Body Contouring

Jeris Burnell (left) answers a customer's questions at the Wal-Mart pharmacy in Camden where she is a pharmacist.

Burnell's problem is a common lament for patients who achieve major weight loss after a gastric bypass. "You're going to have a lot of sagging skin. It's everywhere on the body since people lose weight everywhere," said Dr. Harold Friedman, professor and chief of the Division of Plastic and Reconstructive Surgery in the Department of Surgery.

When such patients meet with Dr. Friedman he's aware of the tell-tale signs of their predicament. "They are still wearing clothing to cover things up such as long dresses to hide sagging skin on their thighs," he said. "Even though they have lost a lot of weight, psychologically they still don't feel normal," he added.

Burnell remembers the frustration she felt before she consulted Dr. Friedman in the fall of 2005. "No matter how much you exercise after surgery, you can't tone loose skin or totally hide it," she said. She recalled, "I couldn't wear anything with short sleeves because I had really bad 'bat wings' that hung down from my arms." She also struggled with the persistent rashes that plague patients who are left with loose hanging skin.

So Burnell sat down with Dr. Friedman to see how he could help her with body contouring – using plastic surgery techniques to reshape excess skin after gastric bypass.  She appreciated the forthrightness of the surgeon. "I need for patients to have realistic expectations. If they think that in one fell swoop they can look like Twiggy, it's not going to happen that way. It may take a number of operations and we may never achieve exactly what they want," he said.

The surgeon's first rule of thumb is that he will not perform any body contouring surgery until a patient's weight loss has stabilized for at least six weeks. Then the first surgery is generally a circumferential body lift in which excess skin is removed from the abdomen, buttocks and outer thighs. Patients may choose to undergo additional plastic surgeries to address extra skin on their faces, upper arms, inner thighs, and breasts. While it's possible to perform more than one procedure at a time, Dr. Friedman makes it clear to patients that his priority is taking sufficient time to address each particular area. "Patients who have body contouring after bariatric surgery are harder to operate on than other patients because you are removing so much more tissue. It's a little more complicated," Dr. Friedman said, explaining that individuals who have lost a lot of weight have also lost elasticity with their skin. "You have to overcorrect somewhat in order to achieve a good result."

When patients are looking at two or more surgeries, Dr. Friedman advises them to wait at least three months between each body contouring procedure. A few months after she had seven inches of skin removed from the front and five inches from the back, Jeris Burnell underwent surgery to eliminate the excess skin on her arms and hips. While she is planning additional plastic surgery, she is elated with her transformation so far. "After Dr. Friedman's surgery I finally realized that I'm not a size 3X any more," said the five foot, three-inch redhead, who now enjoys shopping for flattering styles in size four petite. "My husband said I looked a lot like the girl he married," she added with a smile.

In addition to the physical changes she underwent and the improvement in her health status, Burnell found that her journey through bariatric surgery and body contouring has yielded an additional bonus. "Being overweight for so long I had gotten myself in a shell," she said, explaining that she at one point she did little more than go to work and return straight home. "I'm a lot happier with myself now and not afraid to go out or get in touch with old friends anymore," she said.

Reprinted from Connections newsletter, May 2007

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