Myth or Fact:  After bariatric surgery, I will need to have extra skin removed.

Daniel Cronk, MD

After bariatric surgery, I will need to have extra skin removed. If I lose weight more slowly, I might be able to prevent this from happening.

Questions about skin are one of the most common concerns we hear from patients before surgery.  Some are afraid to even consider surgery because they believe there will be too much uncomfortable, sagging skin to deal with. Others who seek out the bariatric operation believe less rapid weight loss will prevent extra skin, allowing time for the skin to adapt and be less bothersome. What I have learned in my greater than one decade of performing bariatric surgery is that misconceptions about extra skin post-surgery are abundant.

We cannot deny that significant weight loss can lead to extra skin. But there are so many variables affecting the skin both before and after surgery that this potential problem is not the same for all people. The amount of elasticity has a huge impact on what the skin does after the fat underneath melts away. Those who are younger tend to have more elastic skin and may have a better chance of it springing back into place. By contrast, those with a history of smoking or significant sun exposure will have less elastic skin and a greater tendency to have problems. The amount of extra skin also depends on, to a great degree, how much weight one has to lose and how that weight is carried on the body.  Those with more weight to lose (for example someone with a body mass index over 55) will have a greater chance of having more extra skin after surgery. Those who already have a fatty apron (or skin folds on the stomach) will likely have more extra abdominal skin, as opposed to someone who carries their weight with a typical “beer belly” or around their thighs. And, no, there is not any research or anything in my experience that leads me to believe slowing down weight loss will change any of these above factors or the amount of extra skin that develops.

So will you have to have skin removed after bariatric surgery? In the end, this comes down to personal preference, insurance coverage, and financial resources. I would say that greater than 95% of our patients never have skin reduction surgery. A very high number of these patients simply find out the skin is not bothersome enough for them to feel motivated to do anything about it. A smaller number really do have problems with the skin and would like it removed, but do not have the insurance coverage or money to pay out of pocket for skin reduction surgery. It is an unfortunate reality that the majority of insurance plans do not pay for skin reduction surgery, even if they previously covered the bariatric operation. Those plans that do cover it usually require months of documentation of problems with the skin, not all that different than the insurance mandated 3-6 month diet before bariatric surgery. Cash pay prices for skin reduction surgery can run $5,000-10,000 or more.

I’m going to declare both of the statements in the title of this article as myths. It is not statistically likely you will have skin reduction surgery after bariatric surgery. And by the time you start your bariatric surgery journey, there are few if any factors you can change to reduce the amount of extra skin you may develop.

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