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Skin Quality & Skin Elasticity for Plastic Surgery After WLS

March 9, 2020

Congratulations! You have lost 100+ pounds… now what? You feel more energetic. Your joints feel better. Your diabetes and hypertension are gone. Many of your co-morbid conditions have either resolved or improved since your weight loss surgery.

Unfortunately, the excess skin around your abdomen, breasts, neck, arms, and thighs is still there. This is a common problem after significant weight loss.

Abdominoplasty (tummy tuck), mastopexy (breast lift), brachioplasty (arm lift), thigh lift, and facelift are common plastic surgery procedures that address post-weight loss skin excess and have been discussed in other articles on ObesityHelp. However, less has been written about the impact of skin quality and skin elasticity on the results of these plastic procedures.

During the initial weight gain process, significant fatty tissue accumulates in the subcutaneous layer under the skin. The skin becomes stretched and thinned out.

Often significant stretch marks occur. If we look at the cross-section of the stretch marks, we see that the normal skin layers are much thinner. Essentially, the skin is torn. There is no way to repair this damage short of removing the skin containing the stretch marks.

Other changes in the skin are invisible. Compared to people without a history of significant weight changes, the patients of weight loss surgery (WLS) tend to have much more stretched out skin regardless of whether they have stretch marks or not. As a result, any procedure designed to tighten the skin envelope is more likely to have recurrent laxity.

Finally, the ligament system connecting the skin to the deeper layer of tissue is often elongated as a result of stretching from the previous fat deposition. This also has a profound effect on the results of many surgical procedures.

Effect of Skin Quality & Elasticity on Surgical Procedures

Facelift: We lift the skin of the face and neck and often the fat pads of the face and the muscle layer of the neck and anchor them to a more desired position. Over time, laxity will recur in every person. However, in the patient with significant weight loss, this process can occur much earlier. This is particularly noticeable in the neck.

Breast Lift: After massive weight loss, most people will have significant loss of breast volume while the laxity of skin worsens. Mastopexy, or breast lift, can tighten the skin and, if necessary, restore the volume with implants. Since the breast is primarily shaped by the tightened breast envelope, stretching of the skin can cause the breast to droop much earlier after surgery.

Abdominoplasty: After massive weight loss, most people are bothered by excess skin around their abdomen. This can be addressed by an abdominoplasty or tummy tuck. Not only can the excess skin be removed, but the laxity of muscles can be tightened, and the abdomen flattened. Skin laxity will also have an impact on the results of abdominoplasty, although this probably will be less than in the other operations.

Arm Lift and Thigh Lift: These are also common cosmetic procedures after WLS. They both involve the tightening of the skin and often removal of excess fat. Excessive stretching of the skin is detrimental to the results of both these procedures.

Improve Skin Quality & Maintain Your Plastic Surgery Results

Now that we know what changes in skin quality occur with weight gain and later WLS, what can we do to optimize the results and longevity of the results?

Maintain Stable Weight: Fluctuation of weight will continue to stretch out the skin more and exacerbate the pre-existing laxity.

No Smoking: Putting aside the cancer risks, smoking has a significant impact on skin quality and circulation. This is particularly evident in the aging of the face.

Take Care of Skin: Sunblocks and moisturizers will help reduce skin aging and preserve elasticity. A balanced diet, including adequate vitamins and antioxidants, are also essential to keep skin healthy.

Final Thoughts

As with all plastic surgery procedures, you need to be well informed and have realistic expectations. In particular, you must recognize the changes in skin elasticity after weight loss.

Despite the limitations, most people are very happy with the results after surgery. Procedures such as abdominoplasty, arm lift, thigh lift, breast lifts, and a facelift can vastly improve physical appearance as well as self-confidence.

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Neil Chen


Dr. Neil Chen is a Board Certified plastic surgeon and is the medical director of Plastic Surgery Institute of New Mexico for 23 years. He graduated from Harvard Medical School, trained in General Surgery and Plastic Surgery at Massachusetts General Hospital. This was followed by fellowship training in Hand and Microsurgery at UCLA Medical Center. Since 2010, Dr. Chen has been a cosmetic surgeon exclusively, focusing on the art and science of his passion. His emphasis on natural rejuvenation and cosmetic surgery has earned him praise as one of the most sought-after Albuquerque plastic surgeons.