When Diet and Exercise Aren’t Enough: Plastic Surgery

My Bariatric Life Health Guide
  • my bariatric life dr. joseph f. capella 

    These photos show my transformation from plastic surgery 10-years after gastric bypass weight loss surgery. The photo on the left was taken just before my tummy tuck. The center photo was taken roughly 3-months after my tummy tuck. The photo on the right was taken 1-month after my total body lift and 7-months after my tummy tuck.


    Weight loss that occurs from bariatric surgery or as a result of dietary and lifestyle changes leads to significant changes in your physical appearance. Beating the battle of the bulge will no doubt satisfy you. But with few exceptions, people whom achieve significant weight loss develop generalized areas of excess skin and fat. 

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    According to Dr. Joseph Capella, a plastic surgeon who specializes in body contouring after massive weight loss, the primary cause of excess skin following weight loss is relatively simple. Similar to pregnancy where the muscles, skin and other tissues of the abdominal wall expand to accommodate the fetus, a similar process occurs with the accumulation of fat in the body. There are important differences however. The process of fat accumulation in morbidly obese individuals often begins during childhood or adolescence, prolonging the period of tension on the skin. In addition, the area of tissue expansion in obesity is generalized rather than limited for the most part to the abdomen. 

    With weight loss following the delivery of a baby, the affected tissues tend to retract. When the tissues do not return to their previous state it is because they have been permanently damaged. Such is the case with massive weight loss after a lifetime of obesity. In the case of skin, the elastic fibers have been broken. This can give the appearance of striae, commonly known as stretch marks, a condition often seen on the breasts and abdomen following pregnancy. In addition, fat collects in the tissues below the skin and the abdominal wall muscles become relaxed, both conditions cause the lower abdomen to become more prominent. How closely the skin and other tissues of the body resemble their appearance prior to pregnancy or obesity depends on similar factors.

    There are a number of criteria that effect how much loose skin a person will have following weight loss:

    • According to Dr. Capella, probably the most important determinant is age. Younger patients tend to have less loose skin.
    • The next most important factor is the amount of weight lost. An individual who lost 250 lbs. will be more likely to have more excess skin than someone who lost 80 lbs.
    • Other less significant variables include complexion, amount of sun exposure received over a lifetime, heredity and whether or not the person is a smoker.
    • Fair skinned people in general tend to develop more loose skin than darker individuals.
    • Sun worshippers tend to sustain more tissue damage over the years and consequently more loose skin following weight loss.
    • Some people tend to have "better" skin than others of similar complexion and lifestyle. This may be the result of hereditary factors that are not readily apparent.
    • Finally, smoking breaks down collagen, a major component of skin and other structural components of the body. Smokers develop more loose skin than their non-smoking counterparts. 

    The combination of loose skin, excessive fat and relaxed muscles usually does not respond to dieting and exercise. An abdominoplasty, or tummy tuck, will correct these problems.


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    I underwent a tummy tuck in April 2013. You may read my detailed, blow by blow account of my (shocking) experience in my sharepost series, “My Bariatric Life Tells All about Her Tummy Tuck.” 


    Then in October 2013 I underwent a second round of body contouring plastic surgery. You may read all about it in my sharepost series, "My Bariatric Life's Total Body Lift."


    You also may be interested to read my interview with Dr. Joseph F. Capella on Plastic Surgery After Weight Loss.


    Living life well-fed,

    My Bariatric Life


    More shareposts from MyBariatricLife on HealthCentral





Published On: May 10, 2013