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Skin sagging after Bariatric Surgery

Bariatric surgery results in excess weight loss of 60-80% over a period of 1 year after the procedure. Since most of weight lost is because of loss of the subcutaneous fat (fat stored under the skin), it is likely that there will be some loosening of skin after all the extra fat is gone. However, the likelihood of this happening varies according to age, gender, pre-operative weight, fat distribution, parity, previous surgery, pre-existing skin tone, post operative diet and skin care and level of physical activity.

Skin Sagging is less likely in younger individuals less than 40 years of age because their skin is elastic and has the capacity to stretch as well as contract. It is more common in individuals over age 60 because of loss of skin elasticity. Females are more prone to this complication as compared to males due to genetic and hormonal influences. People having a higher pre operative weight and BMI are particularly susceptible for this since they lose a greater amount of absolute weight after surgery and hence the skin sagging is more. People having central obesity with fat concentrated in particular areas of the body have more problems than those with evenly distributed body fat. Females who have gone through multiple childbirths have a greater incidence of skin sagging particularly in the lower abdomen area because of the repeated previous stretching and contraction of the abdominal skin. Previous open abdominal surgery also hampers the elasticity of skin and prevents its contraction when the subcutaneous fat is lost post operatively and this problem is noted around the previous scar marks.

Skin sagging can be prevented or minimised through proper diet, physical activity and skin care. A high protein nutritious diet prevents excess collagen and elastin breakdown in the post operative period. Regular physical activity including a combination of aerobic exercises, stretching and weight training helps to build lean body mass and tone up the underlying muscles thus lessens the skin sagging. Keeping the skin well moisturised by regular applications of creams, oil and massage is also preventive for this adverse event. Last but not the least, drinking plenty of water keeps the hydration level maintained and also has a beneficial role in skin elasticity.

Most people will have only a minor amount of skin sagging after their weight has stabilised. This is usually most evident in the lower abdomen and in the extensor aspect of upper arms and doesn’t cause any issue except for minor cosmetic deformity. However, excess skin sagging causing severe cosmetic disfigurement, decubitus ulcers or problems in personal hygiene may require corrective surgery. This surgery is a superficial operation with good results and few complications.

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