Rapid weight loss may sound like a dream come true to people who have been trying and failing to lose weight. But wonderful as it may sound, rapid weight loss comes with risks and complications that could prevent you from enjoying your new figure. What happens to the excess skin and fat left behind after rapid weight loss? Cosmetic surgery offers the most viable option to really get back in shape

If you are overweight, dropping kilos is a healthy and positive thing. Even a modest weight loss, between five to ten percent of total body weight, is likely to produce such health benefits such as improved blood pressure, blood cholesterol, and blood sugars. Keeping those kilos off can lead to improvements in energy levels, physical mobility, self-confidence and general mood.

However desirable it may be to achieve an ideal weight, losing weight rapidly can carry its own risks and complications. What counts as rapid weight loss? It is considered healthy to lose between half and one kilogram per week, which roughly works out to losing one to two pounds. Anything more than that pushes you in the direction of rapid weight loss.

Bariatric and other weight loss surgery, strenuous workouts, fad diets or some combination of the three are the common ways to attain rapid and massive weight loss. Weight loss surgery and diet pills, as well as many fad diets, can have their own negative health effects, but we are not writing about those here. What we are discussing is one of the most common consequences of significant or dramatic weight loss, regardless of the method used to achieve it: the excess skin and fat it can leave behind.

Weight loss leaves a lot of excess skin and fat

Redundant skin and fat is the most common problem encountered by those who lose a lot of weight quickly.

Before they can celebrate their achievements, some ‘big losers’ discover that they have also lost their shapes, in the body and even the face. The skin that stretched to accommodate that excess body weight does not necessarily shrink back when the body does. Excess skin and the fat layers underneath can literally form an apron in front of the body, sometimes covering the thighs and the pelvic area, and in some cases, reaching as far as the knees. Although all we can see are the excess skin folds, there will also be sagging and laxity in muscles that have lost their tone after weight loss.

This skin and fat apron sometimes forms a continuous fold around the body’s trunk. Excess skin folds can also form in the chest and back. When weight is lost from the arms and legs, the limbs will have loose layers of skin, especially in the upper arms and the thighs. Significant weight loss can also cause the breasts to flatten and hang, with nipples pointing downwards. The face may also look drawn, making a person look ill and unhealthy.

Even if there are no other complications associated with your rapid weight loss, the hanging skin and fat can be a literal wet blanket on your good spirits.

It’s not just about looking good

Excess skin and fat left behind by rapid weight loss is not merely an aesthetic issue. It can have serious health repercussions.

  • The skin folds can and will chafe with every movement. Constant chafing can lead to rashes, abscesses and ulcers in the areas affected. Skin breakdown and damage can occur, along with various skin infections.
  • Carrying around the excess skin and fat can cause backache and posture problems.
  • Walking, sitting and standing—just getting around—can become a challenge.
  • Sagging skin folds can also interfere with maintaining personal hygiene and may create problems during sexual intercourse.
  • More than anything, the constant struggle to live in a body enveloped by a skin too large for its size can be demoralising, having a negative impact on mental and emotional health.

Even though you’ve lost a lot of weight, some people may not notice. And if they do, their comments could be in the tune of,  ‘you look awful! Have you been ill?’ because they cannot see the new you under the excess fat and skin you carry around.

Post-weight loss body contouring surgeries

The best way to deal with the excess fat and skin left behind after rapid weight loss is surgical removal. Usually people who have lost significant weight are asked to wait for at least a year for their weight to stabilise before undergoing body-contouring procedures. If you continue to lose weight following body contouring, you could develop new sagging skin pockets, making the contouring obsolete. And if you rapidly gain weight after contouring, the already weakened and thinned skin can be traumatically stretched. This can cause additional stress, leading to wide scars, visible stretch marks and, in extreme cases, tearing of the skin.

Your weight loss surgeon should be willing to work with your cosmetic surgeon, determining together the right time for you to undergo body-contouring surgery. It is a good idea to check on this before choosing a surgeon for weight loss procedures.

The goal of all body contouring after major weight loss is to improve the shape and tone of underlying tissue, as well as remove obsolete fat and skin.

A number of surgical techniques help contour the different parts of the body following rapid or significant weight loss:

  • Panniculectomy is a surgical procedure that removes hanging skin and fat from the front of the body, focusing on the abdominal area. When the hanging skin has caused physical impairment (making it difficult to walk, for example) panniculectomy is classified as reconstructive surgery. It is performed on both men and women.

