Lasting Change – Plastics after Bariatric Surgery

Tammy Farrell

Plastics – Unwrapped

I can hear it now…”What?! Plastic surgery after bariatric surgery? I can’t even get my bariatric surgery approved! Why are we even discussing this?” With childhood obesity being an enormous concern for our society, people being ridiculed into keeping their weight down (sign our petition against these fat-shaming apps), insurance coverage…and lack thereof… for bariatric surgery, WHY are we talking about plastic surgery?

First, you call it what you’d like –

      • The generic surgery name – plastic surgery (a.k.a. “plastics” to the in-crowd)
      • Something more sensitive to the results received – body contouring
      • A tool for putting things back where they ought to be – reconstructive surgery
      • Or my new favorite – plastic surgery restoration (I came across it this week in a letter written by a team of Italian doctors in the Plastic and Reconstructive Surgery® journal)

After someone has lost a massive amount of weight very quickly whether it was due to surgery or via another means, the body cannot keep up. Fat cells have shrunk, your insides are settling in, but your skin hangs. Exercise strengthens your heart as it builds and tightens your muscles (yeah!)… and it leaves empty room within your skin.

There’s no pretty way to say it. Things sag. Your stomach skin hangs low and creates folds of skin touching skin. Rashes may develop. Your arms jiggle in a way they were never intended to. It’s amusing at first. Funny even. Your excitement about your restored health and changing appearance shifts for many of us into being self-conscious about our loose skin.

Yes. We’d certainly rather have the loose skin than having it filled with the burden that the excess weight brings. No, we wouldn’t give up the increased energy that we have nor do we have any desire to go back to diabetic, heart, or high blood pressure medicines that once were part of our daily routines.

So yes, we are better off for having had bariatric surgery. We’re thankful for what we’ve earned as our benefits of it and for the doctors and medical team that support it.

But…Is it enough?

Reality Check
Making it to the Super Bowl must be an incredible feeling. But wouldn’t you want to go home with the winner’s ring, bragging rights, and that elusive trip to Disney World? Yeah. We would too.

In today’s world, people want to capture wellness in every dimension. Does relieving the body of its excess weight alone bring bariatric patients to true wellness? Or is it only part of the equation?

Bariatric patients learn to be alert to transfer addictions. We know about food records, protein counting, and the real risk of dehydration. Bariatric patients know to anticipate change. In their dietary needs. In their body shape. And in the reactions that they get from other people. But…until you’ve gone through it, all of the anticipation, concerns, and nervousness about how life will be after surgery are just thoughts. Once you’re in the game, it’s reality.

Your Turn
I’d like you to take a few moments to step into my experience.

You prep for bariatric surgery (and life after surgery) for months. You’ve gone through several ups and downs and the day comes that you’re finally on the table. A pre-surgery patient asked me last week what my first feeling was after the surgery. I told her it was relief. The relief was that I’d gotten through the preparation and insurance hurdles and that I no longer had to be concerned with the ‘what if’s’. I was now in my new reality.

The first month passes and you’re in a euphoria for having dropped 25 pounds so quickly. It feels so good to be lighter and in control. More months pass. More pounds gone. At nine months out, things stabilize with having lost 83 pounds. Life has changed. You look at the many goals you’ve put off until “once I lose weight…” and start to pursue them in earnest.

Imagine your body, as it is right now, with 83 pounds having melted away beneath your skin. How do you feel? What thoughts are going through your mind? What do you look like in the mirror or to someone you love? Is it possible, just possible, that the image you had of yourself once you lost that weight looks vastly different than what you had imagined?

Your Voice
In this blog series, we’ll explore whether plastic surgery after an extreme weight loss should be considered a “cosmetic” surgery. I’ll let you decide.

Your comments, as always, are welcome.

Part 2 & Part 3

About the Author:
Tammy Farrell, CPC, CPA, CFE, is a professional wellness coach who specializes in working with fellow bariatric patients in Scottsdale Arizona and nationally via phone calls, webinars, and Skype. Tammy’s company, Believe In Action Coaching, provides personalized guidance, group programs, and workshops as well as free monthly support groups, newsletters and resources for her community. As a mom to two young boys, Tammy loves to keep them active and curious about the world around them.

