What Happens After Bariatric Surgery?

Deciding to undergo bariatric surgery is a life-altering decision, and the weight loss results are usually just one step of the journey. Here, three patients who chose to undergo cosmetic procedures after bariatric surgery open up about their experience.
Patient Perspective
Written by India Bottomley
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Deciding to undergo bariatric surgery is a life-altering decision. Bariatric surgery refers to a number of weight-loss surgeries, with gastric bypass among the most common in the United States. These types of surgery procedures are typically for patients with a body mass index (BMI) over 40 for whom diet and exercise haven't yielded results.

The weight-related results are usually just one step in a much larger journey, as weight loss patients are often left with a body they no longer recognize. As a result, some patients decide to undergo cosmetic surgery once they have reached their desired weight to fine-tune their appearance and remove any lasting visible effects of their past weight.

The types of elective surgical procedures undertaken after significant weight loss vary from patient to patient but often feature body contouring surgery that removes excess skin and excess fat, including:

While cosmetic surgery procedures are not typically covered by insurance, plastic surgery that accompanies weight loss may be partially or fully covered. Consulting with a board certified plastic surgeon will ensure that you get the right treatment and care for your body. Needless to say, the process of undergoing weight loss surgery and subsequent body contouring procedures can be long and both physically and emotionally challenging. We spoke to three weight loss patients who chose to undergo cosmetic procedures after successful bariatric surgery to find out more about their experience.

Jennifer, Long Island

Jennifer had gastric sleeve surgery in 2014 and went in for her the first of her cosmetic procedures two years later. After bariatric surgery, she lost 50 percent of her body weight. She saw big changes in the way she looked and felt, and her relationship with her body changed, too. That led to her deciding to have multiple cosmetic procedures, including a breast lift, excess skin removal, and neck lift. Here, she shares how cosmetic surgery was the final step in her feeling like herself again for the first time in a long time.

The AEDITION: Can you tell us a bit about your weight loss story?

Jennifer: I had been overweight for as long as I could remember — always the chubby kid in the class at school. As I got older, I became self-conscious. I would hide my body in baggy clothes, which, in turn, made it easier for me to gain weight because I wouldn’t notice it as much. By the time I was in my late twenties, I was totally withdrawn socially because of it. I started to worry about my health. I lost a decent amount of weight through diet and exercise before the gastric sleeve surgery. I decided to have surgery because my weight loss plateaued for around a year. I discussed my options with my primary care physician and then my surgeon. After the surgery, I lost weight relatively quickly and maintained my target weight for six months, before I went ahead with the cosmetic procedures.

The AEDITION: What pushed you to undergo cosmetic surgery after losing the weight?

Jennifer: I started to appreciate my body again, which was big for me. I was seeing a therapist at the time and ended up going around in circles until I realized that there was nothing wrong with wanting to look pretty even if that meant getting surgery. I had the excess skin removed first. I thought that maybe it was all I needed to get to where I wanted to be physically, but after that, I went ahead with a neck lift and breast lift. Once I recovered from the second surgery, I looked in the mirror and finally liked who I saw looking back at me. It was an amazing feeling, and the only regret I have is not going ahead sooner.

The AEDITION: How do you feel the procedures changed your relationship with your body?

Jennifer: My relationship with my body changed a great deal from before the weight loss to after my last procedure. Before I think I just went through daily life without giving my body or wellbeing a thought. Now, it has shifted completely. I gear a lot of what I do around staying ‘well.’ Before I had the cosmetic procedures, in particular, I felt some shame around my desire to look better, but I’m pleased I was able to work through that. It’s a privilege to be able to alter how we look to feel more confident, and there shouldn’t be shame associated with that. I think I’ve gained more respect for my body, too, and I’ve become stronger emotionally. And, of course, I feel so much more comfortable with who I am now.

The AEDITION: Do you have any advice for those considering weight loss surgery?

Jennifer: I think it’s one of those things that has a lot of different factors that have to be taken into consideration before taking the plunge. Aside from the medical preparation needed before weight loss surgery, I think it’s really helpful to get some emotional support, too. I certainly went through a massive shift in attitude and seeing a therapist helped me navigate that more easily than I probably would have otherwise. I think patients should be aware that the way they feel about their bodies may not change in the ways they initially expected. It’s all a learning curve, but, personally, I can say it has been worth it.

Zach, Portland

Zach gained weight rapidly in his late teens and throughout college. After trying to lose weight naturally, his doctors advised him to consider weight loss surgery. Due to his rapid weight gain and subsequent weight loss, he had a significant amount of excess skin that he chose to remove surgically. He spoke to us about his experience of the surgery and the recovery process.

The AEDITION: Can you tell us a bit about your weight loss surgery and excess skin removal procedure?

Zach: The surgeon advised gastric bypass was the best route for me, so I had the surgery as soon as I was medically well enough to. Recovery from that surgery was pretty tough — especially in comparison to recovery from the skin removal. After around 18 months, I had reached a weight I was happy with. The symptoms I’d been having before surgery that were linked to the weight had disappeared or improved a lot. I had always envisioned needing to have skin removed after I lost the excess weight. I gained the weight quickly, and the weight loss after surgery was fast, too, so I guess my skin couldn’t keep up! I had spoken to my surgeon about excess skin removal during my first consultation. I wanted to have a clear picture of what to expect. I also needed to be certain I would be able to afford both steps if I needed to.

