Massive weight loss equals massive skin excess: What to do?

We had a visiting plastic surgeon from Iowa, Dr. Al Aly, visit us at Duke and give a grand rounds on  his body contouring experience. Dr. Aly is a well-known and well-published plastic surgeon who specializes in body contouring surgery. We just had a Grabb & Smith question conference on one of his publications, Chapter 53, Abdominoplasty and Lower Truncal Circumferential Body Contouring . (Grabb & Smith’s Plastic Surgery).

As the popularity of bariatric surgery for obese patients continues to increase, so does the need for cosmetic surgery to address the excess skin that remains after they reach their optimal weight. Baggy, drooping skin over the entire body can leave a less than attractive appearance. This excess skin, which does not respond to dieting and exercise, can also cause hygiene isses that may lead to skin infections. Additionally, it may affect self-confidence and serve as a constant reminder of their previous obese state.

Body contouring procedures that may be considered for post-bariatric cosmetic surgery include:

Upper Body Lift – This procedure entails the removal of excess skin and fat in areas such as the arms, breasts, and back. Special attention is needed to keep the scars in natural creases

Lower Body Lift – A lower body lift can eliminate excess skin and fatty areas of the midsection, including the abdomen, flanks, hips, thighs, and buttocks. Dr. Aly discussed his technique, “Iowa Belt Lipectomy” that essentially removes the desired amount of skin, yet maintains an appealing waist contour.

Abdominoplasty – A tummy tuck can create a firm, tight stomach area by removing fat and skin and tightening the abdominal muscles. One must be careful that intrabdominal fat content is minimal, otherwise flattening is compromized.

Brachioplasty – A arm lift removes loose skin and excess fat deposits in the upper arm. Sometimes it can be combined with the upper body lift.

Unfortunately (for patients), at this time, most insurance companies will only pay for an abdominoplasty or a panniculectomy, as well as breast reduction with proper documentation. Some surgeons petition the insurance companies to cover the upper, lower body lift and brachioplasty. However, very few get covered and the patient eventually pays out-of-pocket for the procedure. Maybe the new health bill that was passed by the house includes a clause on post-bariatric body contour insurance coverage….

Matthew Blanton, MD

Plastic Surgery Resident

Duke University Plastic Surgery

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