Reviewed by:Shahin Javaheri, MD
The changes to your body after weight loss surgery can be extreme. Some of those extreme changes can even cause emotional and/or health issues (example: sagging, loose skin).
Plastic surgery is one way to overcome some of the issues, but it should only be done in specific situations (listed below).
As you read below, remember that any additional surgery will likely be expensive, require a hospital stay, and result in additional scars.
TABLE OF CONTENTS
Click on any of the topics below to jump directly to that section
Read the sections below for everything you need to know about cosmetic surgery after weight loss.
- Are you at your low weight?
- What is the state of your current physical & mental health?
- Are you doing it for physical health, mental health, or both?
- Do the rewards from another surgery outweigh the risks?
- Can you afford it?
To decide whether you should move forward with plastic surgery after bariatric surgery, click to expand the questions below.
Bariatric Surgery Patients
& Plastic Surgery
More than 4 out of every 5 weight loss surgery patients report problems with excess skin, the most common areas being the abdomen, upper arms, and the inside of the thighs.
Other problem areas reported include the back, the cheek and over the knees (1).
Am I at my low weight?
Before having plastic surgery, you must wait until you’re at your low weight and have stayed there for at least a few months. If you had weight loss surgery, you’ll need to wait at least one year, preferably two.
If you don’t wait and continue to lose weight after plastic surgery, the excess skin that develops as a result of the additional weight loss may require another procedure to achieve your desired results.
How much does your excess skin weigh?
How is my current physical and mental health?
The better your overall physical health, the less likely you are to experience complications. Work with your primary care physician (PCP) to determine if your physical health is appropriate for plastic surgery.
Diet is also important. For example, if you don’t eat enough protein, your body could have trouble healing (2). If you have any doubts about your diet, ask your PCP to recommend a nutritionist.
In addition, mental health is a big consideration. Surgery preparation and recovery can be a lengthy process, and you must have the proper mindset going into it.
Would I do this for mental reasons, health reasons or both?
For some, the positive affects of extreme weight loss on their mental and physcial health are all they could have ever hoped for. You look better in clothes, you have more energy than ever before and many of your obesity health problems are a thing of the past.
But for many successful ‘losers’, the excess skin resulting from years of obesity presents a new set of mental and physical challenges.
Mentally, the saggy skin may cause you to feel embarrassed both with and without clothes on.
Physically, it can cause a myriad of issues ranging from annoying to potentially serious, including…
- Difficulty getting dressed
- Difficulty exercising, which may impact long-term weight maintenance and health
- Skin fold rashes or breakdown of skin
- Skin fold infections
The severity of the mental and physical issues caused by your excess skin should be weighed against the risks and side effects of surgery along with how much it will cost…
Do the rewards outweigh the potential risks and side effects?
The specific risks and side effects depend on the procedure(s) that you receive and your overall physical health and diet, but in general here’s what you’re up against:
- Plastic surgery carries the risk of any other major surgery, including the risk of bleeding, infection, deep vein thrombosis or (rarely) even death. After reviewing the rest of this page, learn the risks specific to your chosen procedure by clicking the links in the Types of Plastic Surgery section below.
- Losing more than 100 pounds increases your risk of complications by up to 2%. A study of 450 weight loss surgery patients found that patients with 50 to 100 pounds (22.7 to 45.4 kg) of weight loss did NOT have increased risk of complications ( 3). However, risk level went up for patients losing over 100 pounds.
- Risks after malabsorptive vs restrictive procedures. The study referenced above also found that patients undergoing malabsorptive procedures (like gastric bypass) have a higher risk of complications than those undergoing restrictive procedures (like gastric sleeve or lap band surgery).
- Patients typically lose sensation in the area treated. Most patients regain full sensation several months following surgery, but there is a possibility that the sensation loss will be permanent. You must be careful to avoid injury to the affected area until sensation returns as you will not feel the affects of burns, including sunburn or frost bite.
- If you are a smoker or a diabetic, there is a very good chance that you will develop wound problems. With the loss of so much weight, diabetes is often resolved or greatly improved. But if you are unwilling to stop smoking for at least a couple of months before surgery (stopping any closer to surgery will greatly increase your risks), it may be a big enough reason not to move forward. Smoking greatly increases your risk of complications and hinders the healing process ( 4).
