Lasting Change – Plastics after Bariatric Surgery – Part 2

Tammy Farrell


Part 1 of this blog series opened the topic of addressing the needs of bariatric surgery patients and others who have lost significant amounts of weight. Removing the excess skin remains a sparsely researched and rarely discussed topic but fortunately, things are starting to change. (Yeah!)

For ease of reference, I’ll refer to the surgery to remove excess skin as Body Contouring. We’ve set the foundation, so now let’s explore patient AND researcher perspectives.  Let’s go!

Real Conversations
What do bariatric surgery patients – the ones who are directly affected by excess skin – really think about body contouring surgery after having a major weight loss?

Five things come up for us:

  1. Body contouring is reconstructive surgery. Calling it “cosmetic surgery” feels like an insult to what we’ve been through.
  2. Approximately 88 percent of bariatric surgery patients want body contouring surgery according to a study out of Toronto, Canada (Reference). From my own discussions with patients, the 88 percent number is conservative and is likely even higher.
  3. We’ve already changed our lives with the help of bariatric surgery or other drastic means, and we recognize that body contouring surgery (or surgeries) are MAJOR surgeries that include risk and potentially lengthy recovery times.
  4. Cost is THE major barrier to having body contouring surgery.
  5. They/We know that removing the excess skin provides both physical and mental benefits. Aren’t both equally important?

The Researchers…. YES, there are some!
On a hot summer day in Scottsdale…and I do mean HOT (108°), I was roaming around the Internet and for whatever reason, came upon a mind-boggling research study. Try not to judge me for being a science geek. ;)

Anyway, I came across this medical study from doctors and researchers in Geneva, Switzerland, that was the first study I had heard of as having been done about plastic surgery post-bariatric surgery (Reference).

The gist of the study is that the research team believed that body contouring could decrease weight regain, leading to better long-term weight control after Roux-en-Y gastric bypass (and maintenance of the bariatric surgery benefits) and they created a study to prove or disprove their hypothesis. And (imagine that!) they proved that in fact it DOES.

Their conclusion as written in the abstract is “The authors demonstrated that patients with body contouring present better long-term weight control after Roux-en-Y gastric bypass. Therefore, body contouring must be considered as a reconstructive operation in the treatment of morbid obesity.”

Hallelujah!  There it was in black and white.  I felt as if the skies had parted.

Since then, I’ve found references to the Swiss doctors’ research in the journal of Plastic and Reconstructive Surgery®, another in The Bariatric Times, and OAC Board Member, Michelle Vicari, alerted me to it just having been formally presented to the American Society of Plastic Surgeons on Monday, October 13th in Chicago. My hope is that the study continues to gain attention during ObesityWeek, November 2nd – 7th in Boston.

Fortunately, the Swiss Study wasn’t the only one out there.

Another study, this time from of Canada, was specific to cost being a barrier and the impact on the psychological well-being of WLS patients. They concluded “Bariatric surgery patients who desire body-contouring surgery perceive cost as a major barrier. Patients undergoing bariatric surgery may experience improved physical quality of life but not mental quality of life; however, body-contouring surgery may improve aspects of depression and anxiety.”

What people who have had major weight loss have known intuitively and all too personally, has been validated.  Whew!

I’ll stop here with my research quotes so that your eyes don’t glaze over but for the record, I did find other studies from Utah, Philadelphia, and antidotal supportive information from a surgical team in Italy. All the research leads us down the same path, body contouring after major weight loss helps to maintain the weight loss and improve the physical and emotional quality of life for those affected by the disease of obesity.

Reconstructive Surgery or Cosmetic Surgery?
In part 1 of this blog series, I promised to address the question of whether body contouring after major weight loss should be considered cosmetic surgery.

The best reference I found for this (besides my own opinion of course) is on the American Board of Cosmetic Surgery’s Web site:

“The procedures, techniques, and principles of cosmetic surgery are entirely focused on enhancing a patient’s appearance… Because the treated areas function properly, cosmetic surgery is elective… Plastic surgery is intended to correct dysfunctional areas of the body and is reconstructive in nature.”

Jumping over to the American Society of Plastic Surgeon’s site, in order to find Body Contouring after Major Weight loss you have to (currently) look under the Cosmetic procedure section.  Yet they state “after weight reduction surgery, or any substantial amount of weight loss, the skin and tissues often lack the elasticity to conform to the reduced body size.”

Enough quoting for today.

Didn’t we all learn in high school biology that skin is the largest organ in the human body?

If the largest organ in our body is not conforming to our body size, it is dysfunctional….and it is NOT cosmetic surgery.  If it’s not cosmetic surgery, it should not be considered elective surgery.  The only electiveness about it should be whether the individual chooses to have the procedure or not.

Remember my 108° day?  Do you think wearing compression garments (girdles/shapers/etc) forever is the right solution for me?

Now What?
I’ll get off my soapbox now.

In the final part of this blog series, I’ll combine my own ideas with yours so that we can collectively brainstorm where we can take this next.

What can we do with this information?  What can YOU do?

Please add your ideas and comments below.

Part 3 Now Online!

To view Part 3 of this blog series, CLICK HERE.

