Rachael lost 50 kilograms but still felt overweight. This booming surgery changed that

Thousands of Australians who have shed significant amounts of weight through diet, medication or surgery are going under the knife to remove up to 10 kilograms of excess skin as body-contouring operations boom.

Dr Damien Grinsell, a fellow of the Royal Australasian College of Surgeons, said he was performing about four of these operations a week, up from one a week a decade ago.

Rachael Smith had four kilograms of excess skin removed after shedding more than 50 kilograms.Credit: James Brickwood

“It’s life-changing,” the Melbourne surgeon said of the operations, which involve cutting large amounts of skin from areas such as the stomach, arms, thighs and breasts.

“It means they can get back to a normal life, wear normal clothes and exercise normally.”

Medicare data reveals that last year more than 5400 Australians had body contouring surgery to remove loose skin on their arms, thighs, stomachs, backs and legs. When breast lifts and reductions are included – which are also sought by patients for reasons not linked to weight loss – this rises to 14,200 people.

Plastic surgeons say this is only the tip of the iceberg as it does not capture the thousands of patients who pay upfront for their operations without claiming any Medicare rebate.

In November 2023, Rachael Smith paid $37,000 for a 360 abdominoplasty (or extensive tummy tuck), upper and lower chest abdominoplasty and a bra line lipectomy. The procedures came after the 52-year-old from Botany in Sydney’s south-east lost 51 kilograms.

“It still feels bizarre,” she said of the procedures, which removed an additional four kilograms of loose skin from her frame.

“I still look in the mirror and can’t believe it is my body.”

Smith had ensured she kept the weight off for two years before going under the knife. She said the eight-hour operation helped restore her confidence and transformed the way she perceived herself. While the Sydney mother has been left with scars, they are fading over time.

“Before I had the surgery I had lost all this weight but still felt like an overweight person,” she said.

While Smith has private health insurance, she incurred large out-of-pocket costs. She said it’s unfortunate that many people can’t afford the fees involved.

“It was a very big decision to spend $37,000 on myself rather than our mortgage, but it’s a motivation to stay healthy. Too many women don’t see themselves as a priority … they are worth it.”

Grinsell said many patients undergoing these surgeries had lost significant amounts of weight following the use of weight-loss drugs such as Ozempic, and bariatric surgery, which reduces the size of the stomach. Others have used a combination of these measures.

Many patients having loose skin removed are uninsured or don’t meet the strict criteria for medically necessary surgery and elect to have it as a cosmetic procedure.

Plastic surgeon Dr Damien Grinsell says more patients want surgery to remove excess skin. Credit: Penny Stephens

Grinsell said excess skin, which can weigh up to 10 kilograms, is uncomfortable, restrictive and can lead to infections and rashes.

It’s also a perpetual reminder for patients of their former selves, which can exacerbate mental health issues.

He said there was a misconception that if people continued hitting the gym and toning their muscles they would get rid of loose skin.

“The amount of skin that we’re removing from these patients is vast … there’s no way any non-surgical means will be able to treat that amount of loose skin.”

Mounjaro is a popular weight-loss medication, along with Ozempic.Credit: Bloomberg

All the surgeons interviewed for this article agreed with one thing: the benefits of weight loss far outweigh the discomfort of excessive skin.

These benefits include a reduced risk of cancer, stroke and heart disease, lower blood pressure, improved insulin resistance and better sleep.

Dr David Morgan, president of the Australian Society of Plastic Surgeons, said patients had to have lost at least five body mass index units and kept that weight off for six months to be eligible for a Medicare rebate. They also have to have experienced persistent skin infections or rashes due to their excess skin.

“Not everyone will necessarily meet all of those requirements, and that may well be why some people choose to have it completely out-of-pocket as a cosmetic procedure,” he said.

Morgan said the profile of patients seeking skin-removal surgery was shifting.

“What’s changing is the cause of the weight loss,” said the plastic surgeon, who is based in the Melbourne bayside suburb of Brighton. “It’s gone more away from stomach stapling variants to more drug-related weight loss.”

Morgan said stomach and breast surgery was the most popular surgery because the scars could be hidden beneath clothing.

“It helps how they feel on a daily basis,” he said. “They don’t have this loose skin moving around all the time and the problems caused by heavy skin resting against skin. If they get a smooth silhouette back, they feel a lot happier, even if there are scars.”

Dr Carmen Munteanu, who has been performing body contouring surgery for 15 years, said the procedures delivered important psychological benefits.

“Before the surgery they say, ‘I have lost all this weight but I still can’t wear bathers. I look like a deflated fat person,’” the Melbourne-based plastic surgeon said. “This gives them another lease on life.

“It peels away layers of shame and boosts self-confidence. That is so rewarding.”

A Melbourne mother, who did not want her name published for privacy reasons, said she forked out $25,000 for a tummy tuck and breast lift this year after losing 30 kilograms.

The 50-year-old achieved this weight loss over eight months through the use of weight loss drugs Mounjaro and Ozempic, as well as exercise and an overhaul of her diet.

“It’s called a mummy makeover,” she said of her procedures. “I’ve had four children, caesar scars and excess fat and skin around my stomach that I couldn’t get rid of.”

About three kilograms of skin was removed from her body. While the procedure was incredibly painful, she is delighted with the results.

“I felt better in clothes, I felt better without clothes. It improved my marriage … the change to my mental health has been massive.”

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