The AEDITION: How did you decide when to have the excess skin removed?

Zach: The decision was based in part on medical advice and partly when I felt ready. My bariatric surgeon explained I ideally needed to reach my goal body fat percentage and needed to maintain my weight for a while before considering it. There are also other factors I was told about, including the need for me to be able to find a diet that was rich enough in nutrients despite my new restricted appetite so I was strong enough for another major surgery. I went through a period when the weight loss was so exciting. I looked completely different, but then I started to notice the excess skin getting in my way. It became an issue when I wanted to exercise. It was sore and generally acted as a reminder of who I used to be. Honestly, I needed to psych myself up to have another surgery. Recovery from the first procedure was difficult. It was a total lifestyle change, but recovering from the second surgery was straightforward in comparison.

The AEDITION: What was the recovery process from the excess skin removal procedure?

Zach: The first stand-out thing is that it was 100 percent less of a struggle than the main gastric bypass recovery. It was more of a ‘follow the steps and it will work’ kind of recovery, whereas the first surgery was more trial and error — especially with adjusting when to introduce new foods. I was surprised at how soon I was able to move around freely, and the benefits from the skin no longer being there were quite incredible. I had no idea how much I hadn’t been able to do as a result of the skin. It was so nice being able to start feeling ‘normal.’ Aesthetically, it took some time for the swelling to go down and for the scarring to look less angry. It was such a smooth process that I am considering having a similar procedure for the excess skin on my arms and maybe a thigh lift, too. Eventually, I’d like to have the scars treated with lasers so they’re less visible.

The AEDITION: Are you pleased with the results of your cosmetic procedure?

Zach: Totally. To me, it’s still clear that my body’s been through a lot, and I guess if you’re trained or know what you’re looking for, you’d notice, too. I’m not in a position where I feel confident enough to take my shirt off at the beach, but that’s on me more than on the results of the surgery itself. I think clear and frank communication with your surgeon is important. Don’t be afraid to ask them honestly how good the results will be, what to expect from the scars, and so forth. It’s okay to take your time. I know for some people the excess skin becomes painful, so, obviously, there’s more of a rush there. But, if not, hold off until you feel ready. Once it’s done, you’ll see it’s not as bad as you thought it would be.

Rochelle, Texas

Rochelle’s weight loss came after gastric band surgery. She lost weight relatively quickly and ended up with a lot of excess skin, which made her feel like her body was not what she had hoped for after weight loss surgery. Once her weight stabilized, she underwent a number of procedures to tighten the skin on her stomach, thighs, and arms, as well as having a face and neck lift. We spoke to Rochelle about her experience with cosmetic surgery after major weight loss.

The AEDITION: Can you talk us through the sequence of your procedures?

Rochelle: I had weight loss surgery and ended up with a lot of loose skin that I couldn’t sort out any other way aside from having surgery. I knew from the outset it was likely I would need to have excess skin removed after successful bariatric surgery, so I was kind of prepared for it. I had the stomach area seen to first, and the next step was the thigh lift once I recovered from that. I then decided — after having a smooth recovery from those two procedures — to have my arms contoured. Finally, I had a neck and facelift. It sounds like a lot, but I waited a year or so between each step and considered it part of my recovery from past unhealthy habits.

The AEDITION: How did you find the recovery time and process from each of the cosmetic procedures?

Rochelle: Recovery from the first two procedures was very straightforward. I think probably because the only other experience of surgery I’d had was the gastric sleeve procedure, and, of course, recovery from that is more ‘drastic,’ for want of a better word. By the time I had the procedure on my arms, I was kind of over having to have another surgery. It took its toll on me emotionally more than anything else, which I think is often the case. But the neck and facelift were a whole other story. It felt like I’d found the missing piece of the puzzle. I’d been waiting to look at myself and see who I used to be before the weight gain, and that was the procedure that finally did it. From speaking to other patients on the same journey, I think recovering from bariatric surgery is as much about finding love for yourself again. The surgery was a key part of that for me.

The AEDITION: Are you pleased with the results?

Rochelle: On the whole, yes. I think one thing that shocked me somewhat was the extent of the scars. They just didn’t cross my mind. That’s something I’d say future patients could maybe look into a bit more. But that aside, the surgery has been life-altering in the best way. I was deeply unhappy before the procedures, and I can’t attribute my shift in attitude completely to the surgery, but it has been a great help. What surprised me most was the change that came from the [panniculectomy] surgery. The excess skin that was removed was able to show the true change in how my body looked, which was awesome.

The AEDITION: Do you have any advice for other people who are considering a similar treatment process?

Rochelle: My main advice is to pace yourself when it comes to scheduling subsequent surgeries. It’s a real temptation to rush through it all, but listen to your body and consult your doctors to see when the right time is for you. I found being a part of online support groups helpful. Some have a bit of a toxic atmosphere, but there are really good ones out there. They helped me to check whether little symptoms were normal or not and also gave me a community, so I felt less alone in going through such a big change. I’d also suggest being as open as you can be with your close friends or family. You will likely need their help a lot during recovery. I made sure to schedule my procedures for times when they weren’t too busy, so caring for me wasn’t a complete burden! It’s a long process, but I think it’s worthwhile.

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INDIA BOTTOMLEYis a contributing writer for AEDIT.

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