Houston Chronicle
Thu 01/04/2007
Sherri Blatt decided to have gastric bypass surgery in April 2005, five years after she gave up drinking. She had replaced alcohol with food, and her weight climbed to 240 pounds.
In the months after surgery, she learned to scrutinize food labels. She took up running. In short order, she went from a size 22 to a size 4. But one aspect of Blatt's new body resisted all self-improvement efforts: pounds of excess skin.
"I told my husband, `I worked so hard to get here ... and then I look in the mirror,' " said Blatt, 40. "My body image was not where I wanted it to be."
Weight-loss surgery works miracles for many and can solve life-threatening health issues such as diabetes and sleep apnea. But a nagging side effect of the procedure keeps some from leading normal lives.
Stretched-out skin doesn't always spring back, forcing bariatric patients to undergo multiple plastic-surgery procedures - face-lifts, thigh-lifts, tummy tucks and full-body lifts - to tailor baggy skin to fit newly trim frames.
"I have some patients who have pain because they have so much extra skin. It folds over on itself and pinches all the time," said Dr. David Wainwright, associate professor in the Division of Plastic Surgery at the University of Texas Medical School at Houston. "They've lost all this weight, but they can't enjoy it because they have this other problem - either rashes or all this skin moving with a mind of its own. Exercise is difficult for both of those reasons. It's not where they were hoping to be."
With nearly one-third of U.S. adults obese, demand for weight-reduction surgery is soaring. Bariatric procedures grew from 6,800 in 1996 to about 102,700 in 2003, according to the Journal of the American Medical Association. For many who achieve dramatic weight loss, more surgeries to trim excess skin will follow.
Many don't realize that as they get older, their skin loses its elasticity - "so that's a shock," said Dr. Vadim Sherman, a Baylor College of Medicine surgeon. Patients typically reach their weight-loss goals two years after the surgery. That's about the time they start looking at "skin reduction."
Houston plastic surgeon Russell Kridel had one patient whose 110-pound loss - achieved through healthful eating and exercise - made his face look old and tired. Kridel gave the man a face-lift and a chin implant. Sometimes Kridel adds little pads to the cheekbones.
"When people lose a lot of weight in the face, you need to fill that out," Kridel said.
Operations range from about $3,000 to trim skin from the upper arms to $8,000 for a body-lift, according to the American Society for Aesthetic Plastic Surgery. The body-lift, or a circumferential panniculectomy, involves an incision that encircles the trunk and takes about six hours. By contrast, gastric bypass can be done in two hours.
Insurance sometimes pays for post-bariatric plastic surgery if skin is causing rashes or other medical problems.
That was the case for Blatt, a nurse at Memorial Hermann Hospital, who had to truss up her extra skin in tight exercise clothes just to go for a run. She saw body-contouring surgery as the only thing between her many successes and becoming the person she wanted to be.
She was in recovery from alcohol addiction; her once-troubled marriage was repaired; and she was close to attaining physical health: "My life was finally turning around. Everything started clicking together."
So she went to Wainwright in 2006 for a tummy tuck, a little liposuction on her hips and a breast-lift. When her husband saw the results, he said, "Oh my god - that man is an artist!" |
