I Just Can’t Get Rid of This

This plays out in my office all the time when I evaluate patients for body contouring procedures (I left out the beginning of the quote)…  Here is the complete quote: “I go to the gym all the time and I just can’t get rid of this!”.  As the patient says “this”, she is grabbing a hunk of skin, typically on the lower abdomen.  Most commonly, she’s a mom or has lost a bunch of weight.  Or both.  But now she’s reasonably fit (or maybe super fit!) and is frustrated that the rolls didn’t go away at the gym.  She’ll run down all the things she’s done to no avail:  it could be gym memberships or personal trainer, kick boxing, nutritionist, running, yoga, or pilates.  Here’s the thing…  You made your muscles toned and tightened, not your skin!  Working out tones muscle, not skin.  Losing weight shrinks fat, not skin.  

Skin relies on its elasticity to accommodate to the new contours.  The elasticity may have been permanently damaged by stretching (pregnancy or obesity), hormonal effects (pregnancy, menopause), age, smoking and others.  So there are many variables at work and most you don’t have control over, such as age, genetics, the after-effects of pregnancy, and luck.  Why can some women have flat firm tummies with no stretch marks after pregnancy, or lose 70 pounds and have no folds around their waist?  I have no idea.  They are lucky outliers.  So what can others do?  

There is a spectrum of procedures for recontouring the torso, but when excess skin is the problem (or a stretched-out abdominal wall, which can be another confounding issue after pregnancy or weight loss), a surgical procedure to remove skin is in order and liposuction isn’t enough.  These procedures run the gamut from a mini-tummy tuck that just removes skin from the lower abdomen and leaves a scar a bit longer than a C-section scar, to a belt lipectomy, which is more typical after massive weight loss and leaves a scar all the way round the abdomen and waist.  The most common for mothers after pregnancy is a standard tummy tuck.  I believe patients should do everything they can to get in shape and lose weight prior to surgery, but when those efforts have plateaued, body contouring procedures can complete the process.

Douglas J. Mackenzie, MD

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