You did it!  You worked hard and lost the excess weight after bariatric surgery.  The scale is showing a number that puts a smile on your face, however, what you see in the mirror may put sad or angry emojis in your head.

First, don’t blame yourself.  In all our years working with patients, there is no way to tell who may end up with sagging or loose skin.  Yes, there are some factors that can predict how massive weight loss can affect your skin, but none that are conclusive.  Certain factors like patient age, length of time patient carried the excess weight, genetics and even the rate of weight loss are some things that can affect skin elasticity.   

Many patients who have lost weight after weight loss surgery are faced with the issue of sagging skin.  Not everyone feels the need to have it removed.  Some patients are perfectly happy to use shapewear or clever clothing tricks to hide any lumps and bumps.  However, cosmetic surgery is a great option for many people.  There are quite a few different procedures that can help with the unique issues that are seen with patients after losing a large amount of weight.  

Here are the main types of cosmetic surgery for post bariatric patients:

Abdominoplasty (tummy tuck) 

What doctors call an Abdominoplasty, most of us just call a tummy tuck. This surgery is meant to flatten the stomach by removing extra fat and skin and tightening the muscles of your abdominal wall.

Options vary from complete, to mini or partial abdominoplasties.

Complete abdominoplasties typically involve repositioning your belly button, as the surgeon makes an incision from hipbone to hipbone to contour as needed. But don’t worry! Your surgeon will carefully craft your belly button for a final appearance that shows little to no change.

Mini or partial abdominoplasties are often recommended for those with fat deposits below their belly button. This procedure typically only takes a couple of hours and likely will not require any reconstruction to your navel, depending on your case.

Depending on the procedure, your belly button may be moved, and liposuction may also be involved. When you meet with your surgeon, make sure to explain your goals and discuss if the procedure can meet those expectations.

If you are planning to get pregnant in the future, please discuss it with your surgeon. Many doctors do not recommend this as future pregnancies can cause issues with the tightened muscles.

Back lift

A back lift surgery is used to contour and tighten the upper or lower back by removing the excess fat and loose skin. This procedure is often done with other procedures to create and upper body or lower body lift, depending on the areas treated.

For the upper back, there are generally 2 different techniques that can achieve different results.  One involves an incision along the bra-line or mid back: a bra-line back lift.  The other involves incisions down each side from the armpit to the hip: a vertical torsoplasty. There is also a waist-line lift which focuses on the lower back and is generally done with a tummy tuck and butt lift for a lower body lift.

Make sure when discussing your goals with your cosmetic surgeon that you cover their experience with each option and their thoughts on your case.  Look over their gallery of before and after pictures to better understand the affects and potential scars.

Body lift (upper body lift or lower body lift)

A body lift is used to improve the shape and tone of the underlying tissue that supports skin and fat. The excess or loose and sagging skin and fat are removed. This procedure can help improve dimpled skin surfaces and remove unsightly lumps and bumps we can see after weight loss surgery

A body lift is a combination of a few different procedures depending on your needs and your doctor’s recommendations. There are a few different types of body lifts.

Upper body lift typically includes:

• Arm lift (Brachioplasty)
• Breast lift (Mastopexy)
• Back lift

Lower body lift typically includes:

• Tummy Tuck (Abdominoplasty)
• Thigh lift (Thighplasty)
• Buttock lift

Brachioplasty (arm lift)

Many cosmetic surgeons that work with post bariatric patients offer Brachioplasty or arm lifts.  This procedure reduces that excess or loose arm skin that droops or swings downward.  Incisions are typically made on the inside or back or the arms and the excess skin and fat at removed.  The surgeon then tightens and smoothes out the supporting tissue to create new definition to the upper arm.  Liposuction may also be used to reduce localized fat pockets.

Results from arm lifts are typically long lasting.  As with other procedures, these are most effective is your weight remains stable after surgery.  Gaining or losing large amounts of weight can diminish the affects.

Gluteal lift (Buttock Lift)

Since weight loss surgery patients tend to lose large amounts of weight, many are left with sagging or loose skin in different areas. Some patients even complain about losing their butts. A buttock lift, or gluteal lift, can help with that. In order to achieve a smoother and more pleasing contour, excess sagging skin and fat are removed. A traditional gluteal lift will not make a butt larger, but may improve a dimpled, irregular skin surface. This procedure may be included in a body lift or may be performed separately.

There are other procedures like buttock augmentation or fat transfer (Brazilian Butt Lift) that can also help by implanting or transplanting material to increase the fullness or roundness of the area.

