Latest / This Is My Journey | The GLP-1 Podcast / S2 E8: Loose Skin After Weight Loss – When Is Surgery the Right Option? (Dr Gediminas Samulėnas | Nordesthetics)

Transcript

S2 E8: Loose Skin After Weight Loss – When Is Surgery the Right Option? (Dr Gediminas Samulėnas | Nordesthetics) · This Is My Journey | The GLP-1 Podcast

• 0:00
  So for many people, weight loss is only part of the journey. And after significant weight loss, especially with GLP-1 medications, people can often find themselves facing a new set of challenges that they weren't prepared for. So things like loose skin, changes to the face, neck.
• 0:16
  uncertainty around surgery and confusion about what options are realistic or safe. So today's episode is all about cutting through that noise. We're talking honestly about excess skin after weight loss when surgery may be appropriate, how to approach it responsibly, and what patients should know before making such an important decision. So let's roll the intro and I will introduce you to today's special guest.
• 0:45
  Welcome to This Is My Journey, the podcast where real people share real stories of transformation, resilience, and growth. I'm Mark, and after navigating my own path through major lifestyle change, I created this space to open up honest conversations around identity,
• 1:02
  mindset and what it really takes to evolve. So along the way we'll also hear from professionals you know from pharmacists to psychologists and fitness experts who help us make sense of the science and support behind these journeys. So whether you're just starting out deep in the process or you're finding your footing after big change you are not alone. This is your place, this is my journey, let's walk it together.
• 1:30
  Welcome back everyone and today I'm joined by Dr. Geremines Samulinas, a board certified surgeon at Nord's Aesthetics specializing in aesthetic surgery and cosmetic procedures. Dr. Samulinas works closely with patients navigating body and facial changes following significant weight loss, helping them understand their options and set realistic expectations. So as someone myself who has lost a significant amount of weight, you know, and
• 1:54
  I'm now navigating them decisions around excess skin and surgery. This conversation is especially important. So today's episode brings together the surgeon and patient perspective with the goal of educating all of you listening and helping you feel informed, confident and supported on this journey too. So Dr. Samuel Lienes, thank you so much for joining me today. Hello, thanks for having me here. It's a pleasure. No, it's great, honestly, to have you because I think it's such an important conversation
• 2:20
  perspective, I think for anybody that's going through this weight loss journey and really, really excited to dive into some of the questions I have for you because I know I have a personal interest in it, but also for a lot of people that listen to this podcast, they will also be really interested in hearing what you've got to say. So really to start with, for anyone who maybe, you know, doesn't know you, you know, I follow you on social media, so I'd encourage anybody else to go follow you as well because some of the content that you put out is very, you know, it's great in terms of
• 2:49
  reassuring people on this journey. But could you tell us maybe a little bit more about your background and the work you do at Nord's Aesthetics?
• 2:57
  Sure. Well, you already made a very good introduction. Thank you. I'm mainly an aesthetic surgeon, and I usually do facial surgery and body surgery after weight loss. It's a very hot topic now because there is a huge demand for these medications because people want to lose weight. Obesity numbers are raging, and people have to understand the whole journey from A to Z. Because, yes, these drugs, if successful, hopefully the usage is successful, it brings a lot of benefits.
• 3:26
  But it's not that simple. And the main problem is that people struggle to find correct information, objective facts, how all of this journey is going to end, what results they could reach, what they could expect realistically. Basically, we want to clarify facts. I suppose, you know, I have my own.
• 3:49
  personal interest in this conversation as well but you know from your experience what are the most common concerns that patients have regarding significant weight loss
• 4:01
  Quality of life. Yeah. Because yes, they get the result. They lose a significant amount of weight. But it doesn't only bring happiness. Yeah. It brings a lot of excessive skin. Mm-hmm. And I've never met a person who is happy with it. Yeah. So they are starting to seek solutions. What would be a clever way
• 4:20
  to solve this. And that's definitely a surgery. There's no other effective way. I know from my own personal perspective, you know, getting and losing 126 pounds for me, you know, getting down to the size I am now, I think it's been very telling because I've, you know, certain areas now that I'm, I suppose, and don't get me wrong, they're not as, as,
• 4:41
  you know, problematic and as big an issue as being obese. But I think for me, no, I think it's the confidence side of things. And I think when you get left with that excess skin, it's you just want to make yourself a little bit better. And as you say, quality of life is such a massive part of the journey afterwards when you lose all that weight. So for me, it's really I've been really interested in why does excess or loose skin occur and.
• 5:08
  you know, why are some people, I suppose, more severe than others?
• 5:13
  Well, firstly, congratulations with such a weight loss. It's a huge milestone. Yeah. And people who lose weight very quickly, they develop more loose skin. Yeah. The pace of weight loss is very important. And also the age group. The younger the person decides that he or she will not continue this way and makes a decision to lose weight, the better it is. Because younger people have good skin elasticity. And if we would take two different poles, like black and white,
• 5:41
  A person who decided to lose weight when he or she is above 40 or 50. Okay. And a much younger person. And if that person lost weight very quickly and the other one did it very methodically and slowly, we would have two completely different outcomes. Because the first example, the person would definitely need surgery badly because...
• 6:05
  the amount of excessive skin would be really severe. And the younger person, after gradual, slow weight loss, they can consider surgery. But it's not that they must get it. The quality of life is much better. And when we lose weight,
• 6:20
