Why some people “snap back” after losing weight & others don’t [Bob Basu, MD, Houston]

Eva Sheie (00:00):
You're listening to Where Before Meets After. When someone loses a lot of weight, is there something happening in the body other than us getting smaller?

Dr. Basu (00:08):
That's a very complex question. There's obviously tons of health benefits from weight loss, whether it be through your cardiovascular system, your skeletal system, your joints, your organs, your kidneys. The list of benefits from weight loss goes on and on. I think since we're talking about loose skin, there's also a lot of changes going on to the quality of your skin. Not only do you lose volume, meaning from fat loss, but this can also manifest with loose skin. And the type and quality of your skin can significantly change. It's quite common for us to see this. So what happens to the skin? With weight loss, whether it be 10 pounds or 210 pounds, you can lose that elasticity to the skin. What that means is that you're losing the tone, the tightness of the skin. Some people see this with stretch marks, some see this with severe laxity.

(01:01):
They lose that recoil, the tightness of that tissue. So in addition to just removing skin, board certified plastic surgeons who are experienced with body contouring after weight loss or facial contouring after weight loss, they have to also consider the quality of your skin has changed. And that's a really important part of a treatment plan to manage loose skin after any weight loss.

Eva Sheie (01:24):
Is your skin quality affected by your age? Do younger people have an easier time snapping back?

Dr. Basu (01:30):
It varies from patient to patient. I think a lot of this has to do with nutrition. Patients' nutritional states vary. Some patients are taking a lot more protein. They're doing a lot more muscle building or resistance training to maintain muscle mass as they lose weight. If you're nutritionally optimized, you're physically fit and active and you're maintaining your muscle mass while you're losing weight. I do think the elasticity is a little bit better, but a lot of this has to do with genetic factors. And you can do everything you need to do, nutrition working out, which is great. But if you have the genetic factors that are going to lead to poor elasticity, meaning poor tissue quality, then there's really not much you can do. With loose skin, I also want to set patient's expectations correctly. So even in my hands with all the experience when I'm doing circumferential body lift, I have patients who've lost 150 pounds.

(02:24):
And some patients, I can get them looking like they have a contoured six pack abdomen where they look like a fitness model influencer. With other patients, same amount of weight, different tissue quality. I'll do the same procedures, same techniques. I'll do some soft ab etching, but they will get some relaxation of that skin. What does that mean? It means they get some looseness. Now it's not going back to what they had before, not even close, especially when you're removing five, 10, 20 pounds of loose skin on a body lift. However, they can potentially get some relaxation of the skin. Why? Because remember, we talked about the tissue quality. All of us are working with the tissue that you have. We cannot change the intrinsic quality of the tissue. Now, there's some technologies that we have such as radio frequencies that could help build collagen, but ultimately there's some inherent limitations.

(03:18):
So why does some of my weight loss patients get incredibly fitness model results? And I'm doing the same procedure on other patients, they're getting a huge improvement, but it's not as toned because it has to do with the variability of your tissue quality. So that's one of the limitations that all surgeons have. We can only work with the tissue that you have. We really cannot change your tissue, and that's an inherent limitation of what we could do today in plastic surgery.

Eva Sheie (03:46):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wearbeforemeetsafter.com. Where Before Meets After is a production of The Axis.