Ask the Practitioner: Skin Removal Surgery Considerations

Article By: Rachel Ignomirello, MS, RDN, CSOWM, LDN

Rachel Ignomirello is a Bariatric Dietitian and Board-Certified Specialist in Obesity and Weight Management.

The journey through metabolic and bariatric surgery (MBS) doesn't end at weight loss; it's about achieving a healthier, more active life. However, significant weight loss can leave behind excess skin, posing new challenges. Understanding the role of skin removal surgery can be a vital part of embracing your transformed body.

1) The importance of skin removal surgery.

Excess skin can lead to physical discomfort and skin conditions, making skin removal surgery not just a cosmetic consideration but a health-related decision. From improving mobility to alleviating skin irritation, the benefits extend beyond aesthetics.

2) Technical insights into skin removal surgery.

Types of procedures:

• Abdominoplasty (“tummy tuck”): This procedure focuses on removing excess skin and fat from the abdominal area and tightening the muscles of the abdominal wall. It's ideal for patients looking to address sagging or a bulge in the abdomen that doesn't improve with exercise.

• Panniculectomy: Unlike a tummy tuck, a panniculectomy solely removes the excess skin and fat hanging below the belly button. This surgery is often recommended for individuals who have undergone significant weight loss and are left with a large "apron" of skin.

• Body lifts: Body lift surgery can be categorized into lower, mid, and upper lifts. A lower body lift addresses excess skin around the abdomen, buttocks, lower back, and thighs. A mid-body lift might combine abdominal and lower back skin removal, while an upper body lift focuses on the arms, breasts, and upper back.

• Arm lift (brachioplasty) & thigh lift: These procedures remove excess skin from the upper arms and thighs, respectively, often after substantial weight loss. They help in achieving a more toned appearance.

Surgical considerations:

• The surgical team will evaluate your overall health, nutritional status, and skin elasticity. They'll also review your medical history to identify any factors that could affect surgery or recovery.

• Clear communication about your goals and expectations is crucial. The surgeon will discuss what the surgery can realistically achieve and how it aligns with your vision of your post-MBS body.

• Based on the assessment and your goals, the surgeon will recommend the most suitable procedure(s). This decision is tailored to your specific needs, whether it's targeting a single area of concern or multiple areas for a more comprehensive transformation.

Understanding insurance coverage:

• Many skin removal surgeries are often categorized as cosmetic, making them less likely to be covered by insurance. However, the panniculectomy may qualify for insurance coverage under certain conditions if it's causing physical discomfort, skin conditions, or other health-related issues.

• Patients should review their insurance policies and understand the specific criteria for coverage of skin removal surgeries, possibly involving direct communication with insurance representatives.

• If seeking insurance coverage, documenting the medical necessity is crucial, including detailed medical records of chronic skin rashes, infections, and other problems exacerbated by excess skin. Engaging with healthcare providers experienced in post-MBS surgeries can be invaluable for preparing the necessary documentation and advocating on your behalf.

Recovery & care:

• The first few weeks post-surgery are critical for healing. You'll likely have drains to prevent fluid buildup, bandages over incisions, and may need to wear compression garments to reduce swelling and support the affected areas.

• Close follow-up appointments are essential to monitor your healing and identify any early signs of complications, such as infection or poor wound healing. Adhering to your surgeon's guidelines is crucial for minimizing risks.

• Full recovery can take several months, and results will gradually improve as swelling subsides. Maintaining a stable weight through a healthy diet and regular exercise is vital to preserve the results of your surgery. Additionally, proper skincare and sun protection can help scars heal better and prevent further skin damage.

3) From a practitioner's perspective.

Our role as healthcare providers extends far beyond the operating room. We are committed to guiding our patients through the entire journey, from making informed decisions about skin removal surgery to navigating insurance coverage and supporting them through recovery. Our goal is to ensure that the decision to undergo skin removal surgery not only enhances physical appearance but also promotes a healthier, more fulfilling life post-MBS.

BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.