Mastopexy  (breast lift surgery)

After weight loss surgery, breast tissue can sag and basically look deflated.  Breast lifts can restore some of that fullness by lifting the breast tissue, removing the excess skin and in some cases adding breast implants. There are a few different incision paths that the surgeon may make.  The nipple and areola are generally moved back up to a more natural height.  In some cases, enlarged areolas are reduced to be more in line with the new look created by the breast lift.

Like most of the other cosmetic procedures, large swings in your weight can have negative effects on this procedure. Pregnancy and breast feeding can also affect your results. For these reasons, doctors recommend for patients to wait on this procedure until after they have finished having children. You will also want to try and maintain a consistent weight, as large fluctuations can also hurt your results

Panniculectomy

The panniculectomy is a procedure to address large amounts of hanging skin on the lower belly area. This is a problem for many patients who have had massive weight loss after bariatric surgery.  Not only is the sagging skin uncomfortable and unsightly, many patients develop rashes, infections and ulcers in the folds of this skin.  The panniculectomy can be considered a medical necessity if the skin hangs below the pelvic area and the infections aren’t responding to treatment.  Most cosmetic surgeons who work with post bariatric patients are familiar with the insurance policy guidelines for coverage.

This is an invasive surgical treatment.  The surgeon will be removing the excess skin and fat, sometimes called the “apron”, and suturing the remaining skin back together.  Some patients will leave the procedure with temporary drainage tubes.  The main goal is to resolve the medical and mobility issues caused by the hanging pannus. As with the other cosmetic procedures, keeping a stable weight after surgery, will help the patient to retain the benefits of the skim removal.  

Thighplasty (thigh lift)

A thighplasty, also known as a thigh lift, is a cosmetic surgical procedure to tighten and improve the appearance of the thighs due to excess or loose skin, that can be a result of significant weight loss. Many patients complain that their thighs are dimpled with sagging or flabby skin. The goal of a thigh lift is to lift and contour the thighs so that they look slimmer and in proportion with the rest of your body.

Thigh lift surgery reshapes the thighs by removing excess skin and fat, resulting in smoother skin and better contours of the thighs and lower body. A combination of a thighplasty and liposuction techniques may used to get the desired result. The skin is cut from the inside and top of each thigh. Patients will generally have incisions down to the top of each knee. Most patients will see immediate results with the removal of excess skin, the long-term effects will show up as the swelling and bruising diminish after a few weeks.  Large weight fluctuations will harm the results and can create loose or sagging skin issues. 

How long after weight loss surgery should cosmetic surgery be considered?

Most surgeons will expect you to not only have stopped losing weight from your bariatric surgery, but may require that you have kept most of the weight off for a few months before agreeing to schedule a cosmetic procedure.  Generally both bariatric and cosmetic surgery patients ask patients to wait close to 18 months from the weight loss surgery procedure before scheduling at cosmetic surgery.  This will help with the long term affects of the cosmetic surgery.  Large fluctuations in your weight can undo much of the work that is done with cosmetic surgery.  Also, many surgeons will ask that women wait on the cosmetic surgery procedures until after child birth.  Please speak candidly with your doctors to make the best decisions on proceeding with cosmetics

In some cases, insurance may cover some or part of these procedures

Some insurance companies will pay for the excess skin removal. If the skin hangs below the pubic bone and rashes occur, insurance may pay for a panniculectomy. They may also cover costs if the excess or loose skin causes mobility issues. Your best bet is to work with a cosmetic surgeon who has been operating on weight loss surgery patients for years. They will have a better understanding of the insurance policies and how to prove that the surgeries are needed or medically necessary.

How to pay for your cosmetic surgery

Medical/Healthcare Credit Cards

Medical credit cards vary from your traditional credit card, mainly because they can only be used for certain healthcare needs or medical procedures.  Most of the healthcare credit cards already have a network of providers who accept them for payment for their procedures. If you are approved for credit with one of these companies, they generally have a list of providers that you can search by area and by type of cosmetic surgery procedures performed.

Generally, the medical credit cards can come with higher interest rates, however, most generally include a lower or deferred-interest offer promotion if the charges are paid in full before the timeframe is over.  So, you can save on interest charges, but you must pay off the balance before the deferment time is up. After that timeline, you have to pay all of the interest calculated from the initial purchase amount, not the remaining balance. 

Medical credit cards can be great options for paying for your cosmetic surgery, you just need to have a plan in place to keep the costs as low as possible by paying off the total plan during the interest free time.

