Dramatic Skin Removal Surgery Donation

May 20, 2015

 3 Surgeons Donate Dramatic Skin Removal Surgery for Patient's WLS Loss of 650lbs

At 980 pounds, Paul Mason was once one of the world’s fattest men. Bariatric surgery helped him shed 650 pounds, but he was left with 100 pounds of excess skin. This skin was not only debilitating, often confining him to a wheelchair, but it was a health risk as well, causing multiple infections that landed him in the hospital.  Mr. Mason underwent gastric bypass surgery in England, where he lived until recently, but the state health system there would not pay for the follow-up skin contouring operation he needed.

The story of his weight loss was initially chronicled in the New York Times in 2012. Two years after his bariatric surgery, a follow-up story in New York Times described Mr. Mason’s new issues with excess skin. This story caught the attention my colleague and friend, Dr. Jennifer Capla, from Lenox Hill Hospital in New York. Like me, she specializes in surgeries for patients who have lost large amounts of weight and was moved by Mason’s story, saying, “It was so sad that he had gone through this whole journey and come full circle, and he couldn’t even do basic things and no one would help him.” So, she offered to waive her fees to perform surgery to remove Mason’s excess skin, if he could make the trip to the United States. By this time, Mason’s story was drawing worldwide attention, so the talk show, “The View,” brought him across the pond and plans were made to have his surgery in New York City.

“While this patient represents an extreme case due to the amount of weight, his story represents the struggles that many weight loss patients suffer with and demonstrates how body contouring procedures can be life-changing for these patients. These procedures help patients come full-circle and help them complete their weight loss goals.”   ~Joseph Michaels, MD

Given the degree of skin excess, the length of surgery, and his underlying medical conditions, the complicated skin removal procedure would require a team of surgeons with expertise in treating after weight loss patients, so Dr. Capla reached out to Pittsburgh-based plastic surgeon Dr. J. Peter Rubin, and myself. (We also waived our fees, as did Lenox Hill Hospital.)

Mr. Mason had the single largest weight loss of any patient that any of us had previously treated. The surgery took more than nine hours to complete, and 48 pounds of skin were removed from Mr. Mason’s legs and stomach. Working around the blood vessels was a major challenge, because the vessels had grown over time to support a 980-pound body. Therefore, it was important to be meticulous in caring for these blood vessels to avoid excessive blood loss while removing his redundant skin. The whole process involved cutting through excess skin, suturing blood vessels and stitching together incisions.

Mason will most likely have further surgery at a later date to remove hanging skin from his arms and buttocks. Food is no longer an escape for him, as it was during the emotionally troubled years when he put on hundreds of pounds.

You dig yourself out of that escapism that surrounds you — I don’t know what word I would use, but it was like crack, really — and then you grasp at life,” Mr. Mason said of his new outlook.

Post-Op Weight Loss Surgery Body Contouring

While Mason’s case may be an extreme one, post-weight loss body contouring is not uncommon. In fact, it is the fastest growing trend in plastic surgery due to an increase in bariatric surgery. Although nearly 200,000 bariatric operations are performed each year, and approximately 80% of bariatric surgery patients desire body contouring, less than one-third of those patients actually go through with it.

These procedures can be a financial burden for some, since insurance companies typically only cover part of the costs when the skin removal is proven to be medically necessary. Some insurance plans also have carve-outs that exclude skin removal procedures following weight loss. Access to qualified physicians can also cause problems, because these body contouring procedures should be performed by plastic surgeons that specialize in these procedures.

Physical and Mental Benefits of Body Contouring Surgery

There are many physical and mental benefits of body contouring surgery. A recent study shows that patients who have body contouring after their weight loss are better able to maintain that weight loss over the long term. Another similar study found that patients who undergo body contouring surgery report less anxiety and depression as compared to patients who have not had body contouring.

Patients considering weight loss surgery need to be fully aware of the complications related to their excess skin after their bariatric procedure. It can be helpful for patients to discuss this with their bariatric surgeon or to consult with a body contouring specialist before the weight loss surgery to be better prepared for the outcome and to potentially prepare and save for these procedures at an earlier time point.

Skin contouring is a lesser-known, but incredibly important part of weight loss surgery, and it is important that patients undergoing a bariatric procedure familiarize themselves with the entire process. These procedures are not for vanity and they can be a useful component to a patient’s comprehensive weight loss plan, as evidenced by our experience with Mr. Mason.

Photo credit: Dr. Joseph Michaels



Dr. Joseph Michaels is a board certified plastic surgeon specializing in after weight loss body contouring in the Washington, DC area. He is in private practice and he is also an Assistant Professor in the Department of Plastic Surgery at Johns Hopkins Medicine. He received his B.A from the University of Pennsylvania and his M.D. from The Mount Sinai School of Medicine, where he graduated with honors. Dr. Michaels currently practices at Michaels Aesthetic and Reconstructive Plastic Surgery.