The Final Step

Shedding Excess Skin After Weight Loss

"I look like a Sharpei. What can you do about all this skin?" exclaimed a typical post-bariatric surgery patient to Dr. Brian Reagan, plastic and reconstructive surgeon. An estimated sixty million American adults are obese, with six million being morbidly obese. For those patients, bariatric surgery has proved successful in reducing weight and saving lives. But these patients don't rejoice in their transformation until the resulting redundant skin is gone, and this is when Dr. Reagan gets involved. "The first thing I do is congratulate these patients for their life-saving weight loss. From the smile on their faces, I can tell that they aren't used to a lot of compliments," says Dr. Reagan.

Dr. Reagan notes the unique challenges of post-massive weight loss with plastic surgery. "Resection of skin often needs to be more aggressive placing with the scars as symmetric and hidden as possible. Under-resection leads to unsatisfactory results, but over-resection can lead to serious complications. The demand for sound intra-operative surgical judgment is high." Given the relative newness of this sub-specialty, Dr. Reagan routinely attends medical symposiums to remain the forefront of the latest approaches.

In 2005, almost 70,000 body contour procedures were performed after massive weight loss; a twenty percent increase from 2004. Patients should wait about a year after their bariatric surgery, to allow weight stabilization, before undergoing further surgery. Before proceeding with body contouring, a thorough medical history and physical examination is warranted, as nutritional deficiencies, anemia, and hernias are not uncommon among these patients. "Thorough patient education and sound surgical planning are critical to achieving success," states Dr. Reagan. He prefers to stage the contouring transformation in three surgeries. He begins with a truncal body lift/Abdominoplasty and Brachioplasty (arm lift), followed by an inner thigh lift and breast augmentation/lift, and concludes with a face lift and any necessary revisions. Each surgery is followed by a recovery period of approximately tree months. "I tell my patients it will be about a year before we are completely done, so we're going to get to know each other pretty well."

"…I actually feel as though my life started

over after I had the surgery."

Sharon Harrod, fifty-one, had two surgical procedures performed by Dr. Reagan. "When I made the decision in 2003 to have gastric bypass, I decided that I wasn't going to have that surgery without following through with body contouring. I had gone to support groups, and knew people who had the bypass and weren't able to afford the plastic surgery to remove the excess skin. Mentally and emotionally, they still didn't feel like they had accomplished what they wanted. My bypass surgery was very difficult, and a very emotional, hard thing to do. Even though I had made the decision before I had the bypass surgery to have the plastic surgery, I doubted whether I wanted to go through with more surgery and more pain," recalls the 5-foot5 Harrod, who weighed 306 pounds, and lost 140 pounds after her gastric bypass. "Dr. Reagan convinced me that I would be able to have the results that I wanted, and once I met him, I just knew that I had to continue."

Ms. Harrod is glad she did. "Emotionally, I'm not a totally different person. It's been a huge journey. I've changed very much from what I used to be. I actually feel as though my life started over after I had the surgery."

"Twenty year-old" Anna Aquilina also reports a transformative outcome. At 5-foot6, and weighing 275 pounds, Aquilina had her gastric bypass procedure two years ago. After losing 130 pounds, she went to Dr. Reagan for a "tummy tuck, arm lift, and breast augmentation. I fell great. It's really changed my life. It's brought me confidence, and I'm able to buy clothes that actually fit my body. I feel more confident and ready to start my life over again."

Plastic surgery is all about transformations and Dr. Reagan revels in helping his patients achieve their goals. "I really enjoy working with these patients. Their expectations tend to be very reasonable; they just want to be like everyone else. With each step, I can see their confidence grow. It's a pleasure to share in their transformation."