Weight Loss and Maintenance - Lessons For Us All
weight loss is a huge decision, most of you reading have either gone
through a massive weight loss or are contemplating going through a massive
weight loss. One of the most common hesitations in losing weight is the
resulting loose skin that occurs once your body has gone through a significant
weight loss.It is common knowledge that losing weight = loose skin. Loose skin
not only occurs with a massive weight loss but also with natural body
occurrences such as pregnancy. This is because once your body stretches through
weight gain or through pregnancy; your skin loses its elasticity. First
patients come in to talk about weight-loss and bariatric surgery, how it works
and your results.
Many patients, however, decide they want to go the less expensive and
natural way by strict diet and exercise but are concerned about the loose skin.
Our doctors always tell patients to be realistic, being healthy is far more
important than having loose skin. Even when you have loose skin after weight
loss there are ways to remove it such as post-bariatric surgery which includes
tummy tucks, breast augmentations, and thigh lifts. The loose skin, although it
may not seem like it, is a proud reminder of how far you've come and if you
take that extra step to remove the loose skin, your body will be an entire
trophy dedicated to yourself. In this post, we will see why and where that
extra skin came from and how to reduce or remove it.
As we all know, matter cannot be created nor destroyed, so when you
exercise and diet fat is not simply "disappearing" off your body.
What occurs is a form change, just like water and steam. The glucose and sugar
that is harnessed from carbohydrates are the first fuel sources. Once the
glucose runs out, fat takes over.
Your body is a constant interconnected conveyor belt that removes essential
nutrients from the fat and delivers them to specific body parts. Hormones that
regulate our blood sugar levels activate an enzyme in fat tissue called lipase.
Lipase ignites fat cells to release triglycerides, which is what makes fat
cells fat. When they receive a signal from lipase to exit the fat cells, the
triglycerides break-up into glycerol and fatty acids and then enter the
bloodstream for use in your body. The process of breaking down triglycerides
into reusable energy is called lipolysis which is shuffled and reshuffled to
produce heat, water, carbon dioxide, and ATP. Since the fat tissue has lost
some of its components, the cells shrink.
When fat tissue is worked and the cells shrink, wouldn't it make sense that
your skin would shrink as well? Yes and no. In the cases of moderate weight
loss, skin can certainly shrink back to fit the body's new size because of its
elasticity due to collagen in the skin. However, collagen does have its limits.
Collagen fibers weaken with age and results in wrinkles. Rapid growth or weight
gain also outpaces collagen production in the skin causing areas to
over-stretch, leading to stretch marks commonly seen in pregnancy and
adolescents going through puberty.
The most important determinant of how much loose skin an individual will
have following weight loss is their age. Younger patients tend to have less
loose skin than those who are older because of the strength of collagen in your
skin. The next most important factor is the amount of weight loss. An
individual who loses 200 lbs. is more likely to have excess skin than someone
who has lost 80 lbs. There are other factors of who is more likely to have
loose skin such as smoking, sun damage and skin color.
Abdomen, Thighs and Buttocks The abdomen is usually one of
the greatest concerns for individuals following massive weight loss. In both
men and women, excess fat is stored both in the abdomen and beneath the skin of
the abdominal wall. Consequently following weight loss in those areas, extra
skin appears.
Large amounts of hanging skin can lead to the collection of moisture
between the skin folds resulting in a condition called intertriginous
dermatitis, which leads to irritation, redness and pain. Occasionally, the skin
may even breakdown, bleed and become infected. With proper documentation, many
insurance companies recognize this problem and provide full coverage from
surgical removal through a tummy tuck or abdominoplasty.
The abdominoplasty will solely remove the excess skin from your stomach
which is ideal for women following pregnancy. However, for those who have
undergone weight loss surgery or a massive weight loss, excess skin is not
limited to the stomach but also results in the buttocks and thighs. Because of
this, surgeons will perform a procedure specifically for weight-loss patients
called a body lift. This involves an abdominoplasty, thigh and buttock lift all
at one time. This addresses and removes loose skin and cellulite along the
thighs and buttocks as well as the abdomen. Although the resulting scar is
lengthy, it is confined to the waistline and is hidden by underwear, panties,
or a bikini.
The original glandular tissue is significantly more firm than fat and
consequently the skin becomes unable to retract completely and produces
severely ptotic or sagging breasts. This is called breast involution. There are
many treatment options for women following weight loss. If a woman desires less
sagging and wants to be larger, a breast lift or mastopexy is needed. Again,
surgeons will tell you your options and also remind you to be realistic with or
breast augmentation may be satisfactory.
The problems in men are similar however treatment is slightly different.
Men tend to have larger breasts when over weight. Depending on a man's age,
degree of weight loss, and a few other factors he may result in large breasts,
large and/or sagging breasts, or satisfactory breasts following weight loss.
Large and/or sagging breasts in men is called gynecomastia. Here liposuction
alone may be satisfactory, however this is not typical. Most men with both
sagging and large breasts go through a two-staged procedure. The first stage is
liposuction and is performed to remove excess fat and some glandular tissue.
Over the next few months, the breast skin will retract slightly. Three to six
months later, the patient will return to evaluate the situation and determine
if the outcome is satisfactory. Delaying the second stage allows for
significant skin retraction and if a skin tightening procedure is desired it is
likely to require smaller incisions.
Being healthy has far greater importance than excess skin. Although, having
excess skin can lead to some serious issues there are non-surgical ways of
preventing infections such as keeping your excess skin dry.
For those who are able and want to
remove the excess skin, post-bariatric surgery is for you. It is important to
remember that these procedures should only be considered after ones weight has
stabilized; especially after weight loss surgery. This can range from 7-18
months after weight loss.
The most important factor in finding a plastic surgeon who can perform
these procedures is that they must be board certified. If your plastic
surgeon's website or office does not advertise that they are board certified
you must RUN! For everyone who has heard horror plastic surgery stories, this
is probably where it started, having a surgical procedure done without a board
certified surgeon. Use ASPS (The American Society of Plastic Surgery) to find a
board certified surgeon near you.
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