Overview of Skin Toning

Excess Skin and Fatty Tissue

Skin has the wonderful ability to shrink when stretched: it can adapt to sudden weight loss, e.g. after pregnancy. However, this property has limitations, If it has been overstretched, it behaves like a rubber band that has been pulled too hard: it loses its elasticity and can no longer adapt to the new shape. When this happens, often people resort to plastic surgery to fix it.

Causes of Sagging Skin

The skin consists of three layers: The epidermis, the dermis and the subcutis. Among other things, the collagen of the dermis is responsible for its mechanical properties, i.e. it is responsible for the separation from the environment, for firmness, stability and elasticity.

The dermis is composed of three-dimensional collagen. This three-dimensional network can deform within certain limits and thus adapt to changing situations. If this ability is over strained, the network tears and the skin remains overstretched.

How do I get Rid of Overstretched Skin after Weight Loss?

Overstretched skin hangs, no longer fits the to the body, wrinkles appear, it is simply too much. Overstretched skin will also exhibit stretch marks (in the places where the dermis is torn), in the wrinkles there can be sore spots, eczema, ulcers. These areas hurt and itch, In addition, it looks aesthetically unappealing .

This type of excess skin cannot recede on its own, not by sport or by any creams or other obscure treatments. Injection with hyaluronic acid also does not help, the only thing that will help is Surgical skin tightening.

Such procedures are not small and always take place in clinics. As a rule, larger tissue blocks are removed and then undermined, i.e. detached. With the detached excess skin: The upper arm skin, the abdominal skin or the thigh skin, the defect, the “hole”, which is created by cutting away the excess.

The Aim of the Treatment is a Firm Skin

The aim is to achieve that the inner and outer body silhouettes fit together again through the treatment.

The aim is to remove the excess and over hanging skin so that it clings to the body as it should. This means that the excess tissue, i.e. skin, including fat, must be surgically removed.

The Course of Treatment

At the beginning of each treatment there is a detailed consultation. Once everything has been discussed and clarified, blood samples are taken, possibly an ECG, photographs taken and a conversation with the anesthetist, then surgery is performed.

Tissue tightening takes place under anesthesia. Skin and excess fat are removed from the muscle layer, i.e. the muscular abdominal wall or the muscles of the arms and legs, the excess is removed and the tissue is tightened with strong internal sutures.

The operations take 2 – 5 hours, depending on the extent of the work being carried out, we often combine the operation with liposuction.
Afterwards our patients stay 1 – 3 days in our clinic and are cared for competently, carefully and lovingly.

If it concerns the upper arms and the changes are moderate, the intervention can take place under local anesthesia on an outpatient basis.

Scars remain after skin and tissue tightening. We place them in places where they are as inconspicuous as possible: For the abdomen in the bikini zone, for the thigh lift in the groin and the crotch, for the upper arms either in the armpit or (in case of strong change) on the back surface of the arm.

Tightening can also be performed on other parts of the body if necessary: the chest, buttocks, back. A breast lift is of course also possible.

A note on the pain, towards the end of the operation, our patients receive a painkiller via the vein meaning they wake up without pain. Then a pain scheme takes effect: They automatically receive pain drops or pain tablets every two hours automatically, this prevents pain from occurring in the first place and throughout your recovery.

Follow-up Treatment

The operated body parts must be rested for 2 (upper arms) – 6 (abdomen and thighs) weeks.

This means that they may only be moved and little, this is because the tightened tissue is sewn together under proper tension. These rules must be observed so that the seams do not tear open and the skin remains smooth and tight.

After the operation, a compression girdle must be worn for six weeks, on the upper arms, stomach or thighs. It brings the inner wound surfaces together so that they can heal better and reduces the formation of wound water (seroma), bruising (haematoma) and swelling (edema).

Outpatient follow-up checks take place regularly: After two days, one week, two, six and twelve weeks.

Risks/Complications

First of all, there are the risks as with any other procedure: postoperative bleeding, wound healing disorder, infection, if the surgery is done correctly this is rare.

The tightened skin that is under tension can open, this complication is minimized with deep relief sutures in several layers. The previously damaged, tightened skin can give way again. Then the skin must be tightened.

When is it not Advisable to Undergo Surgery?

Serious general illnesses prohibit such an operation.

If someone is overweight is also a constraint, If one were to operate in such a situation, one part of the body would be slim and well-shaped, the rest of the body won’t be. In addition, if the patient is overweight this can become a serious risk factor.

Skin diseases on the area to be operated should not be allowed either.

Costs/Reimbursement by the Health Insurance Company

The costs for such a -not small – operation amount to 3500 – 6000 € net plus anesthesia and ward. If the intervention is medically indicated, the value added tax is not applicable, at least in Germany.

Medically indicated means: There are objective secondary diseases of the excess skin or excess tissue: Ulcers, infections with bacteria or fungi
The health insurance companies only cover the costs if the skin surpluses are very large after very heavy weight loss.

Further Information

The following authors have dealt with the topic in detail: Paul M. Gardner, Luis O. Vasconez