As demand rises, plastic surgeons focus on loose skin surgery

(Originally appeared on WKIO in 2009)

A growing number of plastic surgeons actually understand the differences between loose skin hanging past your knees and a would-be celebrity nose job. And this is a good thing for those who elect to have the surgery.  

The more a doctor or plastic surgeon understands the needs of the post-weight community, the better an experience it will be, says Clinical Plastic Surgeon J. Peter Rubin. His practice, the Life After Weight Loss Program at the University of Pittsburgh Medical Center, is in its seventh year.

 As the name implies, the Program solely focuses on surgeries for the post-weight community. In addition to the program, Rubin is an assistant professor of surgery with the University of Pittsburgh School of Medicine.  He is the official liaison between the American Society for Metabolic and Bariatric Medicine and the American Society of Plastic Surgeons, ensuring the communication channels are open between the two medical fields. He also speaks at a cross-section of bariatric and plastic surgeon conferences internationally. 

Heavily involved in research and writing, Rubin fathered the textbook on loose-skin-specific surgeries, "Aesthetic Surgery After Massive Weight Loss," in addition to plastic surgery guides for the general public, "Body Contouring Surgery After Weight Loss." Rubin's work and ability to communicate with his patients earned him consistently glowing reviews among his patients.  "Loosing 150 pounds was no easy task (and keeping it off), but the transformation of my body is unbelievable," says one of his reviewers at <a href=""></a>.  "Equally important, however, in spite of his popularity, his bedside manner, care and individual concern for each patient, his integrity, and the excellence of his team, in my opinion go unmatched."

While plastic surgery procedures have decreased overall,  the market for weight-related procedures have skyrocketed since 1997.  According to data supplied by the American Society of Plastic Surgeons, 67 percent of all thigh and arm lifts conducted by its members in 2007 were the result of major weight loss.  Since 1997, those surgeries were only coupled a few hundred times a year.  As of 2007, they totaled in the tens of thousands.

Given the accolades and the increasing market, it's no coincidence Rubin's success stems from understanding the internal debates going through a client's head when they first enter his office.

"A lot of time my patients are embarrassed to just come to a doctor's office," Rubin says.  "I see so many patients who come to my office and the first thing they say is ‘I shouldn't even be here.  This is not just a vanity issue,' and start on this explanation or that, or just need to explain.  I have to say, ‘These are things I understand.'"

Rubin began his focus on post-weight plastic surgery while training at Harvard hospitals in Boston, Mass.  This was during the onset of gastric bypass surgery in the 90s, which facilitated significant, rapid weight loss and left a surplus of overly-stretched skin in its wake.  By the turn of the century, Rubin noticed the numbers increasing, and their needs were far different than traditional plastic surgery clients.

"We became aware of the changes they were going through and realized there was very little in plastic surgery literature written about these patients and how to take care of them and what procedures should be done," Rubin says.  "We had to reinvent a lot of operations in plastic surgery and create a lot of new ones."

Rubin estimates about 90 percent of his clients include those who lost weight from bariatric surgery, the other 10 coming from traditional weight loss methods.  There's the same 90-10 split between female and male patients. And those estimates come from the few he approves for surgery. 

On a day's average, Rubin says he turns down 12-15 percent of his clients on first visit -- it can take up to a year of tweaking before he approves a patient for surgery. He also places an equal emphasis on screening patients to be certain they're physically and mentally prepared for the surgery, monitoring Body Mass Index and other habits (read: smoking, which hampers the scar's healing process). 

Patients are also intensely interviewed, so that Rubin's clear on their goals and motivations. "It's one of the pitfalls in plastic surgery that people don't do a lot of work in this area," Rubin says.  "With patients, you have to really start with are they ready for surgery and what issues can you make better before you even get to the procedures that they need.  One of the things I learned early on going through that process is vitally important, and if doctors don't have that process with you they shouldn't be involved."

In addition to Rubin, a growing number of plastic surgeons are also giving their sole focus to post-weight body contouring.  Among these include Al Aly of Iowa City; Jego Kenkel, University of Texas at Dallas; Felmont Eaves, based in Charlotte, N.C.  These are doctors who often attend similar conferences as Rubin, and they debate the nuances of post-weight body contouring together.

There are many considerations before going the plastic surgery route -- money, for starters, also anesthesia, recovery time and why you might consider removing any loose skin.  Many members of post-weight folks choose not to have loose skin removed.  As with all things Second Helping, whether to go for plastic surgery's a decision to make on your own terms -- not mine, your loved ones', nor society's.

And the breath of fresh air that Rubin and other specialist surgeons provide is that they'd say exactly the same thing.

"From my perspective, I think that people in plastic surgery who don't do this casually, but focus on it and make this a major part of their practice are better prepared to take care of these patients."

Russ Lane