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Will I need reconstructive plastic surgery after weight-loss?

By J. Timothy Katzen, MD, FACS

Fall 2008

With weight gain, the skin stretches to accommodate underlying excess muscle and fat. After weight-loss, skin tries to recoil or bounce back. The “amount” of skin bounce back essentially determines if you will “need” reconstructive plastic surgery. If there is great recoil ability in the skin, the skin bounces back and one probably will not “need” reconstructive plastic surgery. If however, the skin does not shrink back, then you will probably “need” reconstructive plastic surgery.

Understanding the Skin

The ability for skin to recoil at all is truly amazing. This incredible ability is due in part to the elastic fibers within skin. During childhood, this skin stretching ability allows us to grow without having to “shed” our outer skin. The contractile forces of skin also allow skin to bounce back after such natural things as childbirth.

Skin possesses naturally occurring elastic fibers which act similar to the elastic fibers in a rubber band. The effect of weight gain on skin is similar to the effect of pulling a rubber band. With enough constant stretch applied, the fibers in the rubber band become disrupted or break.

With weight gain, the skin is similarly stretched and the elastic fibers are disrupted. After weight-loss or after removing the load from the rubber band, the elastic fibers contract, but only so much. In either case, the result is a reflection of the ability of the elastic fibers to completely contract. The amount of skin recoil is multi-factorial. There are major and minor factors involved. The two major factors influencing skin recoil are the amount of skin stretch and skin’s age.

Determining if Your Skin Will Recoil

The main factor determining skin recoil is the amount of stretch. Even if skin recoil is excellent, the ability of the skin to recoil may be ruined by the amount of stretch. Typically, the more significant the stretch on the skin, the less likely the skin will shrink back completely. Thus, the more weight you lose, the more likely you will need plastic surgery. Everything else being equal, the skin of a person who loses 600 pounds is different from one that loses 100 pounds. The person who loses 600 pounds is much more likely to “need” reconstructive plastic surgery.

The second major factor determining skin recoil is your skin’s age. Younger skin has better elastic properties and thus, has more inherent abilities to spring back. Conversely, “older” skin is less likely to recoil. Expecting your skin to completely shrink back to the way your tummy looked when you were 20 years old after a 100 pound weight-loss is simply unrealistic.

The correct analysis of skin “age” is also complex. Skin age is determined by your physical age (how old you are) and factors which have accelerated the “age” of your skin. These accelerators of skin aging are the topic of much medical research. These are minor factors in comparison to amount of stretch and “age” of skin. However, these minor factors all contribute to the “need” for reconstructive plastic surgery.

Minor factors accelerating skin aging include:

  • Sun damage
  • Smoking
  • Malnutrition
  • Poor vitamin intake (especially vitamin C)
  • Your genetic skin type

Thus, avoidance of sun, smoking cessation, maintaining a healthy diet and exercising regularly all contribute to healthy skin with maximal contractile or recoil ability. These factors lead to skin contraction and recoil after weight-loss.

However, sometimes it is not even the sheer amount of excess skin that may lead one to seek reconstructive plastic surgery. Even minor amounts of excess skin can become moist and harbor bacteria. These bacteria can then lead to chronic skin infections that are impossible to eradicate without reconstructive plastic surgery. Thus, sometimes even “minor” excess skin may “require” reconstructive plastic surgery.

The Psychiatric Component

There is also sometimes a psychiatric component to the “need” for reconstructive plastic surgery after weight-loss. For some people it is not about the “amount” of excess skin. Some patients feel “fat” even after a 100 pound weight-loss and excellent skin recoil. For these patients, the “need” to have reconstructive plastic surgery is different. This “need” is an emotional one.

For these patients, reconstructive plastic surgery “needs” to be performed in order for the patient to feel “complete.” This type of reconstructive plastic surgery is independent of the physical amount of skin, but still needs to be performed. This type of plastic surgery is performed to make a patient feel whole and to help complete their weight-loss journey.

Reconstructive Plastic Surgery is a Personal Choice

Only you will know if you “need” reconstructive plastic surgery. No one else can tell you – not your family, nor your friends. You may not even know if you “need” reconstructive plastic surgery until your weight-loss is complete. Reconstructive plastic surgery after weight-loss is a personal choice. Always remember, the most important decision you have made has been to lose weight.

Almost always, weight-loss significantly and positively impacts your health. Weight-loss can lead to the elimination of some forms of diabetes and high blood pressure, in addition to reduction on the weight of your ankles, knees and hips. The “need” for reconstructive plastic surgery may be just the final step required for elimination of excess hanging skin and residual fat and the completion of your weight-loss journey.

About the Author:
J. Timothy Katzen, MD, FACS, is a plastic surgeon who practices in Beverly Hills, CA. Dr. Katzen specializes in reconstructive plastic surgery after weight-loss. He has performed thousands of procedures on weight-loss patients. To learn more about Dr. Katzen, please visit

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