Disclaimer: This blog post does not reflect the views of the OAC, the National Board of Directors or staff. Information contained in this blog post is not based on scientific research and has not been validated. The OAC does not endorse any merchandise or program mentioned in this blog post.

19 Comments for this Post
  • Jeff Newell
    October 7, 2014 at 9:53 am

    great topic! I look forward to reading more. I’m in my pre-surg phase now and this is on my radar

    • Tammy Farrell
      October 7, 2014 at 8:54 pm

      Thanks for your comment Jeff! I’m glad you’ve found it interesting. I hope you enjoy the series and continue to participate on the blog and within the group.

      Best of luck with your pre-surgery process.


  • Barbara
    October 7, 2014 at 9:02 pm

    wish to have surgery but insurance will only cover lower part of belly.. nothing else. arms upper belly. fed up with insurance companies.. they ok the surgery lets finish it..

    • Tammy Farrell
      October 8, 2014 at 2:07 pm

      I appreciate you adding your voice to the discussion Barbara. Your frustration is very valid. Talking about this as a needed piece of the solution to resolve obesity is a good way to raise awareness of our needs.

      Thanks again for your input.

  • Mary Grisaffi
    October 8, 2014 at 8:36 pm

    Had lap band in Oct 2007 and lost 85 pounds was 11 pounds from goal. I still felt fat and would not look at myself in the mirror. I didn’t feel finished and the hanging skin on my stomach with the rashes and the back pain didn’t help. I had puffiness in my upper stomach that would not get any smaller either even though I was working out 3 to 4 days a week. Turns out I had to have muscle repair along with an extended tummy tuck. I also had an arm lift. All in all the surgeon removed about 14 pounds of excess skin & some fat. Now I was self pay and that was only because I some inheritance money left over after paying off some bills. I wanted to get the surgery now (I am 61 years old I want to enjoy the new body for awhile. LOL) and didn’t want to argue with the insurance company. Anyway long story short I had the surgery on 16 May 2014 and loved the results when I could get into little underwear and were tank tops. Then I stated to think hay my upper abdomen should be flatter and when I wear my bra there are little fat bulges at the top of my arms front and back. I spoke to a trainer friend who is around the same age as me and a WLS person of over 10 years. She pointed out to me that I am healthy and was successful in my weight loss and that my PS went great and that I am 61 and not 25. She said I look fantastic and the thing I need to work on is my body perception. I don’t know if this makes sense to anyone but my weight problem is a mind problem. I do feel much better now that my friend put me straight and I am liking myself much more. I do think there are some that do not need plastics (reconstruction) surgery but for those that do and it is medically documented that insurance company’s need to step up and provide coverage. I also think that before and after surgery therapy with a therapist that knows about obesity also needs to be coverage and this for many if not most is a necessity. Ok I have gone on to long, sorry.

    • Tammy Farrell
      October 9, 2014 at 4:16 pm

      Thanks for sharing your experience Mary. I’m so glad that your health has improved.

      I completely agree that working with a therapist or qualified support person is an essential piece that should be explored by all WLS patients. So often the focus is on the surgery and the surgery date itself rather than on the life you’ll live after the surgery. Your point about weight and body image perception being a challenge is on target. Accepting who we are and where we are now while celebrating our successes are what can keep us grounded (but not obsessive) about the results of our mind and body work.

  • Brian Trainor
    October 9, 2014 at 1:35 pm

    On Apr 23/14 I weighed 320 lbs. At my heaviest I was 354. On that date I flew to Tijuana and had WLS with Dr. Jaimie Ponce De Leon, a brilliant surgeon.

    I was to have the Sleeve surgery but during the surgery he found I had a tumour growing at the bottom of the inside of my stomach. Dr. PDL removed it but couldn’t do the sleeve because of the location so he did a mini gastric bypass instead.

    I have never felt pain, or been sick the entire time and 5 months post-surgery now I’m down 105 lbs (215lbs) with 26 to goal. I feel great.

