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Weight-loss surgery only half the battle: Excess skin costly to remove in N.B.

Tom Smith is half the man he used to be. 

With the help of weight-loss surgery to shrink the size of his stomach, the Memramcook man lost nearly 300 pounds. And while that’s given Smith a new lease on life, it has come with some unexpected problems. 

After such a huge weight loss, Smith was fully anticipating being left with extra skin. But he didn’t realize the problems that would cause.

And it goes well beyond vanity, he said. The extra skin is cumbersome and often painful.

Obese man sitting at a table with a birthday cake in front of him.
Tom Smith lost about half his body weight following gastric sleeve surgery in November 2019. (Submitted by Tom Smith)

While Smith said he wouldn’t dissuade anyone from such a life-altering surgery, he wants them to know what they’re getting into. 

Smith advises people to do their research “because it’s not an automatic fix.”

“You still have to do the work. It’s just a tool to help you along the way.”

He also warns people to expect extra skin. 

Front view of a shirtless man taking a photo of himself, showing low-hanging folds of skin in the lower abdomen.
Tom Smith said the low-hanging folds of skin from his abdomen cause discomfort, irritation and even pain. (Submitted by Tom Smith)

“Don’t think that just because you lose the weight you’re not gonna have extra skin because you will have some no matter what. I guarantee that.”

And if they do end with up folds of loose skin, Smith wants people to know that followup surgery is rarely covered by Medicare — as the original surgery is. 

“Surgeries performed for cosmetic purposes are not entitled services under Medicare,” according to an emailed response from Sean Hatchard, a spokesperson with the Department of Health. “Most weight-loss-skin removal surgeries are not eligible for payment unless the excess skin causes medical problems.

“In the event there is reasonable doubt as to the Medicare coverage of a proposed surgery, medical practitioners are required to apply to Medicare for consideration prior to rendering a service to determine the coverage status.”

Smith said his doctor forwarded the referral to Medicare, but he’s never heard anything back. 

A before-and-after, side-view display of a man who lost a lot of weight.
Tom Smith just before his gastric sleeve surgery and four months after. He’s since lost more weight. (Submitted by Tom Smith)

Dieppe plastic surgeon Dr. Ali Husain said in most cases, the surgery is not considered medically necessary.

“It’s a grey area,” he said.

“It’s not really clear-cut that this is absolutely medically necessary. I would say that probably it only becomes medically necessary when it gets to the point where the person can’t function. They can’t, you know, get up and walk because they have such a big overhang of skin or they’re getting recurrent infections or wounds developing in the skin, that kind of thing.”

When Medicare does pay, said Husain, it only pays for the medically necessary portion of the surgery. 

“As a plastic surgeon, that makes my skin crawl doing that,” he said. “Because when we do something, we want to do it perfectly. We want to get the best result possible with the nicest scar and the nicest result. … We want everything to look good after.”

Removal costs at least $10,000

Husain estimates the cost of the initial procedure to remove the excess skin between $10,000 and $15,000, and the followup cosmetic surgery to contour the skin and minimize scarring would be about the same.

A man takes a selfie in front of a bathroom mirror to show folds of loose skin after a significant weight loss.
Tom Smith was left with folds of loose skin after losing nearly 300 pounds following gastric sleeve surgery. He said the worst area is his lower abdomen, not shown in this photo. (Submitted by Tom Smith)

He said excess skin is a common result of severe and rapid weight loss after gastric surgeries like bypass or sleeve. 

“When you do these surgeries, you’re basically limiting the amount of caloric intake, which then leads to rapid weight loss, especially the body fat. And the skin doesn’t have time to adapt, so the skin just becomes very loose afterwards.”

When someone loses a lot of weight, the hanging skin can present problems, said Husain. 

“It creates areas of moisture under the folds of the skin and that can create skin irritation and chafing and that kind of thing. So, yeah, it can become quite a problem.”

Always a struggle

Smith, 43, said he’s always struggled with his weight. At five feet 11 inches, he topped out at 530 pounds. His physical health declined, and his mental health suffered as a result.

“I tried just about everything. I just couldn’t get the results out of it.”

It took him seven years to get down to 416. 

By 2019, he was approved for gastric sleeve surgery, which shrunk the size of his stomach. That helped lose him a lot more weight and by the summer of 2021, he was down to 240 pounds. At that size, Smith was able to exercise more effectively and build more muscle, which took his weight up a bit.

A collage of three pictures of Tom Smith and his wife showing his weight loss over the course of three years.
Tom Smith at various stages of his weight loss journey. (Submitted by Tom Smith)

The problem now is the extra skin. The worst area is his abdomen. He said it hangs and “pulls on the upper part of the body, like my back.” 

It also moves around a lot, resulting in chafing, which often causes him pain. 

He also has to be very vigilant about cleaning under the folds of skin. As a farmer, his work is often strenuous and because of the extra skin, the folds often get very sweaty. 

Smith said he often has to take painkillers to ease the pain enough to go to sleep. 

He said he knows other people who had the same, or similar, surgery as he had, and they weren’t covered for the skin-removal surgery either. 

Other provinces pay under certain conditions — or for the medically necessary portion — but do not extend the practice to what they consider esthetic reasons. 

Smith said he doesn’t care what the scars look like — he’s not looking for the cosmetic treatment. He just wants to be rid of the extra folds. He’s even willing to pay for a portion of the surgery. 

“They say it’s cosmetic but I’m not even looking for it to look good. I just want it gone so I don’t have to deal with it. Looks-wise, I don’t care.”

Smith is fine with the cosmetic portion not being covered, but when the leftover skin interferes with his quality of life, he believes its removal should be covered by Medicare.

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