Thursday Styles; Skin Deep Thesis

The New York Times

August 3, 2006, Thursday Late Edition – Final

SECTION: Section G; Column 1; Thursday Styles; Skin Deep; Pg. 1 LENGTH: 1690 words HEADLINE: Newly Petite In Skin That’s XL BYLINE: By NATASHA SINGER; Jean Hanff Korelitz contributed reporting for this article. BODY: AS more severely obese people take drastic steps to lose weight, many are facing an unexpected hurdle in their struggle to slim down: rolls of loose skin that are heavy, uncomfortable, and prone to rash and infection. Body contouring, to cut away and tighten the excess skin that can develop after major weight loss, is one of the fastest-growing invasive cosmetic surgeries in the United States.

The procedures can be life-altering for those emerging from extreme obesity. For some, they can liberate a size 8 body from a size 22 suit of skin. But these procedures have their drawbacks. The cost, which can run up to $100,000, is often not covered by medical insurance. And the series of procedures can take years to complete and leave lifelong scars — and that’s if all goes well. Some health researchers are questioning whether body contouring is growing too fast, without a medical consensus on its risks and benefits.

Further, doctors said some patients are unaware they may eventually need body contouring; they argue that plastic surgeons should consult with patients before their weight loss, so they are better prepared for how their body shape may change. ”Socially, do you think we have done them any good when, after they have lost all that weight, they still look like elephant man with skin hanging down to their knees?” said Dr. Rajiv Y.

Chandawarkar, chief of plastic surgery at the University of Connecticut Health Center in Farmington. ”Are they prepared for the pain of body contouring,” Dr. Chandawarkar continued, ”for the surgical stigmata that can look like someone cut you in half?” Melissa Byrd, for one, said her doctors’ warnings never registered with her before she had gastric bypass surgery and lost 150 of her 300 pounds. ”I saw photographs of people who looked like shar-peis, but I didn’t really care then,” said Ms. Byrd, 32, a textile saleswoman in Charlotte, N.C.

After her weight loss, she had so much extra skin on her trunk that she had to fold her loose stomach into her pants, she said. She later had body-contouring during which Dr. Felmont F. Eaves III, a plastic surgeon in Charlotte, removed 11 pounds of skin, she said. Last year, people who lost 100 pounds or more, through surgery or highly restricted diets, had about 68,000 body contouring procedures, a 22 percent increase from 2004, according to data extrapolated from a mail-in survey of doctors conducted by the American Society of Plastic Surgeons.

The boom is being fueled by procedures to combat morbid obesity in those who are 100 pounds or more above ideal weight. Doctors performed at least 112,000 stomach-reduction surgeries in 2003, a 740 percent increase over 1998, according to the Nationwide Inpatient Sample, a database of in-patient operations at hospitals compiled by the federal Agency for Healthcare Research and Quality. Al Roker of the ”Today” show and singer Carnie Wilson have publicly discussed having weight-loss surgery.

In a report last month, the agency said that 40 percent of patients who have obesity surgery develop complications within six months. Even so, surgeries like gastric bypass and lap banding are becoming popular routes for the extremely obese to improve health by shedding dozens of pounds. Losing a few pounds does not cause sagging skin.