    I lost type 2 diabetes, high blood pressure and high cholesterol along with the 15 pills/day I needed to take. I started walking a month after surgery and progressed up to 6 miles/day nonstop at s quick pace. That lead me to try running. I now run 4 miles nonstop and walk two afterwards every second day. As a matter of fact I joined a local running club last night, something I couldn’t ever have imagined 5 months ago.

    My blood analysis is perfect, I’m not deficient in anything, I drink 10 cups of water/day and use “My Fitness Pal” to track my food. I consume 70-100 gms of protein/day with low carbs ( mostly fruit).

    Yes, I have massive amounts of loose skin. At 57 yrs old I look at myself in the mirror and see nothing but wrinkles. My stomach is a prune but not sagging, my man boobs are though, and the under side of my biceps flap like wind socks.

    I’m going to wait a year before I look into plastics to see if any of it will tighten ( though at my age I don’t expect too). I remind myself that I did this for health, not ego. I wanted to be in-diabetic and I accomplished that.

    In Canada insurance won’t pay for WLS or plastics so the WLS was in my dime ($12,000US) Our universal health plan will do the surgery for free but the waiting list in most provinces is 5 years and that’s if you qualify. The line in the sand for plastics to be covered by the government is to lose 100 lbs. Well, I’m there so I’ve been referred to a local Plastic surgeon and it won’t cost me a penny. Thank goodness for the Canadian a Universal Health Care System. Slow? Yes! But free.

    Will I get plastics done, definitely on my stomach and boobs. I don’t really care about my arms, inner thighs, or face. The key us to remember why you had WLS. For most of us it was to improve our health and to live a longer, and hopefully less painful yet mobile life. Life is about quality and at 15 pills/day, wearing a CPAP mask each night, having just had lower back surgery for s herniated disc and my gall bladder removed because I ate too much grease, where was my life’s quality?

    I have it back now.

    • Tammy Farrell
      October 9, 2014 at 4:28 pm

      Congratulations on your amazing transformation Brian! It’s so inspiring to hear about how you’ve embraced your new found health and energy.

      Eliminating your diabetes, high blood pressure, high cholesterol, sleep apnea and 15 pills a day! I will never get tired of hearing about those medical and quality of life improvements. :)

      I applaud the Canadian health system also for recognizing that plastics should be available to those who need and desire it. (I’d lower the 100 lb threshold to 83 lb though to slide me in!) ;) As more evidence comes in on the medical and psychological benefits of plastics after massive weight loss, I’d love to see the US private and public insurance follow suit.

      Continue to enjoy your newly improved life Brian!

  • Kathy Crawford
    October 11, 2014 at 9:37 am

    I’m six years out from my gastric bypass surgery and have never regretted making that decision. I’m 64 years old now and have lost as much as 160 pounds, but currently have added a few pounds making me a very comfortable weight of around 135. I have seen several plastic surgeons throughout the area, Nashvillle, Indianapolis, Cincinnati, and Indianapolis. Their suggestions, from the few who were willing to consider the job, sound wonderful and I would like to be able to follow up, but I can get no help on the insurance front and the surgeries required would be almost 40,000 dollars, baring complications. As a single retired teacher, this just can’t happen. I have an abundance of excess skin everywhere, but my thighs are the worst in terms of being unsightly. I had dieted in the past and lost over a hundred pounds on two previous occasions only to have those pounds return and bring friends. The elasticity in my skin is gone and it has the appearance of an old balloon that has been inflated and deflated several times, resulting in a rather puckered quality and major sags and pouches of skin. I can adjust the appearance of the torso of my body and smooth out the sags and bags, through the use of good undergarments and shapers, but the arms and legs are out there for the world to see and comment on, and trust me, these comments are just as hurtful as those I heard before the weight loss. I have been publicly humiliated and chastised for wearing a swimsuit at a water park with my grandchildren, had male “friends” who cringed and walked away after seeing me in swimwear….I’m not talking bikini, but a conservative black skirted suit.) I should be used to that as it was common before my bariatric surgery, but I did not realize I would “traumatize small children” or lose the company of interesting people by doing what I love with those I love.
    I love my new life and the ability to get out and go and do things that were physically impossible before. I hope this blog will help to raise awareness of some of these issues. I realize that because I was older when I had the surgery, my skin was less likely to be as elastic as that of younger patients, and I also realize that as I continue to age, the problem will probably get worse and the willingness of plastic surgeons to tackle the task will go away, but I would never want to go back to the “fluffy” me.

