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Cosmetic procedures can help maintain and improve your results after extreme weight loss. Here, some of the most common questions patients have about skin tightening and body contouring after metabolic surgery.

In extreme cases obesity can be treated with specific surgical procedures to stimulate weight loss and help alleviate the problem. By the time doctors are recommending bariatric or metabolic surgery, you can be sure it’s a last resort. In such cases it’s understood that the patient simply isn’t responding to traditional weight loss methods – and likely never will.

But even following metabolic surgery, there’s always the risk of those pounds eventually returning later on. You may also be left with loose, excess skin as a reminder of your former self.

Whether you’ve already gone under the knife for weight loss surgery or are considering it as a potential solution in the near future, there’s sure to be a few questions you’ve been wondering about – or will start wondering about soon.

To this end we’ve assembled a short FAQ on the subject of plastic surgery after weight loss, and more specifically about what can be done to avoid post-operative weight gain, remove excess skin, and fully benefit from this new lease on life.

Can you still gain a significant amount of weight after bariatric surgery?

Yes, you absolutely can put weight back on again.

Gastric bypass surgery is currently one of the most effective known treatments for obesity, with most people losing major amounts of weight as a result. But in order for the procedure to be a success over the long term, patients must be prepared to adopt the requisite lifestyle changes that come with it.

Recent statistics show that within two years of gastric bypass surgery, only half of all patients will have re-gained weight. After five years, the average patient manages to keep off roughly 60% of the weight they lost through surgery.

The cause of weight regain in 95% of gastric bypass patients is behavioral. While the surgery changes the anatomy and effectively reduces one’s appetite to a certain degree, weight gain can be expected if the patient doesn’t change their lifestyle and continues to take in more calories than they burn.

Dr. York Yates, a board-certified plastic surgeon with a busy practice in Layton, Utah, confirms that “while it’s much more difficult to gain weight after a bariatric surgery, a sensible diet and exercise is still an important part of the procedure.”

The arguable good news, however, is that re-losing the weight is just a matter of adhering to the diet & exercise combo. A second gastric bypass surgery is rarely the way to go because it comes with an increased risk of complications, including infection, bleeding and leaks in the gastrointestinal tract.

This Is Us Star Chrissy Metz Chooses Self Acceptance, Healthy Lifestyle

chrissy metz

One of the most compelling characters on NBC’s award-winning comedy-drama series This is Us is Kate Pearson, expertly played by breakout star Chrissy Metz, with many scenes taking place at Overeaters Anonymous and in a camp for overweight people.

In Season 1, Kate considers the option of undergoing fat reduction gastric bypass surgery, and deals with the fears and excitement that go along with a procedure of this magnitude.

We recently spoke with Metz about her character’s trials and tribulations, and about the real life challenges of being a plus-size actress in Hollywood.

“It’s wonderful because, obviously, it’s a life that I’ve led. And while I’m not exactly like Kate, I am a lot like her. I’m not saying that I’m not happy with who I am, but a part of me does want to change. I do want to live a healthier life.”

That’s not to say that she’d actually consider surgery – in an interview with People, she shut down rumors that have been circulating to that effect – even if in set and in real life she does still feel self-conscious at times.

During an especially difficult scene where her character is shown standing partially nude on a scale, Metz chose to embrace her own vulnerability, leading to one of the show’s most talked about moments.

“That was a really difficult scene, but it was also really wonderful,” she told us. “These are our vessels. It’s not everything that we are. I’m not just my body.”

“Anyone that feels discrimination, I think, can really relate to the character,” she concluded.

Is liposuction after weight loss surgery a realistic option?

Unfortunately not. It really all comes back to diet and exercise. Weight loss surgery, while a genuine lifesaver at times, isn’t some magic bullet. Rather, it guides you towards a new start, but if you don’t change your lifestyle you can rest assured that eventually the weight will pile right back on.

That said, liposuction is occasionally used in conjunction with some weight loss surgeries but, rarely, if ever, with a major procedure like gastric bypass. As Philadelphia-based plastic surgeon Dr. Benjamin Lam points out, “it all depends on the amount of weight loss. If the weight lost is significant, usually the result is a lot of loose skin left behind. If this is the main concern, then liposuction is not the best choice for correction – excision of the excess skin is the procedure of choice.”

