Even AFTER Jacqueline Adan lost 350 pounds, she knew her journey wasn’t over.
The excess skin shed from her stomach, legs, arms and chest caused pain and made it difficult for her to see the results of her weight loss. He wondered how long he could live with the discomfort.
“I would get the loose skin over 500 pounds, but I wasn’t living my best life,” the 32-year-old from the San Francisco Bay Area told TODAY. “I went to my regular doctor complaining about the skin. It caused problems not only physically, but also mentally.”
While plastic surgeons offer various procedures that remove loose skin and lift sagging body parts after weight loss, insurance companies consider these procedures cosmetic and do not cover them. Adan knew she was alone.
“Nobody was helping me,” he said.
Adan, who shares her experiences on Jacqueline’s journey, she met Dr. Joel Beck, a plastic surgeon at Bay Area Aesthetic Surgery, who knew that various procedures could help her quality of life. Adan first had a lower body lift, which removed skin around the stomach and back and lifted her bottom and pubic area.
The difference was immediate.
“When I looked down and didn’t see any of that skin on my stomach or went to shower, I didn’t have to pick it up,” she said. “I started crying hysterically.”
The recovery was painful, but she knew it would benefit her health long-term.
“It was worth it,” he said.
What is skin removal surgery?
When people lose a lot of weight, their skin often hangs off their bodies, giving a bloated appearance. Heavy folds of excess skin can cause health problems such as frequent infections and pain.
“You’ll have laxity and excess skin folds, which leads to functional problems, such as the skin getting in the way during exercise and activities,” said Dr. John Fisher, assistant professor of surgery and director of the clinical research program at The System. of Health at the University of Pennsylvania, told TODAY. “It can lead to wound problems.”
While insurance doesn’t normally cover skin removal, it sometimes pays for a procedure called a panniculectomy, when doctors remove a fold of skin. Although this can correct some of the problems, patients often dislike its appearance because it does not include any contours. But Fischer and other plastic surgeons try to get documentation of patients’ problems to submit to insurance for partial coverage.
“Insurance companies have very specific criteria,” Fischer said. “We have to advocate very, very strongly for patients.”
Doctors want most patients to lose weight before having skin removal procedures.
“You always want to wait until they hit their lowest point,” Beck told TODAY. “Three to six months after they plateau and they’re not losing more weight, that’s when I would think about it.”
Patients with complications, such as uncontrolled diabetes or extremely high blood pressure, do not qualify for surgery, although patients who typically seek skin removal are healthy.
“Many of the patients who lose significant weight reverse many of their medical conditions and are in a healthy state,” Dr. Michele Shermak, a Baltimore-area plastic surgeon, told TODAY.
While patients who lose massive amounts of weight often need multiple surgeries all over the body, some patients only have extra skin around their waist and can have a tummy tuck or what is also known as a tummy tuck for tightening.
“Most people come to fix their stomachs. It’s often the first area they like to get into,” Shermak said.
The mental impact of skin removal.
Adan’s reaction to excess skin is not unusual.
“Patients will tell you they feel like they’re living in someone else’s body and haven’t completed their journey,” said Dr. Alan Matarasso, president of the American Society of Plastic Surgeons and clinical professor of surgery at Hofstra University, Northwell School of Medicine, told TODAY.
Lexi Reed, aka Fat girl who is bored on Instagram, she lost 312 pounds and also dealt with loose skin. The exercise was difficult, but she had no idea how much pain it was causing her until her husband, Danny, picked her up and she felt immediate relief.
“I would cry. I would be in so much pain that I thought something was happening to me or I was dying,” the 28-year-old from Indiana told TODAY.
Last Halloween had a 360 bottom lift. Her doctor removed seven pounds of skin from her stomach and back while lifting her butt and reshaping her abs. She had also raised the sides of her legs.
Recovery was challenging. The first time she sat down she started crying. She had drains and wore compression garments for weeks, all common during recovery from skin removal. But the pain was worth it.
“I felt all the emotions. For once in my life I could see my toes. For once in my life I could see my belly button. I didn’t even recognize myself in the mirror,” he said.
She is undergoing a 360 lift in September and admitted she is “nervous but excited”.
While Adan has had about seven operations, her last one on her legs came with a serious potential complication from the surgery — poor wound healing, or “flap necrosis,” where the skin dies. He needed a skin graft to heal properly. Wound healing and fluid accumulation are the two most common complications from such procedures.
“Sometimes fluid collects under the skin,” Mataraso explained.
Even with a second surgery and a longer recovery time, Adan is happy with her procedures. He worked with an attorney to help navigate insurance coverage and reached a resolution.
“I don’t regret any of the decisions I made with skin removal,” he said. “Six to eight weeks of my life to recover is worth the rest of my life to not be in pain.”