    • Tammy Farrell
      October 14, 2014 at 12:13 am

      Kathy, thank you for your raw honesty about what you’ve experienced both in terms of receiving medical treatment for your excess skin and the cruel comments that you’ve received. My heart goes out to you.

      You’ve done awesome on maintaining your weight loss and I’m glad you’re loving and enjoying your life.

  • Michelle Vicari
    October 13, 2014 at 12:12 pm

    I think there needs to be a clearer understanding of the difference between cosmetic plastic surgery and post weight loss reconstructive surgery and recognition of that in insurance coverage. I have had a couple of post weight loss surgery plastics procedures done they were needed from both a physical and an emotional standpoint yet none were covered. Also just Saturday results of a study were presented American Society of Plastic Surgeons conference that showed post wls plastics may contribute to improving long-term weight loss results.

    • Tammy Farrell
      October 14, 2014 at 12:25 am

      I completely agree Michelle, post weight-loss surgery should be recognized and evaluated separately from cosmetic plastic surgery.

      Thanks for making me aware of the ASPS conference presentation. Reading the study’s abstract last month was what inspired me to write this blog series. It was and is exciting to read the evidence and recommendations supporting the need for reconstructive surgeries. I’ll provide a link to the abstract in Part 2 of this series.

      I enjoyed talking with you at the Lunch with the Experts in Orlando at the YWM 2014 Convention last month. The work you do for the bariatric community and the OAC is much appreciated.

      • Michelle Vicari
        October 14, 2014 at 2:42 pm

        Enjoyed speaking with you too Tammy. Thank you for this much needed blog series. Looking forward to Part 2.

  • Maureen
    October 15, 2014 at 12:15 pm

    Good timing for me, I am scheduled for a tummy tuck Nov 19th after losing 250 lbs with RNY. In the part of Canada that I am from (Ontario) only the panniculectomy is covered and qualification is pretty strict, but if approved (I was) most PS will let you “upgrade” to save on costs. I’m looking forward to these posts

    • Tammy Farrell
      October 16, 2014 at 12:44 pm

      Another shout out for Canada for providing care to people after their weight loss! :)

      Congrats on your weight loss Maureen. Great job! Best wishes on November 19th!

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  • Kelly
    October 18, 2014 at 10:42 pm

    I had lapband Nov 2007, I lost 100 lbs and like everyone else, hated the way I looked, sure I was healthier, but I had to still buy 2 sizes bigger pants to fit my jabba the hut hanging belly. So I looked into reconstructive skin removal. I had 5 consults, and I ended up going to Dr Timothy J. Katzen. my husband and I both loved him, we took out a medical loan and instead of getting a new car that we wanted, I got a new body. :-) I had a extended tummy tuck with anchor cut and a small crescent breast lift with implants. I paid 3 years of payments. :-D and I am SOOOOOOOOOOOOOOOO happy. we submitted to insurance and they denied, So I paid myself. I then thought I was done with surgeries. but I lost another 25 lbs and then one day sitting at a stop light I caught a glimpse of my huge batwing arms in the mirror. Ugghhh scrotum arms I called them, So I told myself I wanted to get a Brachioplasty, I started saving that day and it took me 3 years of saving, and July 20013 I had my arms done by Dr Katzen OMG I LOVE my sexy skinny arms…. I paid CASH for my arm surgery….. No loan, all cash. :-)
    I would tell anyone that wants skin removal to start saving now, if your insurance wont cover it, find a way to do it yourself, you will be not be sorry. I stopped getting my hair colored at the salon, I did it myself, I stopped mani/pedis, I did em myself. I clipped coupons, I wash my own car instead of paying someone to do it. I recycled. anything I could save $$$ on I did. and I put all the savings away in the “Kelly Fund” OH and I still drive that same car I decided to keep back in 2007. it is now 10 years old.

    • Tammy Farrell
      October 20, 2014 at 3:36 pm

      Thanks for sharing your story with us Kelly. I admire your determination and your story is a nice illustration of how setting and following your priorities pays off.

      Take care.

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