Anyone who has lost 40, 60 or more kilograms – for example after gastric bypass or sleeve gastrectomy – has gained a great deal in terms of health. Often, however, one problem remains: the skin has lost its elasticity and forms loose folds. Post-bariatric surgery comprises the plastic surgical procedures used to remove this excess skin and restore the body’s contour.
More than an aesthetic problem
For many people affected, excess skin folds are not just a cosmetic issue. Common complaints include:
- sore, inflamed skin in the folds (intertrigo), often with fungal or bacterial infections,
- chafing and pain when walking, for example on the inner thighs,
- limitations in sport, hygiene and clothing,
- psychological distress because body image does not reflect the success despite the weight loss.
The main procedures
- Abdominoplasty (tummy tuck, panniculectomy): removal of excess skin and fat on the lower abdomen, often with tightening of the abdominal muscles. In pronounced cases, a circumferential lift (body lift) that also includes the flanks and buttocks may be advisable.
- Upper arm lift (brachioplasty): removal of excess skin on the inner side of the upper arms. The scar usually runs along the inner side and is not very visible in everyday life.
- Thigh lift: tightening of the inner thighs, with an incision in the groin or along the inner side depending on the findings.
- Breast lift or breast reshaping: in women, the sagging breast is lifted and reshaped; in men, excess breast tissue is removed.
- Face and neck lift: in selected cases, if significant excess skin has developed here too.
The procedures are usually planned in several stages a few months apart in order to limit the surgical risk.
The right time
A prerequisite is a stable weight for at least six to twelve months. After bariatric surgery, it is generally recommended to wait about 12 to 18 months after the procedure. Also important are an adequate supply of protein, iron and vitamins, not smoking and well-controlled concomitant diseases – because deficiencies and nicotine significantly increase the risk of wound healing problems.
Risks
These are major operations with long scars. Possible complications include wound healing problems, seromas (fluid collections), infections, haematomas, thromboses and conspicuous or widened scars. Careful planning, thrombosis prophylaxis and consistent aftercare with compression garments reduce the risk.
Insurance coverage
In Germany, statutory health insurance funds only cover the costs if there is a medical necessity – for example in the case of recurrent, medically documented skin inflammation in the folds that cannot be controlled conservatively. Purely aesthetic corrections are self-pay services. An application should be submitted before the operation with photos and medical reports.
Note: This article is for general information only and does not replace medical advice. Seek advice from a specialist in plastic and aesthetic surgery.
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