published Sunday, March 3rd, 2013

Thinned & skinned: Losing a lot of weight is great, but then there's the excess skin

Fourteen pounds of excess skin is equal to 2.5 chihuahuas.
Fourteen pounds of excess skin is equal to 2.5 chihuahuas.

What is obesity?

For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the "body mass index." BMI is used because, for most people, it correlates with their amount of body fat.

An adult who has a BMI between 25 and 29.9 is considered overweight.

An adult who has a BMI of 30 or higher is considered obese.

An adult who has a BMI of 40 or higher is considered morbidly obese.

Source: Centers for Disease Control

Facial Flesh

After extensive weight loss, the skin of your face probably will sag on your jowls, neck and cheeks. Here are some tips to lessen the problem:

Exfoliate your face weekly to increase blood circulation and remove dead cells. It also helps to form the collagen fibers that give your skin its elasticity. After exfoliating, use a moisturizing or skin tightening cream. Gels and lotions with soy, aloe vera or yeast extracts also help.

Eating lean proteins -- chicken, fish -- will help build muscle in your face. Muscles need protein to keep its fibers healthy and increase muscle mass, leaving less room for fat and filling in saggy spots.

Daily facial exercises help tighten the skin. Exercises include puckering your lips and holding them for 5 seconds, or jutting your chin out while looking up for 10 repetitions.

Source: livestrong.com

Brenda does not want to die yet, so with her 60th birthday looming and a history of heart problems, she decided to lose some of the 340 pounds she was carrying.

But even after losing 110 pounds, she discovered she had a new problem.

"I had a lot of flab on my arms, legs and belly," says Brenda. "Several physicians told me if I could or did have that flab taken off, it would help with my diabetes, my heart and my back. Since I have heart trouble it scared me. I thought, 'Who can afford it?' But if it can help me live longer, I will."

Brenda -- who asked that her last name not be used because, well, we are talking about skin flab, after all -- is not alone in either her physical dilemma or her financial concerns.

According to the American Society for Metabolic & Bariatric Surgery, 72 million Americans are obese and about 18 million have morbid obesity, which the medical community defines as being more than twice your normal weight. About 200,000 adults in the United States have metabolic/bariatric surgery annually to deal with obesity, according to the society.

The same report says obesity or a body mass index of greater than 30 is linked to more than 40 diseases, including Type 2 diabetes, heart disease, stroke, osteoarthritis and cancer.

For people who lose 100 pounds or more, the good news is they can rid themselves of many of those illnesses, have more energy and feel better in general. But they'll still have to deal with excess skin.

According to Dr. Mark Brzezienski, assistant professor of plastic surgery at the Chattanooga unit of the University of Tennessee College of Medicine, when you lose an extensive amount of weight, excess skin won't just shrink back to normal. While most patients can expect some contraction of the skin, it will be more pronounced in younger, healthier people with lesser degrees of weight loss, he says.

"When you have 100-pound or 150-pound weight loss, the only way to lose it is through surgery," he says. "If you've been 400 pounds for 10 years, no matter the way you lose it, your skin has been stretched."

The surgery is expensive and almost never covered by insurance, according to Brzezienski. Costs can vary from doctor to doctor and procedure to procedure, but an estimate for an abdominoplasty -- removing an apron of skin hanging from the belly, aka a "tummy tuck" -- would be around $7,000.

To have excess skin removed from arms, thighs, face, breast and abdomen would be around $33,000, he says.

"Tummy tuck," however, is not a term Brzezienski likes "because it minimizes the magnitude of the surgical intervention."

Brenda could not afford to have all of her excess skin removed from her arms and legs, so she focused on the area that was giving her the most problems healthwise -- her belly. She had about 14 pounds of excess skin removed, she says. It was not only unsightly and hard to deal with when it came to buying clothes, it was causing her problems physically.

"I had tremendous belly flab," she says. "It hung down about 4 inches on top of my legs."

She had the surgery done less than four weeks ago and says that, after 18 days, she felt great.

"In fact, I'm out right now buying new pants," she says. "I used to wear 3X pants and they were snug. I'm now in a 1X and they are getting too loose. The pair I just bought are not the stretchy ones, either."

Brenda says 75 to 80 percent of the reason she decided to have the surgery was for health but, yes, the other 20 to 25 percent could be attributed to vanity.

"I could live with fat hanging down, but it was a hindrance, and I want to live longer. I do enjoy the way I look. It'd be a lie if I say I just did it for my health."

Brzezienski says not everyone who loses a great deal of weight is a candidate for surgery to remove the excess skin. Anyone who wants to undergo skin removal surgery should be evaluated by a board-certified plastic surgeon to determine whether the surgery is a good risk for them.

"As with any surgery, patients who are younger and healthier tend to do better," he says.

Even before thinking about surgery, the doctor needs to determine if the weight loss came through healthy means and not illness or some underlying problem, he says. Then the patient needs to have reached their desired level of weight loss and have maintained their current weight for a year.

It's important for the patient to understand all the risks involved to have a realistic expectation of the results, he says. Risks include bleeding, infection and blood clots, but these occur rarely, he says, There's also a possibility of irregularities in the body's contours after surgery, he adds.

More complications are seen in smokers, the elderly and patients with other chronic medical issues, Brzezienski says.

"You know there is no free lunch with these things and that is a point I try to bring to people with every consultation," he says.

For people who can't afford to have the surgery or who should not have it for medical reasons, there are several companies that make garments specifically for people with excess skin, including hi-end compression garments.

Staff writer Karen Nazor Hill contributed to this story.

about Barry Courter...

Barry Courter is staff reporter and columnist for the Times Free Press. He started his journalism career at the Chattanooga News-Free Press in 1987. He covers primarily entertainment and events for ChattanoogaNow, as well as feature stories for the Life section. Born in Lafayette, Ind., Barry has lived in Chattanooga since 1968. He graduated from Notre Dame High School and the University of Tennessee at Chattanooga with a degree in broadcast journalism. He previously was ...

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