Credit Cards

Most cosmetic surgeons and surgery centers will allow you to pay all or part of your bill with your credit card. If you are planning to open up a new card, make sure you shop around and see if you can find options for introductory specials like zero or low interest.  As the interest charges on credit cards can be high, make sure you come up with a plan to pay off the balance as soon as possible so that you aren’t hit with high interest charges that can really slow down your payment progress

Home Equity loan

A home equity loan is a loan that is taken out against the equity that you have in your home. This type of loan uses your home as collateral for the funds, so use these funds wisely. You do not have to use the same company that you use for your mortgage. Credit unions, banks and other mortgage lenders should all offer home equity loans. Like any other type of loan, take the time to shop around and find out who can offer you the best deal. Make sure that you are looking at the interest rates, closing costs, application fees and any other charges that can add to your costs. You can even negotiate lower fees by getting the banks to compete against each other. As with the other types of loans or financing options, your credit score is going to be an important part of getting approvals. Make sure that you have checked your credit report and worked to clear up any issues that may be harming your credit.

Personal loan

Banks, credit unions and online lenders are another option to help you pay for your cosmetic surgery.  These personal loans are generally available for many different purposes, including plastic surgery and medical expenses.  You may have even used one to pay for your weight loss surgery.  Before you go through the trouble to apply, make sure that you check with the lender.  You don’t want to get the hard inquiry on your credit history, only to find out that the loan cannot be used for a plastic surgery procedure.

Personal loans are typically unsecured, meaning that you don’t have to put anything as collateral for the loan.  These loans are generally structured for a set amount of money, that is to be paid back in monthly installments, over the term of the loan.  So, before applying for the loan, make sure you know roughly how much will be needed to cover the cost of your cosmetic procedure.

Medical loan/Medical lending

There are many options for medical loans, like other personal loans, they can also be unsecured.  As the costs of healthcare are increasing, we are seeing more and more options become available for medical lending.  These loan programs are typically personal loans that can only be used for medical procedures.  Like other loans, potential lenders will review your financial details, credit history and score to determine if they are willing to approve you for a loan for a cosmetic surgery. 

In many cases, you can apply online.  Some of the medical lending companies can give you a lending decision within a few minutes of receiving your application.

Your 401k plan

Depending on your 401k, some employers will let you take out a loan or withdrawal from your own 401k assets. Most programs have preset guidelines on what circumstances they will allow these moves. Please contact your plan administrator for all rules related to this type of moves.  There are many specific rules on withdrawal limits and payback timeframes, not to mention some tax implications.  Do your research if this is the option you are choosing to help fund your cosmetic surgery.

Bottom line, should you finance?

Almost every time you finance, you will be increasing the cost of the procedure.  The interest rate and other financing charges can make an expensive procedure, much more expensive.  Make sure that you do your research and understand all the terms, conditions and timelines that apply.  Check out as many different options as possible to see what programs and interest rates are available to you. Take your time and make the best decision based off as much information as you can get.  Cosmetic surgery is a personal decision and so is how you opt to pay for it.

Does cosmetic surgery help with long term success after weight loss surgery?

According to the American Society of Plastic Surgeons, having body contouring or excess skin removal does help with long term weight loss.  They specifically studied patients after gastric bypass, who lost an average of 100 lbs.  Those patients who had a cosmetic procedure after their bariatric surgery had an average of 14 lbs regained after 7 years post-op, compared to an average of 50 lbs regained in the group who had not had experienced a cosmetic surgery.

When we think we look better, we tend to feel better.  Weight loss surgery patients who move forward with a cosmetic surgery procedure may have a little extra spring in their step.  They have taken the extra step to invest in their appearance.  That alone may be a strong force in their desire to keep those extra pounds from sneaking back up.  Bottom line, you do what feels right and works for your life.  You worked hard to get the weight off, you deserve to enjoy your new life.

Key take-aways

Cosmetic surgery, just like gastric sleeve or gastric bypass surgery, is a very personal decision.  There are quite a few different options to help you to reach your desired results. Take your time, do your research on which procedures will help you look and feel your best.  Find a board certified cosmetic surgeon and look at their reviews and their patient gallery.  Our top tip…. Make sure that they have experience with weight loss surgery patients.  Working with excess/loose skin and getting everything tightened back up is a skill that comes after experience.  Please make sure you look for doctors who understand the unique needs that come with patients who have lost quite a lot of weight.