You can read more about panniculectomy, its risks, complications and benefits in the procedures section of this website.

  • Corset trunkplasty or a corset lift removes excess skin from the upper and lower parts of the abdomen. The corset lift is comprised of three incisions, all in the front of the body. In most people, the prominent vertical scar fades away significantly over time. The procedure takes about five hours to complete.

Recovery from the corset lift is much less complicated than recovery from a lower body lift. It takes about the same time as tummy tuck surgery (abdominoplasty). You may need to wear a compression garment for a few weeks, and you will certainly have to rest and take things slowly for about six weeks.

  • Lower body lift is a single procedure that combines multiple surgeries to remove or correct the sagging skin on the abdomen, outer thighs, buttocks, hips, and waist. The surgical incisions run around the body and remove excess skin and fat as one single strip or ‘belt’. This is what gives the lower body lift its other name, belt lipectomy.

A lower body lift eliminates the hanging apron of skin and fat from the front, flattens the belly and pulls up the droopy pubic area. It lifts up the thighs and, in the back, lifts and helps define the buttocks, creating a better-defined waistline. The obvious disadvantage is the scar extending around the body.

Although this lift is most often performed on men and women after massive weight loss, other groups can also benefit from it. It is an option for women who were never obese, but carry around 14 to 18 kilos of excess weight they cannot seem to lose. People who have undergone liposuction and have excess skin in the lower trunk and thighs are also candidates.

It takes 6 weeks to recover from a belt lipectomy, and you may have to wear compression garments for some of the recovery period. Complete healing can take as much as a year. Until the swelling subsides and recovery is complete, you may not be able to see the outcome of your surgery.

  • Bra-line back lift – Ideal candidates for the bra-line back lift are women with fat rolls above and below the bra line in the back. Although some men could benefit from this procedure, most do not develop rolls of back fat from weight loss or ageing. And of course, the fact that the scar is going to be hidden under a bra or a bathing suit—a major selling point of this procedure among women—does not apply to men. For them, the best way to remove back fat is still liposuction.
  • Breast contouring and breast augmentation – Breast contouring is a surgical procedure that improves the shape and tone of breasts and removes excess fat and skin following massive weight loss. If a lot of volume has been lost, breast contouring can be combined with breast augmentation.
  • Arm lift or brachioplasty is a surgical procedure that corrects sagging of the upper arms. Following significant weight loss, the upper arms typically sag and look loose. In severe cases, this is referred to as bat-wing deformity. An arm lift can make the upper arms more toned and firm. You can read more about the arm lift in the procedures section of this website.
  • Buttock lift is a surgical procedure that corrects sagging in the buttocks, improving contour by removing excess skin and fat and making them more firm.
  • Thigh lift – The medial thigh lift is a surgical procedure to correct sagging of the inner thighs. An outer thigh lift corrects sagging of the outer and mid-thigh areas. You can read more about the thigh lift in the procedures section of this website. Thigh lifts are often combined with other procedures such as a tummy tuck and buttock lift, in a procedure called a lower body lift.
  • Facial surgeries – The excess skin, fat tissue and sagging muscle tissue in the face can be repaired with surgery of the face and neck. You can read more about these procedures in the procedures section of this website.

Liposuction may also play a role

In an article titled Plastic Surgery After Rapid Weight Loss, J Brian Boyd, Chief of Plastic Surgery at the Harbor-UCLA Medical Center in Los Angeles, says that people can end up with one of two scenarios following rapid weight loss. One group ends up with lots of redundant skin but not too much subcutaneous fat, giving them the appearance of a Shar-Pei dog. Others, although they too lose significant weight, retain a lot of subcutaneous fat. This leaves them with a persisting soft bulkiness with the consistency of marshmallow beneath their skin.

According to Professor Boyd, better results are generally achieved in body-contouring dermolipectomies—surgical procedures that correct skin and fat excess in any body part—when skin redundancy is not accompanied by bulky subcutaneous fat. Preliminary liposuction can convert bulky marshmallow to the Shar-Pei dog. He also states that excessive subcutaneous fat severely limits the amount of tightening possible by conventional nip-tuck procedures.

Not everyone needs all of these procedures. Exactly what you need after massive weight loss will only come clear after you have lost the weight.

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