- Scarring is unavoidable and may be significant (further discussed below).
Can I afford it? Cost, Insurance and Financing
The cost of bariatric plastic surgery, which ranges from $3,500 to $30,000 or more, will completely depend on your location and the procedure(s) performed. Metropolitan areas are more expensive than rural areas, and more involved procedures requiring longer operating times and hospital stays are more expensive than less involved procedures.
If your chosen surgery is not being done for health reasons, you will almost certainly not get insurance to cover the treatment, although getting it covered will be difficult either way.
Unfortunately, insurance companies’ policies tend to list most plastic surgeries as “cosmetic” rather than health-related. Even if you can present credible information to the contrary, insurance companies often fall back on the language in their contracts which calls for a denial.
With that said, the savings you could realize may be worth the fight. Before contacting your insurance company about covering plastic surgery, have your ducks in a row including:
- Letters from your doctors and surgeons regarding the medical necessity of the procedure. While a letter from your plastic surgeon may be helpful, letters from your primary care physician and/or bariatric surgeon will be more impactful
since they don’t stand to gain financially from the decision.
Have them include anything that would cost the insurance company money down the road if you don’t get plastic surgery, including mental health issues (i.e. prescription drug expenses, visits to the psychologist) and problems you have already experienced or are likely to experience due to your excess skin (i.e. inability to exercise and the resulting health effects, skin fold problems such as infection and rashes, etc.).
- A detailed letter from you regarding the impact surgery will have on your life may also help. Explain the difficulties caused by your excess skin, such as trouble sleeping, personal hygiene, mental health issues, physical problems, etc.
- Letters from other professionals (i.e. psychologist and physical trainer) confirming the issues included in the other letters.
Even with the best letters from your doctors, there is still a very good chance that insurance will not approve the procedure.
If insurance won’t cover it, fortunately there are very affordable and relatively easy options for financing plastic surgery after weight loss…
There are several ways to secure financing for plastic surgery (or to reduce its cost), including…
- Financing directly through the plastic surgeon’s office
- Secured loans
- Friends and family
- Retirement plan loans
- Permanent life insurance loans
- Plastic surgery loans
- Plastic surgery abroad
See our Financing page for details about each of the above (that page focuses on bariatric surgery financing, but most of the principles are the same).
- The areas include the abdomen, back, breasts, neck/face, thighs, upper arms, or full body
Following are the most common types of plastic surgery after weight loss…
- Abdomen (affordable tummy tuck, also called “abdominoplasty”)
- Back (combined with tummy tuck in a "belt lipectomy")
- Body (total body lift, upper body lift or lower body lift)
- Breasts (breast lift, also called “mastopexy” and/or breast augmentation)
- Neck or face (neck lift or face lift)
- Thighs (thigh lift plastic surgery, also called “thighplasty”)
- Upper arms (upper arm lift, also called “brachioplasty”)
For patients who need multiple procedures, it may be appropriate to combine them into one operation as with a ‘belt lipectomy’ (abdomen and back) or body lift.
Other patients who require more than one procedure may be required to spread their surgeries out over several months in order to reduce the risk of complications and improve the appearance of each area.
- Your hospital stay can be a quick, outpatient procedure (leave the same day) or last up to a week
Recovery from plastic surgery after weight loss depends on the procedure and your overall health and diet.
Some surgeons will allow the less involved procedures to be performed on an outpatient basis (allow you to leave the same day). But for the more involved procedures you should stay at least one night and possibly up to a week for evaluation.
Procedures such as a tummy tuck require drains to be left in for a week or more to reduce the amount of fluid that builds up under the skin which may lengthen hospital time.
For more information about recovery, see our procedure-specific pages listed below.
- You will have some additional scarring, it's impossible to avoid
- There are several ways to minimize the new scars
While the incisions are strategically placed and the stitching techniques often perfected, even the best plastic surgeons leave scars after plastic surgery. Before moving forward it’s important to have a clear understanding of how the scars are likely to look after you’ve fully healed.
Ask your plastic surgeon to share before and after photos of their other patients who have undergone the same procedure. This will give you a good idea of what to expect and about the kind of work they’ve done in the past.
