Tom Smith is half the man he was.
With the help of weight loss surgery to reduce the size of his stomach, the Memramcook man lost nearly 300 pounds. And while it breathed new life into Smith, it came with some unexpected issues.
After such a significant weight loss, Smith expected to end up with extra skin. But he didn’t realize the problems it would cause.
And it goes far beyond vanity, he says. The extra skin is bulky and often painful.
While Smith said he wouldn’t dissuade anyone from such an operation, he wants them to know what they’re getting into.
Smith advises people to do their research “because it’s not an automatic solution.”
“You still have to do the work. It’s just a tool to help you along the way.”
It also warns people to expect extra skin.
“Don’t think that just because you lose weight you won’t have extra skin because you will no matter what. I guarantee it.”
And if they end up with loose folds of skin, Smith wants people to know that follow-up surgery is rarely covered by Medicare — like the initial surgery is.
“Cosmetic surgeries are not eligible services under Medicare,” according to an email response from Health Department spokesman Sean Hatchard. “Most skin removal surgeries for weight loss are not eligible for payment unless the excess skin is causing medical issues.
“If there is reasonable doubt about Medicare coverage for a proposed surgical procedure, physicians are required to request Medicare review prior to providing a service to determine coverage status.”
Smith said his doctor forwarded the recommendation to Medicare, but never heard back.
Dieppe plastic surgeon Dr Ali Husain said that in most cases the surgery is not considered medically necessary.
“It’s a gray area,” he said.
“It’s not really clear that it’s absolutely medically necessary. I would say it probably only becomes medically necessary when it gets to the point where the person can’t function anymore. They can’t, you know, get up and walking because they have such a big overhang of skin or they have recurring infections or sores developing in the skin, that sort of thing.”
When Medicare pays, Husain said, it only pays for the medically necessary portion of the surgery.
“As a plastic surgeon, it gives me goosebumps doing this,” he said. “Because when we do something, we want to do it perfectly. We want to get the best possible result with the best scar and the most beautiful result. … We want everything to be beautiful afterwards.”
The move costs at least $10,000
Husain estimates the cost of the initial procedure to remove excess skin at $10,000 to $15,000, and the follow-up cosmetic surgery to contour the skin and minimize scarring would be about the same.
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 things, you’re basically limiting the amount of calorie intake, which then leads to rapid weight loss, especially body fat. And the skin doesn’t have time to adapt, so that ‘She gets very cowardly afterwards.
When someone loses a lot of weight, hanging skin can present problems, Husain said.
“It creates areas of moisture under the folds of skin and it can create skin irritation and chafing and that sort of thing. So, yes, it can become a real problem.”
Always a fight
Smith, 43, said he has always struggled with his weight. At five-foot-11, he topped out at 530 pounds. His physical health declined and his mental health suffered.
“I tried just about everything. I just couldn’t get the results out of it.”
It took him seven years to drop to 416.
In 2019, he was approved for gastric sleeve surgery, which reduced the size of his stomach. It helped him lose a lot more weight and by the summer of 2021 he was down to 240 pounds. At this height, Smith was able to exercise more efficiently and build more muscle, which increased his weight a bit.
The problem now is the extra skin. The worst area is his abdomen. He said it hangs and “pulls on the upper body, like my back.”
He also moves around a lot, which leads to chafing, which often causes him pain.
He must also be very vigilant about cleaning under the folds of the skin. As a farmer, his work is often strenuous and because of the extra skin, the folds often become very sweaty.
Smith said he often had to take painkillers to relieve the pain enough to fall asleep.
He said he knew of others who had had the same or similar surgery to his, and they were also not covered for skin removal.
Other provinces pay under certain conditions — or for the medically necessary portion — but do not extend the practice to what they consider cosmetic reasons.
Smith said he didn’t care about the appearance of the scars — he wasn’t looking for the cosmetic treatment. He just wants to get rid of the extra creases. He is even ready to pay for part of the operation.
“They say it’s cosmetic, but I don’t even want it to look good. I just want it to go away so I don’t have to deal with it. Appearance-wise, I don’t care.”
Smith agrees that the cosmetic part isn’t covered, but when the remnants of skin interfere with his quality of life, he thinks its removal should be covered by Medicare.