Getting comfortable with the skin they're in

SEATTLE - Dropping half her body weight left Jessica Loos feeling not only healthier and happier, but also like a candle that was melting.

Flaccid skin began hanging from her arms and thighs. Her breasts drooped like an elderly woman's. Rolls settled at the base of her belly.

So two years after a successful stomach-reduction operation caused her weight to plummet from 323 pounds to 165 pounds, Jessica, now 29, decided to have a surgeon resculpt her body to better fit her new weight.

Her procedures are part of a wave of plastic surgery that has followed closely behind the nationwide spike in weight-loss surgery.

In 2005, surgeons performed 70,000 body-contouring procedures for patients who'd lost massive amounts of weight. That's a 25 percent increase from a year earlier for a procedure that was practically unheard of a decade ago, according to Dr. Jeffrey Kenkel, a Dallas plastic surgeon who chairs the post-bariatric surgery task force for the American Society of Plastic Surgeons. More than 90 percent of the patients are women.

Jessica and husband Leo, 44, each chose gastric bypass surgery as a last resort to salvage their quality of life.

They had tried unsuccessfully to trim pounds through diet and exercise. Their excess weight was causing medical problems, and they were prime candidates for developing diabetes.

The couple began losing weight immediately after the surgery, and they were on a high. Temporary medical setbacks - including a deficiency of thiamin (vitamin B1) for Jessica - tempered the euphoria, but the couple soon found lasting improvements in their physical and emotional state. They were walking more, fitting into movie seats and reconnecting with family members.

But the rolls of skin left behind were a lasting reminder of what they once looked like.

The Looses realized they would be lucky to claim even a small fraction of the costs of body resculpting through their medical insurance. Some patients get limited coverage if their excess skin is chronically irritated or infected. But in most cases, the surgery is considered cosmetic.

Patients can pay up to $50,000 out of pocket. Plastic surgeons typically insist on cash upfront or offer an outside financing plan - essentially a surgical credit card.

At first the Looses talked about getting three procedures for Jessica and one for Leo, with each surgery lasting about six hours. But the high cost forced them to scale back, at least for now, to two surgeries for Jessica at a cost of $26,000.

Leo was able to use some of the money he got when he was laid off from his job at Microsoft last year for Jessica's surgery. He now works as a computer consultant with Denali Advanced Integration; Jessica is a business student at Bellevue Community College.

Leo, who dropped from 387 pounds to 190 pounds after his bypass, said he's not so concerned about his baggy skin. As with many men, his excess weight was concentrated in his belly and the rest of his body returned to a more natural look.

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THE RISKS

Jessica looked at photos of previous patients and discussed the downsides with her Bellevue, Wash., plastic surgeon, Dr. Sepehr Egrari, before deciding to undergo the surgery herself last year.

The biggest risk was blood clots. Kenkel said he's still collecting data, but estimates 3 to 8 percent of patients develop clots, often in their legs. Treatment can require patients to take blood thinners for up to six months. In rare cases, lung clots can cause death.

The surgery comes with another big trade-off: scars.

"We make their contour better in exchange for scars," Kenkel said. "Sometimes the scars are long and are going to be in areas where they may be visible."

"But this patient group tends to be very educated and very Internet savvy," Kenkel added. "Their expectations are somewhat realistic."

First up for Jessica was a lower body lift to remove her belly rolls. One rather odd risk: She'd lose her belly button if doctors damaged the delicate "stalk" keeping it attached.

But she came through the surgery intact.

She left with a flatter belly and a lasso-shaped scar circling her just above the hips. Her original bypass scar was gone, part of the 10 to 15 pounds of discarded skin. Jessica was told to spend the first week after surgery sleeping in a recliner and moving as little as possible. She wasn't to do anything strenuous for six weeks.

Ten weeks later, Jessica was ready for her second surgery: to reduce and resculpt her breasts and upper arms.

This time, Egrari sliced and peeled back the skin from each breast as if it were an orange, trimming away some fat underneath. He continued the incision under her arms, removing a large wedge of skin. As he prepared to stitch Jessica back together, he used a circular metal ring to cut new holes for her nipples at a point higher up her chest.

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Battling a mental image

Despite not undergoing the third surgery, which would have reshaped her legs and thighs, Jessica was impressed with her new look. Her belly was flat, her arms no longer flabby and her breasts much improved, if a little small for her taste. In the months afterward, the scars that outlined her new contours began to fade a little.

Yet she felt unsatisfied. Her body, it seemed, still had many flaws. She hadn't reached the idealized image she'd sought. It wasn't a surgical problem, she said, rather a problem of perception.

"I'm trying to work on seeing what Leo sees when he looks at me," she said. "It helps with the visual difference. When I lift my arm up, I don't see any flab, and when I look down, I don't see the fat rolls."

Kenkel said Jessica's experience isn't uncommon.

"Some patients who enter the whole process have a mental image of what they used to look like, and oftentimes it's hard to get to that mental image," he said. "Their skin is permanently damaged by obesity and has lost its elasticity."

Today, looking back on their three-year weight-loss journey, Jessica and Leo say the changes on the inside have been as great as the physical transformation. Both say they feel things more acutely now and have shed the feelings of detachment they experienced when they were overweight. The experience has strengthened their relationship.

In the end, the Looses say, their journey has been about accepting who they are.

"I've realized I'll never look like the model in the Victoria's Secret catalog," Jessica says. "And that's OK."

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(c) 2006, The Seattle Times. Distributed by Knight Ridder/Tribune News Service.