Monday, November 10, 2008

Patient Skin Care Questions

I recently received any e-mail from a reader

I found your blog while searching for information on the panniculectomy procedure... thank you for your clear differentiation on this procedure versus a tummy tuck! The pictures gave me the aha moment.   :)

…... I have not had WLS, but instead have worked at life-style changes. …..So here I am now, roughly 100 pounds down with +/- 70 pounds to go... no insurance coverage and many skin issues to deal with - some cosmetic, but most necessary to prevent the awful skin irritation………. Surgery is cost prohibitive, but lack of surgery leaves us feeling sub-human. There has to be an answer to this - I just must not be Googling it right :p

I do have a couple of questions if you could take the time to answer them... perhaps you would consider placing them on your blog page……. 


Here are her questions (rephrased slightly) and then my answers:

Q1.  Have you come across compression garments that keep the pannus elevated without being miserable to wear?

  • Depending on body type (apple or pear shape for example) this can be difficult to find.  The best advice I can give you is to measure yourself at the waist, across the largest part of the pannus, and beneath the pannus (hips).  You may find (and I realize this may be embarrassing) that the best fitting girdle may be one designed for a pregnant woman.
  • Compare your measurements with the manufacturer’s size chart.  Very often it won’t be clear which size is the one for you.  I would (if possible) try on the one which fits closest to your pannus measurement and also the one which fits the hip measurement.  If the first feels too loose and the later too tight, try the size in-between.
  • Try both panty girdles (medium to heavy grade, as the elastic will last better) and one-piece bra/girdle combinations.  It will be a matter of trial and error, as it is with most clothes.  You will need to try them on.

Q2.  I have very thin skin - where the stretch marks are from the weight gain and pregnancy.  I always worry about the skin tearing because it is  so thin.

  • This is a very real issue and the skin can tear from the forces exerted on it – ie the weight of the pannus.  Make sure you let your family doctor or dermatologist know when this happens as the documentation of this may help you get your insurance company to pay for the panniculectomy.  This becomes a medical issue not a cosmetic one.  You want it to be documented in your physician’s chart.
  • Prevention of the tearing comes down to reducing the weight or the pull of the pannus on your skin.  If you can find a decent girdle that is comfortable enough to wear, this can help. 
  • Also, babying the skin with non-perfumed, non-alcohol based lotions that won’t irritate or excessively dry the skin will help.  Try using Gold Bond ointment or Aquaphor or A&D ointments.
  • Once the skin tears, it becomes a matter of wound care to prevent infection and allow healing.

Q3.  I get this horrible red rash or skin irritation under the skin fold and on the corresponding skin it is touching.  It's debilitating, humiliating, and results in an embarrassing odorous discharge.  I have the same issue under the breasts and with my thighs.

  • I have had patients tell me that using deodorant (roll on) in the skin fold to decrease sweating helps. 
  • Wearing clothing that helps prevent the skin to skin contact helps.  For example, the girdle you asked about above.  Finding a well fitting bra that supports the breasts up and away from resting on the chest skin.
  • Good skin care as in the previous question/answer.


Ultimately there are no simple answers to your questions I’m sorry to say.  I would encourage you to document any skin tearing and/or rashes and/or skin infections you get.  This documentation can help in getting any excess skin excision surgery done in the future classified as reconstructive rather than simply cosmetic.

Lastly, and maybe most importantly, may I commend you on changing your life style so that you have lost the weight.  I hope you continue to do stick to it.  Thank you for your kind words.


Other posts that you may find interesting:

Panniculectomy vs Abdominoplasty

Insurance and Healthcare Thoughts

Tips for Finding a Good Bra Fit

1 comment:

Anonymous said...

I found a great solution to the skin irritation when I discovered how liners in the armpit area can reduce skin inflammation and heat rash there. I use cotton liners, cut in squares and folded in half as liners between the pannus and the underlying skin-- just tuck the fold in there like an apron's slip. It wicks away moisture and keeps skin off skin. I found that powders only trapped and held the moisture there, making a perfect breeding ground for fungal growths!