Aging Skin Does Weird Stuff

I feel like I start every other post with, “Gosh it’s been a long time since my last post.” Sorry, I’ve been battling mental rebellions over this whole “needing to be vigilant every day” thing that my life is.

Since my last post I’ve done the thing I said I was doing – eating sensibly, not starving myself, exercising for about an hour 5-6 days a week, not getting on the scale. But then a couple of weeks ago something happened that really rattled me. I noticed a new angry red stretch mark on my belly just above my belt lipectomy scar. Then a few days after that I noticed a bunch more on my abdomen above and to the left of my belly button (I have some old white ones there already from when I was ~400 pounds). Then a couple of days ago I noticed some on the other side that mirrored those ones above my belly button.

I freaked out. I worried that my negligence of the scale meant that my weight had somehow ballooned up without me realizing it into previously unknown highs, so high I was getting new stretch marks. That didn’t even make any sense! I’ve been 400 pounds in my life, when I had the belt lipectomy they didn’t take any skin in a vertical direction, only horizontal, so there should be plenty of space there. I couldn’t have gained THAT much! I’m certainly not getting any taller!

I told my husband about the situation, and he said, quietly and meekly (because he knows what a minefield this topic can be for everyone), “You look the same to me, I don’t think you’ve gained a bunch of weight, sweetie.” And then he said even more quietly, “Maybe all those twisting, stretching core workouts you do are causing them, maybe you need more room for all of the badass ab moves you are doing?”

There was nothing for it but to get on the scale this morning. I braced myself for the worst, but I did not find that the worst had happened. I weigh exactly what I always do when I am not starving myself or otherwise trying to lose weight to attain the mystical goal weight in my brain. I weigh the normal, maintenance, enjoying-my-life-while-still-being-careful weight I always revert to between diet programs. The weight I should probably just get used to and accept. That weight.

So what the hell, body?

The only thing I can guess is it’s a combination of what my brilliant husband said, and my aging skin. It’s been drier than usual lately, noticeably so. And I do really work my core with my workouts – many of them incorporate Pilates and yoga moves that twist, stretch, and otherwise pull at my midsection. That’s the best I can guess. Pass the cocoa butter, please?


All About Loose Skin After Weight Loss, and Surgery

I’ve had a few questions recently about loose skin due to weight loss. Specifically, loose skin due to large and/or rapid weight loss. I can only tell you what I know, what I experienced, and what I learned from my plastic surgeon.

If you lose a lot of weight, you’ll probably have some loose skin. How much depends on what your highest weight was, what your lowest is, and genetics. I had a lot of skin removed after losing 200 lbs, and my surgeon was really good about explaining to me the mechanics of what you see happening in your skin as you increase and decrease. Basically, if you have a lot of stretch marks that have filled in with that translucent light shade after their initial appearance as red streaks, that shimmery light color is new skin growing to accommodate your body as you gain weight (disclaimer: this applies to Caucasian skin – I don’t know about other skin but I’d welcome the information).

The next question I get is: Should one plan to lose slowly, then, to allow the skin to shrink? Well, the answer I received is that once that new skin has filled in the stretch marks, you have grown new skin. That’s pretty much all there is to it – you now have new skin and there’s nowhere for it to go when you lose but to sag. If you are extremely lucky, you may have extremely elastic skin that doesn’t get stretch marks and bounces back without leaving you with excess folds. But if you are not (like me), you are going to have loose skin no matter how slow or fast you lose.

My philosophy is if you need to lose anyway, then lose it however works best for you, learn to keep it off via maintenance, and deal with the loose skin when you have time.  Personally I’d rather have loose skin than full skin that inhibits living my life.

Now, about my own personal skin: I had two major surgeries to remove loose skin, one in 2005 and one in 2006. The first one was a belt lipectomy. My surgeon took a 12-inch wide strip of skin from all the way around my torso. The surgery involved almost 10 hours under anesthesia and I was off work recovering for a full month, wearing a medical corset for that entire month. I also had some drains which I had to empty several times a day for the first week or two, as well as staples and stitches.

Over the course of the next year the internal dissolving stitches which had been used to secure what some of my friends affectionately call my “skin pants” dissolved and the scar dipped considerably low at each of outer hips, likely because I carry a LOT of my weight in my “saddle bags.” The scar tissue wasn’t able to hold up the weight and so my surgeon decided to do a re-section of my outer thighs to put in permanent internal sutures and pull up the thigh tissue, and while he was at it I asked him to do an inner thigh lift (no wikipedia entry found).

The scar for the resection simply followed the previous scar along the outer hips, however the scars for the inner thigh lift were significant. They include scars in each groin crease and a scar running down the inside of each thigh to a point about 2-3 inches above each knee. The skin and tissue in my groin has been secured to the pelvic bones with permanent internal stitches to keep the weight of my thighs from pulling the groin area down over time. This surgery took less time – 6 hours if I remember correctly – and the recovery was only 2 weeks off work, during which I needed to wear compression pants down to the knee. Unfortunately, because I was unable to find compression pants that were long enough I had some complications which resulted in the formation of a seroma right above the inner knee on my left leg which didn’t resolve on its own despite several visits to have the doctor drain it with a needle. I underwent one more procedure (in-office, local anesthesia only) to cut out the lining of the seroma and a final drain placed for another week or so. This may have been the most stressful procedure for me due to being wide awake.

I have never once regretted the decision to have my extra skin removed. Even during the long weeks of painful Vicodin-fogged recovery, there was never a moment when I wished I hadn’t done it. I had so much loose skin that my body looked like a deflated balloon. It wasn’t going to shrink back – I’d stretched it beyond that capability when I was at my highest weight. In fact, I’d always had an apron pannus from the earliest age I can remember – even as a child. Getting rid of that badge of dishonor was one of the easiest decisions I’ve ever made.

HOWEVER. The scars on my inner thighs have been a source of on-going angst over the years. You see, when I gain weight they have to stretch a bit, and when they stretch they hurt. It’s a stinging, pulling sensation that doesn’t feel good in any way whatsoever. So over the last couple of years as I’ve gained back these 50 pounds, my scars have been hurting. And now that I’m losing? They haven’t hurt in weeks.