causing the loathsome pounds to finally come off.

However, in most cases where the person has lost at least 100 pounds, the skin has been so stretched, no amount of exercise can ever again reduce it back to a normal size. The gastric bypass patient is usually left with massive hanging skin running from the chin to the knees. In a few extreme cases, the patient pulls up the hanging skin like a long skirt to allow unobstructed walking.

According to the American Society of Plastic Surgeons, about 52,000 people had some type of body shaping surgery in 2003, the first year the association has tracked the category. While The American Society of Bariatric Surgery reported 103,000 stomach stapling operations in 2003, they expect 144,000 such procedures for 2004. And, as more people choose gastric bypass, ever more plastic surgeons will be removing excess skin.

Moreover, the procedure is not cheap; a total body lift in most parts of the nation averages about $30,000 with the low end of the spectrum priced at about $20,000 while in plastic surgery hot spots like New York City, a total body lift by a top doctor can cost upwards of $50,000. Medical insurance coverage is iffy, with many companies turning down any purely cosmetic operations.

Benjamin Hornik, M.D., a plastic surgeon at the WISH (Weight Intervention and Surgical Healthcare) Center in Downers Grove, Illinois, has seen such an increase in body shaping procedures in the last year; he offers seminars so patients can learn en masse about the procedure.

“According to our best estimates, upper arm skin contouring was up 1300% in the last decade,” says Dr. Hornik.

Also seeing increases in 2003 over 1992 levels were breast lifts, up 700 percent, while buttock shaping and tummy tucks rose 500 percent and thigh shaping patients increased 400 percent.

“You could almost call the skin reduction operation a ‘facelift for the figure,’” says Dennis Hurwitz, M.D. the Pittsburg plastic surgeon who performed the six-hour operation on Maria Beal, taking off almost 20 pounds of skin.

“After I dropped 155 pounds, it was like having a size 26 skin on my size 8 body,” says Sally Stewart, 42, an administrative assistant at Carnegie Mellon University in Pittsburg. “After I got dressed in the morning, I found myself tucking excess skin back into my clothes; plus, it seemed like I always had a belly button infection, caused by all the skin folds making it very hard to get that area clean. And, my excess skin flapped all over when I jogged.”

Sally says after body shaping, she now wears with confidence shorter skirts, goes to yoga daily and takes aerobics four to six times a week. And nobody looks at her oddly any more.

Fairly clear guidelines apply to both men and women who want body contouring, experts say.

“The person should have lost at least 100 pounds, had a stable weight for 12 to 16 months after the gastric bypass operation, be in good health and not planning on becoming pregnant,” says Dr. J. Peter Rubin, M.D., an assistant professor of plastic surgery at the University of Pittsburg Medical Center. Good candidates for a body lift should also have no medical problems that prevent them from going under anesthesia and should not smoke, a habit which decreases blood supply to all tissues in the body and slows healing.

The most common – and usually first –body shaping procedure after massive weight loss is often the tummy tuck (abdominoplasty) which removes the apron of skin hanging from the stomach.

The average woman’s skin loss is about seven to 15 pounds, says Dr. Rubin who also runs a research program, studying the metabolism of human fat, donated by his thankful patients.

The WISH center offers a hint of what weight loss patients may see during their course of treatment: Prospective body shaping patients are screened for their tolerance to exercise, have a minimum of two visits before surgery to learn about risks, complications, recovery, diets and exercise and the psychological aspects of maintaining a new weight and appearance.

Other weight loss patients want excess skin removed from their sides and back and their buttocks reshaped. Yet others need a lower body lift, which includes removing and lifting the skin up from the knees to the crotch, almost like pulling up a pair of pants. Some surgeons do all the procedures at once while others complete the job in two to four sessions.

Recovery usually includes several days of hospitalization. In four to six weeks, the patient can return to work, with other normal activities being resumed at about eight weeks. Scars can take a year to completely heal and usually fade after about three years. One possible downside is when surgeons tighten the skin too much. Then, the patient will have difficulty bending forward and feel constrained until the skin stretches somewhat.

According to Valerie Ablaza, M.D. of the Plastic Surgery Group in Montclair, New Jersey, celebrities like Queen Latifa, Carnie Wilson and Patti Parshall (the once 300-pound actress seen on “Everybody Loves Raymond”) who have had gastric bypass operations and then body shaping procedures have captured more of the public’s attention.

“I have several middle age patients who once weighed over 300 pounds,” says Dr. Ablaza. “And now they feel confident enough to wear low rise pants that show their belly button. One or two women – with grown children -- have had their belly buttons pierced with diamond studs.”

Says Susan Downey, M.D., a staff plastic surgeon at the University of Southern California: “The body shaping operation creates long scars down the arms, up the legs and across the lower stomach,” “We hide the scars as well as possible, putting them under bikini and bra lines and on the insides of arms and legs about where clothing seams would be.”

Adds Pasadena, California, plastic surgeon Jeannette Martello, M.D., editor of Skin Deep Magazine, a consumer magazine about cosmetic and plastic procedures: “Many female body shaping patients have reported back to me that sex is better. Patients no longer worry about special positions because of overweight and too much skin getting in the way, so they are able to get closer to their partners. And, when I do a tummy tuck on a woman, the clitoris is brought higher, toward her stomach, where it receives more stimulation and friction during sex.”

Remember our bride Maria Beal and her problems fitting into clothes because of too much skin?

After her body shaping, she wore a blue sleeveless gown at her wedding, wowing the 400 guests.

Medically Reviewed by David M. Metzner, MD (

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