Skin excess after gastric bypass surgery: Is it preventable?

After a gastric bypass, such as gastric bypass, you may experience excess skin or excess skin – due to losing a lot of weight. You wonder if you can prevent this; if you can counteract it. And what are the options if you want to get rid of excess skin? Dr. Thomas Vermeer, gastrointestinal surgeon at WeightWorks, has now successfully performed more than hundreds of gastric reduction surgeries and gives educational meetings about gastric reduction. He regularly receives questions from patients about excess skin after gastric reduction surgery. “Skin excess can be uncomfortable and cause symptoms. The younger you are, the easier the skin shrinks with you after a stomach reduction.”
In this article, we discuss the most frequently asked questions about skin excess and some myths about what you could do to prevent skin excess. We also provide information on complaints associated with excess skin and what you can do to get rid of excess skin.

Skin excess after Stomach Reduction: what is the cause?

When you lose a lot of weight quickly after your gastric bypass, your skin often cannot shrink with you fast enough. This is because the skin loses its elasticity as you age or when it is stretched too quickly, as in obesity. As a result, you may develop excess skin in areas under which fat has decreased. Not everyone suffers from excess skin, but the risk is greater if you lose a lot of weight rapidly and if you are older. It is impossible to predict in advance who will suffer from excess skin and who will not. Younger people generally have better skin elasticity, which can make it easier for the skin to shrink after weight loss. You can have excess skin in different areas of your body, such as your abdomen, buttocks, arms, legs and chest. Women may experience that their breasts are less firm and droop more.

Preventing skin excess after gastric bypass surgery: is it possible?

When asked if you can prevent excess skin after gastric bypass surgery, the answer is: No.
Currently, there are no scientifically proven ways to prevent excess skin after gastric bypass surgery. The rate of weight loss cannot be influenced, nor can the weight at which a person eventually remains stable. Of course, there is much on the Internet about what you could do to reduce the likelihood of excess skin. Figure 1 shows four examples of fables about things you could do yourself to prevent excess skin. In other words, these statements are not true!

Figure 1 4 Myths about preventing excess skin after gastric bypass surgery

The myths in Table 1 originated from the idea that moisture and creams are generally good for the health of your skin. It is also believed that by exercising (cardio and abdominal exercises) you can get a flat stomach. Finally, there is the idea that by losing weight more slowly, the skin shrinks along more easily and there is less chance of excess skin. Despite the fact that the above actions cannot prevent excess skin, we do advise everyone to drink plenty of water, exercise and take vitamins. This is extremely important after a gastric bypass for the recovery of your body in the short and long term.

What symptoms can I experience from excess skin after gastric bypass surgery?

Not everyone with loose skin or excess skin after gastric bypass surgery suffers.
Still, there are several physical and psychological symptoms that can occur. For example, the skin folds can chafe and cause skin irritation (blemishes) or (fungal) infections. In hot weather, you will sweat faster between the skin folds. When you suffer from overhanging skin on your belly and legs, this can hinder you when moving. So you may suffer physically from the excess skin. It can also cause you to literally feel less comfortable in your own skin; to feel ashamed of your own body. Shame can lead to avoiding activities (e.g., wearing short sleeves, not wanting to be seen naked by another person, etc.).

Can excess skin go away by itself over time?

Excess skin does not naturally recede over time. Nor is this the case if you have changed your lifestyle, eat healthier and exercise more. More muscle mass, however, can make excess skin less visible.

Treating excess skin after gastric bypass surgery: what are the options?

If you want to be less bothered by excess skin after gastric bypass surgery, there are several options.

1. Wearing Corrective Clothing: Special corrective clothing can help you feel less bothered by hanging skin during movement.
   It can also help you feel more confident if you want to wear fitted clothing.
   While corrective clothing helps, it does not prevent or reduce excess skin.
2. Skin Removal Surgery: Want to get rid of your excess skin? Then surgery is the only way at this time. Skin removal surgery, such as a tummy tuck, is a serious procedure that removes excess skin and tightens the rest of the skin. Recovery usually takes several weeks to months, depending on how major the surgery is and how quickly you heal. Other surgeries to reduce excess skin include an arm elevator, thigh elevator and breast elevator.
   On the Internet, you can find options such as creams or laser treatments to reduce excess skin. Creams and lotions can improve the condition of your skin, but do not remove excess skin. Laser treatments can tighten your skin, but won’t help enough with a lot of excess skin after a stomach reduction.

Skin correction after gastric bypass surgery: when can it be done?

Doctors have established rules (Guidelines Contour Reconstructive Surgery) about when you can get a skin correction for excess skin after gastric bypass surgery.

5 Rules to qualify for skin correction after gastric bypass surgery:

1. Your BMI must be less than 35
2. Your BMI should not be less than 20
3. Your weight must be stable for at least one year
4. There should be no problems with the gastric bypass itself – requiring additional surgery
5. You must attend monitoring appointments at the gastric reduction clinic

Generally, people do not comply until around 18 months after surgery. If you go to a plastic surgeon for a skin correction, they may contact the clinic where you had the gastric bypass surgery. This is important to see if you are compliant and can safely get a skin correction. Perhaps it is frustrating that you have to wait for a correction. However, it makes no sense to do a skin correction when your body is still changing.

Abdominoplasty after gastric bypass surgery: will it be reimbursed?

You should generally assume that surgery will not be reimbursed. In fact, there are many rules you must comply with. The plastic surgeon will make an assessment and may make an application to the health insurance company. In some cases, the costs are reimbursed by the insurer. This usually happens only if there is a medical necessity. If you have no physical complaints and you do not like your excess skin, this is not a reason for the insurer to reimburse the surgery. If the excess skin leads to a lot of psychological complaints, you could talk to your insurer. Check with your insurer about reimbursement options and which clinic they recommend. Also ask for information about the surgery and aftercare you will receive.
The cost of abdominoplasties and other skin corrective surgeries can vary greatly. Prices depend on the type of surgery and the clinic where you have the surgery performed. Costs often range from €3,000 to €8,000 per procedure.

Does WeightWorks do tummy tucks?

No.
Only stomach reductions are performed at WeightWorks. However, you can be referred by the surgeon to a clinic that performs these skin corrections.

I now know more about excess skin after gastric bypass surgery.
What can I do if it bothers me?

As you can read, there is no way to predict who will experience excess skin and develop symptoms after gastric bypass surgery. At WeightWorks, we understand that you are wondering if you can prevent excess skin and what you can do if it bothers you. During follow-up checkups, you will have the opportunity to ask questions about this topic. If you are considering a skin correction, one of our surgeons can arrange a referral. However, it is a good idea to take a quick look at the rules (see text above) to see if you qualify for a correction.