title: Understanding excess skin in postbariatric patients: objective measurements and subjective experiences.
abstract: BACKGROUND
  Excess skin is a well-known side effect of massive weight loss after bariatric surgery. However, there is a lack of longitudinal follow-ups.
  
  
  OBJECTIVE
  The primary aims of this study were to investigate the development and amount of excess skin after laparoscopic Roux-en-Y gastric bypass and to relate objective results to subjective experiences.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  From 2009 to 2012, 200 patients were included and assessed with respect to excess skin before and 18 months after bariatric surgery. Patients were measured according to a standardized protocol and completed a questionnaire regarding their subjective experience of excess skin.
  
  
  RESULTS
  A follow-up visit was completed in 149 patients (78%). All ptosis measurements decreased after weight reduction except for ptosis on the thighs. When comparing objective measurements with patients' subjective experience and discomfort from excess skin, we found little or low correlation in most body parts (rs.03-.67). The prediction analysis indicated that, for every centimeter of ptosis on the abdomen preoperatively, there was a 2-fold greater probability of having a postoperative ptosis on the abdomen of>3 cm (OR = 2.32, 1.76-3.07).
  
  
  CONCLUSIONS
  The objective measurement of excess skin provides unique information in postbariatric patients' body habitus. Although the measured excess skin decreased compared with preoperative measurements, patients seem to become more aware of and disturbed and discomforted by it after the weight loss. Importantly, the objectively assessed measurements of excess skin correlated fairly with the perceived discomfort.
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital and Department of Clinical Sciences/Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. Electronic address: christina.biorserud@vgregion.se.
authors.forename: Christina
authors.initials: C
authors.lastname: Biörserud
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital and Department of Clinical Sciences/Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Torsten
authors.initials: T
authors.lastname: Olbers
authors.affiliation: Department of Clinical Sciences/Plastic Surgery, Sahlgrenska University Hospital and Department of Clinical Sciences/Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Trude
authors.initials: T
authors.lastname: Staalesen
authors.affiliation: Department of Clinical Sciences/Plastic Surgery, Sahlgrenska University Hospital and Department of Clinical Sciences/Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Elander
authors.affiliation: Department of Physiotherapy, Sahlgrenska University Hospital and Department of Gastrosurgical Research and Education, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Monika Fagevik
authors.initials: MF
authors.lastname: Olsén
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D012727:Sex Characteristics; D012867:Skin / Q000033:anatomy & histology*; D055105:Waist Circumference / Q000502:physiology; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
keywords: Bariatric surgery; Excess skin; Laparoscopic gastric bypass; Obesity; Objective measurements; SESQ; discomfort