Lipedema surgery / Loose skin afterwards
Loose Skin After Lipedema Surgery
Lipedema reduction surgery removes the abnormal tissue, and most of the skin over it shrinks back. Some does not, especially at later stages and after weight loss. This page covers why, how long to wait, and the operations that remove it: the thigh lift, the arm lift, and the lower body lift.
Overview
The question that comes after the surgery
Patients considering lipedema surgery often ask about loose skin before anything else, and for good reason: after years of carrying the tissue, the skin may have been stretched past the point of recovery. The answer is different for each patient. Skin that is still elastic shrinks back over the months after surgery, and a good number of patients never need anything more. Skin that has been stretched for years, or through large weight loss, may stay loose, and for those patients a second kind of operation removes it.
The two operations are different in every way: what they remove, how they are done, how they heal, and how insurance treats them. They are planned in sequence, with the lipedema surgery first and skin removal, if it is wanted, once the swelling has settled.
Why skin stays loose
Who ends up with loose skin, and why
What the skin does after liposuction
When the lipedema tissue is removed, the skin over it is left with less to cover. Skin that is still elastic shrinks back to the new contour over the following months, the way it does after cosmetic liposuction. Compression and time do most of the work, which is why the final result is not judged until the swelling has settled.
Years of stretch
Skin that has been stretched for years loses some of its ability to recoil. The longer the lipedema has been present and the further it has progressed, the more likely some skin stays loose. At stage 3, where folds of tissue have already formed, the folds often remain as folds of skin after the volume underneath is removed.
Large weight loss
Patients who have lost a lot of weight, whether through diet, bariatric surgery, or GLP-1 medications, often have loose skin before lipedema surgery is even discussed. Removing the lipedema tissue then adds to it. For these patients, lipedema surgery and skin removal are planned as one course of treatment.
Age and skin quality
Skin elasticity declines with age, and it varies from person to person. Stretch marks, thin skin, and skin that already hangs when you lift it are signs that it may not fully retract. Dr. Ovadia goes over what to expect from your skin at the planning stage, not after.
Timing
When skin removal is planned
Finish the lipedema surgery first
Skin removal waits until the lipedema reduction is complete for that area. Removing skin and then removing more tissue underneath it would undo the skin tightening, and the operations have different goals.
Let the swelling settle
After the last lipedema operation on an area, the swelling takes months to settle and the skin keeps tightening over that time. Skin removal is generally planned at least 6 months later, and often closer to a year, so that only the skin that is truly going to stay loose is removed.
A stable weight
Skin removal gives the best and longest-lasting result at a stable weight. Losing a significant amount of weight afterwards loosens the skin again; gaining it stretches the scars.
Staged like the rest
As with lipedema surgery, skin removal is done one area at a time, and the thighs and arms are usually separate operations. Dr. Ovadia goes over the order with you based on what bothers you most.
The operations
Thigh lift, arm lift, and lower body lift
Which operation is right depends on where the skin is loose and how far it extends. These are the three that come up after lipedema surgery.
Thigh lift
The inner thighs are the area most often left loose after lipedema surgery on the legs. A thigh lift removes the excess skin from the inner thigh. For loose skin confined to the upper inner thigh, the incision can be placed in the groin crease where it is hidden. For skin that is loose the length of the thigh, which is more common after lipedema, a vertical incision along the inner thigh is needed to remove it, and the trade is a longer scar for a much tighter leg.
The knees and the lower legs can also be addressed, usually with liposuction refinement or a small excision, depending on what is loose.
Arm lift
For the arms (type IV lipedema), an arm lift removes the loose skin that hangs from the upper arm. Dr. Ovadia generally places the scar along the back of the arm so that it is not visible from the front, and can place it along the inner arm instead when that suits the patient better.
Our arm lift page covers the incision options, recovery, and before-and-after photos in detail.
Lower body lift
For patients whose loose skin extends from the thighs onto the buttocks, hips, and abdomen, usually after large weight loss, a lower body lift removes skin around the whole lower trunk in one operation and lifts the outer thighs and buttocks with it. It is the most extensive of these operations and is planned with the same staging as other body contouring after weight loss.
Our body contouring after weight loss page covers how these operations are combined and staged.
What skin removal does not do
It removes skin, not lipedema. It does not treat the condition, it does not replace compression for patients who still need it, and it leaves scars that are permanent even as they fade. For patients whose skin has retracted reasonably well, it is not needed at all. The decision is about whether the loose skin bothers you more than a scar would.