Dr. Yates agrees, but adds,“if there is persistent troublesome fat in specific areas, liposuction can be a good option for contouring. The results after liposuction depend on the quality of the skin after weight loss, and yes, it often requires skin tightening procedures to get an acceptable result.”

What surgical techniques can rid the body of excess skin after extreme weight loss?

The most common skin excision procedures after weight loss surgery are tummy tucks and breast, arm and thigh lifts.

“Gastric bypass is a procedure done to the stomach and intestines to restrict the amount of food intake in order to force weight loss,” explains North Carolina plastic surgeon Dr. Robert Buchanan. “This in turn causes generalized laxity if the skin doesn’t have either the time or ability to contract.”

In other words, once you’ve shed all those pounds you might still be left with a sheet of fat tissue in the lower abdominal area, something known as a panniculus. The procedure most commonly employed to cut away that excess skin and fat is called a panniculectomy. You may also have extra skin around the arms, the back, and the lower body.

An abdominoplasty, otherwise known as a tummy tuck, removes excess fat and skin while tightening the muscles in the abdomen. “This procedure removes the excess skin from the abdominal area, but since the underlying muscles and fascia are stretched, it also tightens them. There’s essentially no weight loss from this other than the weight of the removed skin and attached fat,” notes Buchanan.

In that sense, weight loss after a tummy tuck is largely incidental. Buchanan says the most he’s ever seen a person lose through an abdominoplasty is 20-30 pounds, with the average being closer to 4-8 pounds.

Dr. Samuel Lin, a prominent plastic surgeon with a practice in Boston, Massachusetts, adds that “usually, a significant amount of skin can be removed safely. Generally speaking, the longer the incision, the more skin that can be removed. Recovery time is dependent on the extent of the surgery, but the healing process will be at least six weeks.”

What is a belt lipectomy?

A belt lipectomy is also known as a lower body lift, which is a surgical procedure that reshapes the hips, thighs, abdomen and buttocks. Dr. Lam describes it as “a circumferential lower body contouring procedure where the skin underneath an imaginary belt around the torso is removed.”

“A tummy tuck tightens the skin of the abdomen while a posterior thigh lift tightens the skin on the back side,” says Dr. Yates. “With a belt lipectomy, these can essentially be combined with one 360-degree scar all the way around the body.”

Andrew P. Trussler, MD, a plastic surgeon based in Austin, Texas, elaborates on the procedure, saying how it’s “most commonly reserved for men because it removes skin along the waistline. It’s effective but still doesn’t lift the outer thighs and buttocks like a body lift, which is more appropriate for females to shape the waistline.”

Can excess skin after the procedure be tightened without surgery?

While it can depend on the amount of weight loss, surgery is usually required.

Dr. Yates explains that while “there are a few minimally invasive options, none of them generally do enough to tighten skin that’s been loosened to the degree we typically see in a weight loss surgery patient. Generally skin excision procedures are necessary.”

weight loss

RELATED: How To Tighten Loose Skin After Weight Loss

What can be done to reduce the appearance of skin removal surgery scars?

Not a whole lot, unfortunately. Dr. Lam recommends you avoid too much exposure to the sun and consider looking into scar massage, while Dr. Yates notes that the primary factor determining how severe the scars will be has to do with the skill level of your surgeon.

“It’s the surgical technique – incision placement and closure techniques are the most important factors,” says Dr. Yates. “And yes, there are scar creams that can help the final appearance but, in general, these creams only help a good scar become better,” meaning if it’s not too severe to begin with, the right cream might reduce it’s visibility a little further.

Dr. Trussler concurs that “the proper choice of procedure and technique” along with the placement of the incision, are all key factors that will “help to limit visibility, improve healing of the incision, limit tension on the skin closure, and ultimately improve scar healing.” But he adds that, in advance of the operation, “it’s vital to prepare the patient with protein and vitamin supplementation, which help provide the healing building blocks that are often decimated by bariatric surgery.”

Dr. Trussler notes how “doing this will encourage normal healing rates and limit wound infections. Scar care after healing can help with the process as it can take up to two years for the scars to fade.”

Does insurance cover skin tightening?

Admittedly, the chances are pretty slim, but you never know. It depends if your insurance company deems the procedure medically necessary. Should they instead determine that the procedure is strictly cosmetic then it’s highly unlikely they’ll accept your claim.

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