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 based on scientific research that has not been validated. The OAC does not endorse any merchandise or program mentioned in this blog post.

10 Comments for this Post
    October 18, 2014 at 5:55 pm

    I have lost 297 pounds. Although I did not lose it through gastric bypass. I still struggle with the large amounts of skin. Each of us who have lost great amounts of weight and need these surgeries should ban together. I want to start a foundation, that strictly addresses the needs of people that struggle with obesity. I want to start petitions to take to Congress so the medical necessity codes can be changed for this issue. We fight and conquer this disease daily. I am busy in my state. Can others join me?

    • Tammy Farrell
      October 20, 2014 at 3:52 pm

      Congratulations on your weight loss and maintaining it Cheryl. It’s always good to see hard work paying off.

      Starting a foundation to fight obesity is a wonderful idea. My personal choice is to work on these issues through my individual actions and in conjunction with the Obesity Action Coalition. While the OAC is sometimes more visible on a national level, they encourage their members to work on issues that are important to them at a state and local level also.

      Keep up the great work!

    • My Bariatric Life
      October 20, 2014 at 4:46 pm

      Hi Cheryl, The American Society of Bariatric Plastic Surgeons is pushing for this reform. Perhaps you can join with them in their efforts. Good luck, MBL

  • My Bariatric Life
    October 19, 2014 at 10:22 am

    I am a writer and obesity health activist known as My Bariatric Life and I am one-year out from my body contouring plastic surgery with Dr. Joseph F. Capella (Capella Plastic Surgery) and approaching one-year out from my facial plastic surgery with Dr. Catherine Winslow (Winslow Facial Plastic Surgery). I am 11-yrs out from my RNY gastric bypass with Dr. Vishal Mehta (Mehta Obesity Center).

    I cannot do justice in a few words left in the comments section to the life changing transformation plastic surgery has been for me this past year. The physical changes were outstanding. From the plastic surgery I lost 50 inches and 50 pounds and 6 jeans sizes. I look about 15-years younger. Dr. Winslow gave me back a matured version of the pretty face I had in high school – yes, believe it or not, I was thin and pretty before I became morbidly obese in my adulthood. And Dr. Capella gave me a body better than what I had in high school. Someone told me that they took me from a 1.5 to an 8.5. It is true. Weight loss surgery may have saved my life but it left me with a distorted face and ugly body. You can see the change for yourself in a video montage I put together All in all, I lost 11 pants sizes and 135 pounds from the night before my gastric bypass to today. The side by side photos do not even look like the same person.

    The emotional changes have been magical. It is an amazing thing to experience your body changing so dramatically so quickly. To understand just what that feels like must be experienced for yourself; those whom have gone through it know exactly what I mean. One patient told me that plastic surgery was so much more about finding the person you were meant to be. Another person told me that weight loss surgery saved her life and plastic surgery saved her soul. I am now focused on finding myself and living life fully. I was never a wall flower but there were things that I let hold me back from doing exactly what it is I want to do. Well, no more. I am breaking through all my barriers and grabbing life with both hands. I’ve got a lot of life to live and I intend to live a life I love.

    I am very blessed to have been able to afford plastic surgery. I envy the patients whom get insurance coverage. I sacrificed $40,000 and that was a big investment in myself, but worth every penny. I am equally blessed to have found TWO plastic surgeons who are at the top of their categories in reconstructing massive weight loss bodies. It is CRITICAL that your plastic surgeon be an expert in post massive weight loss plastic surgery. Even though we are normal weight now our bodies metabolically are still morbidly obese. We are not getting simple Mommy Makeovers to tighten up a little flab and loose muscle. Our bodies and faces are literally being reconstructed. So be sure to choose your surgeons very very carefully. The most important questions you can ask your doctor for each procedure that you are considering is, “How many of these have you done and how often are you doing them?”

    Today I am a size 2 and living larger than ever!
    My Bariatric Life

    • Tammy Farrell
      October 20, 2014 at 4:10 pm

      Thank you for adding to the discussion and bringing up important points. I’m so glad that plastic surgery has taken you to the next level of your life.

      50 lbs lost due to the plastic surgery! Amazing! While many of us may long for those numbers, you beautifully describe what the change has done for you emotionally.

      I wish you all the best.

    • Lauri
      November 1, 2014 at 2:18 pm

      Your story is very inspirational. I admire you for what you’ve been through, and I envy that you’ve been able to have the reconstructive surgeries.

      I was able to lose ~100# on my own, but I’ve been struggling with my body image because of the stretch-marked, hanging skin. I’d like to lose more weight, but the idea of that only getting worse is upsetting and a major barrier. It’s like a catch-22.

      How were you able to afford your reconstructive surgeries, if I might ask?
      Thank you!


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  • Dr Richard Peck MD
    January 5, 2015 at 4:54 pm

    Congratulations on your success! I agree with #1 100 percent.

    • Tammy Farrell
      April 16, 2015 at 6:38 pm

      Thank you Dr Peck!

      I expect that medical professionals must get very frustrating when they’re not be able to assist patients that they’re specifically trained to help due to the cost/insurance constraints of the individuals. All the while knowing that they should indeed have access to the procedures that they need to get and remain healthy.


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