You should also be aware of the scarring risks. While about 95% of patients heal with “good-quality” scars, a small percentage of patients get “hypertrophic” scars that are hard and red and can last years. Less than 1% of patients’ scarring results in keloids (tumors of the scar tissue), with Asians and people of African decent being the most likely to get them (5).
In addition to working with an experienced plastic surgeon, there are several things your doctor may recommend to improve the ultimate appearance of your scars, including…
- Applying consistent pressure to the wound using an elastic bandage or special compression garments. For best results, they should be worn for six to 12 months (6).
- Treat scars with silicone gel, cream or bandages for 12 hours per day for at least six months (7).
- Special over-the-counter creams can also be effective.
- Steroid injections into hypertrophic or keloid scars may flatten the scars and soften their appearance.
- Laser treatments have been shown to both improve and prevent abnormal scarring (8).
- 12 steps to finding and choosing the right plastic surgeon
No plastic surgeon, despite their skill and education, is right for everyone. These 12 steps will ensure that you find the right plastic surgeon for YOU…
ABPS and RCPSC Certification
American Board of Plastic Surgery (ABPS) or Royal College of Physicians and Surgeons of Canada (RCPSC) certification assures you that your surgeon:
- Graduated from an accredited medical school
- Completed at least five years of additional training as a resident surgeon in an accredited program
- Has a minimum of five years of residency training in all areas of surgery
- Has a minimum of two years devoted entirely to plastic surgery (ABPS only)
- Passed comprehensive written and oral exams
- Completes ongoing education requirements
Step 1 : Certification
Ensure that your surgeon is certified by The American Board of Plastic Surgery (ABPS) or the Royal College of Physicians and Surgeons of Canada (RCPSC)
Step 2 : Cross references
In addition to the ABPS or RCPSC, find out if your surgeon participates in any professional societies. While ABPS or RCPSC certification is technically “enough”, participation in industry societies further supports the surgeon’s quality and code of ethics:
- American Society for Aesthetic Plastic Surgery (ASAPS)
- American Society of Bariatric Plastic Surgeons (ASBPS)
- American Society of Plastic Surgeons (ASPS)
- American College of Surgeons (FACS)
- Canadian Society of Plastic Surgeons (CSPS)
Step 3 : Check the number of malpractice lawsuits your surgeon has lost (not how many they’ve been named in)
- United States: Check the State Board of Medical Examiner’s database for your state
- Canada: check with your provincial college of physicians
Step 4 : Plastic surgery specialization
Ensure that your surgeon is trained specifically in plastic surgery
Step 5 : Confirm years of surgical training
5 years minimum
Step 6 : Confirm years of plastic surgery training
2 years minimum
Step 7 : Medical facilities
Ensure that the medical facilities the surgeon operates in are accredited. If your surgeon does not have privileges to operate in a local hospital for the specific procedure that you are having(important), there may be cause for concern regarding his or her credentials or history. If they don’t have local hospital privileges, find out why.
Step 8 : Ongoing education
Get proof that your surgeon has fulfilled the continuing education requirements of their respective organizations and societies, including those related to patient safety.
Step 9 : Photographs of former patients who underwent the same procedure
Common sense says that surgeons will only share their best photos, but you should still ask to see them. When comparing the before and after photos, make sure no “camera tricks” were used to make the after shots look better than they really are:
- Lighting should be the same in both photos.
- Shadows should be similar/have the same angle and “darkness” (for example, check the chin’s shadow on the neck or the wall shadow behind the person).
- Confirm with the surgeon that no computer enhancement has been applied to any of the photos.
Step 10 : Get referrals to patients who have had the same procedure by the same surgeon
Call other patients and ask them to discuss their experiences, both positive and negative.
Step 11 : Patient partnership
Even if the surgeon meets all of the above requirements, they must still demonstrate a strong partnership with YOU the patient, including:
- Meet with the surgeon, not one of their nurses or assistants.
- As you’ve read on this page, there are pros and cons to any procedure. If your surgeon puts too much emphasis on the pros and does not properly address the cons, you should be wary.
- Does the surgeon perform the surgery themselves and all of the after care (rather than their nurses or assistants)?
Step 12 : Find and interview at least three surgeons
Use the above criteria. Assuming they all “pass”, trust your instinct and go with the one that “just feels right”.