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When Matthew Diaz came out of his first of two skin removal surgeries, he was 45 pounds lighter, literally and figuratively. The 24-year-old had been struggling with major excess skin after having weight loss surgery years earlier, but couldn’t afford to have it removed. “I’d lost about 250 pounds from my surgery, by eating better and exercising, and everyone kept telling me how proud they were and how good I looked, but I kept all the excess skin a secret,” Diaz says. “I didn’t want anyone to see it. I was ashamed of it, and I used to carefully layer my clothes so you couldn’t tell. I lived like that for two years.”
Then, after Diaz got a message on his blog, where he’d talked about his weight loss, and the follower asked whether he was dealing with excess skin from the surgery, he was inspired to share what his body really looked like underneath in a very public way. He wanted other people who were dealing with the issue to know that they weren’t alone, so he posted a video on his blog exposing his excess skin. The video went viral, and a GoFundMe page was started in his name to raise money for his skin removal surgery. Soon after, Diaz received $57,000 in donations. He was even able to give a lot of the money back to others who needed help with surgery.
Diaz first had a full abdomen body lift, meaning he had skin removed from all the way around his waist, as well as a reshaping of his chest and removal of excess skin on his arms and upper back. His surgeon created a belly button for him, and even removed and reattached his nipples throughout the process. Diaz went through months of extremely uncomfortable recovery, but, he said, “There’s never been a moment I thought ‘I wished I hadn’t done this,’” he says. “I’m comfortable in my skin now.”
Getting his excess skin removed was a positive decision for Diaz, and his viral video and the donations he received allowed him to do it. If you’re considering skin removal surgery after weight loss, here’s what you need to know about the process.
Excess skin can affect people who’ve lost large amounts of weight on their own or through bariatric weight loss surgery. It can often make people who’ve worked hard to lose a lot of weight feel like their bodies don’t reflect their lifestyle, says C. Andrew Salzberg, M.D., Chief of Plastic Surgery Division of Mount Sinai Health System, Mount Sinai, New York. It’s not only a cosmetic issue for many people who’ve lost weight, but a medical one too. “[Excess skin] can cause rashes, painful chafing, infections, and can impede movement or exercise,” says Dr. Salzberg. The skin won’t bounce back over time, and there’s no effective, non-invasive way to tighten up the skin, so surgery is usually the only option to remove it, says Christopher Daigle, M.D., bariatric surgeon at Akron General Bariatric Center, Akron, Ohio.
Having plastic surgery to get the loose skin removed is for anyone who is healthy enough to undergo major surgery, says Dr. Salzberg. Depending on how much skin is removed and how large the incisions must be, the risks of blood loss, recovery and scaring vary. If patients are seeking skin removal after weight loss surgery, Dr. Daigle advises they consult their bariatric surgeon first. “We’re very supportive of them getting the surgery, but it’s important that we look at their weight loss trajectory and make sure they’ve plateaued,” he says, which can take 12 to 18 months post-surgery. If not, the patient could have excess skin surgery before they’re finished losing weight, and then they’ll just have more excess skin and may need a second surgery to remove it.
There are a few different types of plastic surgery procedures that address excess skin after major weight loss. “Each is tailored to the patient and their individual needs,” says Dr. Salzberg. A tummy tuck is the most common, he says, and gets rid of hanging skin on the front of the abdomen. Surgeons make an incision along the bikini line and then another near or above the belly button. They remove this swath of loose skin, cutting around the belly button and leaving that down. They then pull the top incision down to meet the other and stitch up the skin, he says.
Another common procedure is called a body lift, and involves cutting away skin all the way around the abdomen. A brachioplasty takes loose skin off of the arms, while a thighplasty removes excess skin from the upper legs.
Unfortunately, most insurers view the procedure as simply cosmetic, though it’s often not, says Dr. Daigle. That’s why many people opt not to have their skin removed, because out-of-pocket costs range from about $5,000-$15,000 for a tummy tuck and $10,000-$20,000 for a full body lift, says Dr. Salzberg. You may be more likely to get insurance approval if you lost the weight due to bariatric surgery, says Dr. Salzberg, because if they approved that surgery, they may have to also cover any complications associated with it as well.
It also helps to document any physical aliments the skin is causing, so you can argue that it’s a medical issue. Still, it’s difficult to get coverage. Dr. Daigle believes surgeons like himself need to push for more coverage of this procedure. A study he worked on showed that bariatric patients who had excess skin removed actually fared better and were more successful with continued weight loss than their peers who did not have skin removed after bariatric surgery, likely because they had improved self-esteem, felt more comfortable working out and had improved mobility. There are also metabolic benefits, says Dr. Daigle. For example, tummy tucks have been shown to increase good cholesterol.
Recovery is very dependent on how invasive your surgery is, but can range anywhere from two weeks to two months. The pain can often be managed with medication, but discomfort is usually the main issue. There are often issues with fluid collection in the area, so drains have to be put in to help keep swelling down, says Dr. Salzberg. “Patients have to be careful about movement and may wear a compression garment to help,” he says. Once the draining process is done, patients can get back to regular movement and exercise, Dr. Salzberg says. Surgery can be outpatient or require a stay; it all depends how intense your operation will be.
For Diaz, it took between two and three months after each surgery to feel pretty much back to normal, but his surgeries were very invasive and removed large amounts of skin. He said the worst part for him was the discomfort (he thought he had a tight belt on when he first woke up, and it was difficult to even stand up straight for some time) as well as the dissonance he felt toward his completely new body. “It’s like waking up in a different house and being told I live there now,” Diaz says. But he’s starting to regain sensation in his entire body and feel more at home in his skin. He’s been stared at for his scars, but before that, he says, he was stared at for his excess skin. “The difference now is that I feel more comfortable.”
Despite the physical and emotional scars the surgery can leave behind, patients are usually very happy with their results. “After this surgery, they can move on to their new life—this is life-salvaging for a lot of people,” says Dr. Salzberg. “This can help them identify with their new body image.”
“There’s clearly a psychosocial aspect where people just feel better about themselves and their body image overall,” Dr. Daigle says.
“At the end of the day I feel so much stronger and just generally better because I don’t have the literal stuff hanging on me,” says Diaz. He’s back to doing some light cardio and plans to start lifting again when he can, and feels good. While he still has his insecure moments, overall, he’s very happy with the procedure, and he hopes others aren’t ashamed to have it done.
He recently got a sunflower tattoo in the middle of his chest to represent a new beginning. “I had had no feeling in the center of my midsection last year, and in this weird serendipitous moment, when I got hit with the tattoo needle it was like my nerves woke up and I could feel it,” says Diaz. “It made me feel grounded in my skin.”