Not sure whether your skin will shrink back, or whether skin removal is worth it for you? Call or email us, or book a consultation, and Dr. Ovadia will examine you and go over it.
Recovery
What recovery from skin removal is like
A different recovery from liposuction
Skin removal involves longer incisions, so recovery is more like a tummy tuck than like lipedema surgery. There may be drains for the first days, the incisions are closed with sutures, and walking starts the same day with the legs or arms kept comfortably bent at first.
Compression and scar care
A compression garment is worn for several weeks. Once the incisions have healed, silicone scar strips and sunscreen on any scar that will see the sun help the scars flatten and fade over the following year.
The scars
Inner thigh and inner arm scars are red and raised at first and keep fading for a year or more. The inner thigh scar in particular needs patience: the skin there is thin, the area is moist, and small open spots along the incision in the first weeks are not uncommon and heal with simple care.
Insurance
Insurance and skin removal
Requested on its own
Skin removal is a separate operation from lipedema surgery, and it is requested from your insurance plan on its own once the lipedema surgery is complete and the swelling has settled.
What plans look for
Plans consider skin removal when the loose skin causes a documented problem: rashes, infections, or skin breakdown in the folds, or folds that get in the way of walking or daily activities. Notes, photographs, and a record of the problem and what has been tried for it are what a request is built from, and our office goes over this with you.
We go over it with you
Once the lipedema surgery is behind you and skin removal is something you want, the office evaluates the criteria and covered benefits available under your plan, prepares the request to address them, and works through it with you.
Your surgeon
One surgeon for the whole course
Dr. Steven Ovadia is a board-certified plastic and reconstructive surgeon who performs both lipedema reduction surgery and the body contouring that some patients choose afterwards: thigh lift, arm lift, and lower body lift. Planning the two with one surgeon means the lipedema surgery is done with the skin in mind, and the skin removal is timed to the healing of the operation before it.
He also sees patients who had lipedema surgery elsewhere and want the skin addressed. He sees patients in New York City and in Jersey City and Millburn, New Jersey, and by phone or video.
Questions
Common questions about loose skin after lipedema surgery
Will I have loose skin after lipedema surgery?
Many patients do not. Skin that is still elastic shrinks back over the months after surgery, helped by compression. Loose skin is more likely at stage 3, after many years of lipedema, after large weight loss, and with age. Dr. Ovadia goes over what to expect from your skin before your lipedema surgery, not after.
How long should I wait after lipedema surgery before a thigh lift or arm lift?
At least 6 months after the last lipedema operation on that area, and often closer to a year. The swelling takes that long to settle and the skin keeps tightening over that time. Operating sooner risks removing skin that would have retracted on its own.
Can skin removal be done at the same time as lipedema surgery?
Generally not. Lipedema surgery removes tissue through small incisions and relies on the skin shrinking back; skin removal relies on the volume underneath being final. They are done in sequence, lipedema surgery first, with time between. In selected patients with a lot of loose skin before any surgery, Dr. Ovadia may discuss combining them, but that is the exception.
Where is the scar from a thigh lift?
For loose skin confined to the upper inner thigh, the scar sits in the groin crease and is hidden. For skin that is loose the length of the thigh, which is more common after lipedema, the scar runs vertically along the inner thigh. The vertical scar is longer, and it is what makes it possible to remove skin along the whole thigh.
Where is the scar from an arm lift?
Dr. Ovadia generally places it along the back of the arm, where it is not visible from the front with the arms at your sides, and can place it along the inner arm instead when that suits the patient better. The arm lift page goes over both.
Does skin removal treat lipedema?
No. It removes skin, not lipedema tissue. The lipedema is treated by the reduction surgery that comes first. Skin removal is for the skin that is left over afterwards.
What is recovery like after a thigh lift?
Closer to a tummy tuck than to liposuction. There may be drains for the first days, walking starts the same day, a compression garment is worn for several weeks, and lifting and exercise come back over about 6 weeks. The inner thigh scar needs patience and takes a year or more to fade.
I had my lipedema surgery with another surgeon. Can Dr. Ovadia do the skin removal?
Yes. Bring your operative reports if you have them, and Dr. Ovadia will examine you and go over what would help. The same waiting time applies: the swelling from the last operation should have settled.
Next step
Start with a consultation
Dr. Ovadia examines you, goes over your symptoms and what you have tried so far, and tells you whether your findings fit lipedema and what treatment would look like. Phone and video consultations are available.
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Phone and video consultations available · info@ovadiaps.com