  what do we lose? Fat, right? Skin doesn't contract. There is no such thing as skin contracture. And nowadays, scientific field has a lot of interest in developing some kind of device to contract skin. And there are a few methods which are being scientifically proven, but their effectiveness is extremely small. So if...
• 6:42
  a relatively fit person get light bulb suction yes there is a technology to try to shrink skin a bit but if we're talking about people after significant weight loss these non-surgical or minimally invasive options are out of the question yeah no i think for me definitely having done research and stuff you know there's things that can help you know but i think somebody that loses an excessive amount of weight you know surgery is probably realistically one of them options you know that you
• 7:08
  is there for somebody that does have a lot of that loose skin left. It's interesting because for me, I think I've always had a lot of comments about, you know, why have you no loose skin around your stomach area? But I suppose, as you're saying there, you know, anybody that's under 40, you know, we're all very different, I suppose, genetically as well. And I think just...
• 7:28
  yeah i think i've always wondered why i haven't been left with a lot of loose skin but other people have been but obviously age and there's lots of different factors for that how much time sorry how much time did it take for you to lose this amount of weight so for me i was i think it was about 10 months altogether on glp1 that i was on that i lost it
• 7:47
  Now, I never wanted to get down. I suppose for me, if you looked at BMI, my BMI is probably still in the danger zone of obese. But for me, I'm six foot. I, and when you look at me, like I, if I'd lost much more weight, I think I would look too skinny and too, you know, I don't think I would look healthy if I lost a lot more weight.
• 8:06
  That's a very good point. Yeah, for me it was the £126 I'd lost and I was like, I think this is enough now. I don't really want to lose much more because I think it starts eating into muscle mass and all that sort of stuff. So yeah, I was slightly concerned about all that. But...
• 8:22
  But yeah, by 10 months. Interesting fact. Traditional BMI calculations are absolutely incorrect when evaluating post-weight loss patients because fat is lighter than water. Yeah. So the kilo, as we evaluated. Okay. Losing weight brings a dramatic change in appearance. Yeah. But...
• 8:44
  the amount of weight lost and appearance actually is sort of set apart and skin weighs a lot more. And people who lose a lot of fat layer because they lose fat, nothing else, they still carry a lot of heavy skin. And counting BMI gives them pretty weird numbers. Yeah. See, a person who lost a lot of weight has a BMI, which is not considered healthy.
• 9:09
  So we can throw these calculations to the recycle bin, basically. They're not used correctly. Yeah. No, that's really interesting. I didn't know that about skin and about the weight of skin. I suppose if anybody is thinking about going down the surgery route, how soon after that weight loss would you recommend, maybe not the right word, but how soon or how long should that person be maintaining a weight before they should really consider going down the surgical route?
• 9:40
  I would say six months. Yeah, okay. Because losing more weight after surgery will deteriorate results. Yeah, definitely, because there's a few people I've seen that maybe would have acted quite quickly on getting to their goal weight and then wanting the surgery. But I suppose it's the maintenance side of things, being able to maintain. Is there dangers around regaining weight when you've had that surgery?
• 10:01
  No, if the person fully heals, well, the body will change and adapt. Yeah. But, you know, surgery never goes in line with rush. Yeah, yeah. So it's at least six months. If the person is still unsure, take more time, take a year, one and a half years. There's absolutely no hurry. Yeah. No, that's really good advice. You know, being online, we see so many people talking about this type, these types of surgeries and the media and, you know, it's...
• 10:28
  I suppose everywhere in magazines, on websites, everything, you know, or what are the biggest misconceptions that people have about excess skin surgery? So is there, I suppose there's one of them there I just said about, I thought, you know, you had to wait a lot longer before you could have that surgery. Is there any others that you can think of? Well, sometimes people don't get surgery right. They have to be properly prepared. And one would be proper preparation for surgery, having enough natural resources, proteins.
• 10:57
  to heal successfully because weight loss, depending on what kind of weight loss it is, so in this case, it's GLP drugs. Yeah. The person should monitor her or his hemoglobin levels, protein levels, because the body needs resources to heal. These post-bariatric surgeries, any post-weight loss surgeries, they require longer incisions.
• 11:20
  And the body will need these proteins to rebuild certain tissues, to basically build scar tissue and close the wounds. And of course, everyone wishes to have a thin scar and the result as best as possible. But if the person comes nutrient deficient,
• 11:41
  we are taking huge risks because long incisions can either heal in a perfect way or a long gap can open. Okay. So preparation is one thing. They think that they will get the best weight loss result and potentially deplete their proteins, but that stands in the dark. They don't realize that. And then they come for surgery. And when we do pre-op testings, it sometimes appears that they cannot get the surgery. They need to rebuild their iron levels, hemoglobin, proteins.
• 12:08
  And other misconception is tight skin. These two words are connected in the social media. Yeah, yeah. But they are never connected in reality. Skin is never tight. It will never become tight. Even if the surgeon removes so many tissues, so much skin, and closes the wounds on high tension, well, firstly, it leads to increased complication rate.
• 12:30
  Secondly, let's say it's borderline and the patient heals successfully, the skin will stretch again. Yeah. Because our skin is lax. It's opposite to tight. Yeah. We need to have skin relatively loose to be able to allow us movements. So let's say when we lean to the side, we can pinch our side, the opposite that we leaned to, and the skin will become tight. Once we stand straight again, the skin should be somewhat soft.
• 12:57
  And those seeking for tight skin, well, they will never reach this result. It's like a utopia. Yeah. So I would put that under the realistic expectations category. I know I've mentioned it there, but I think social media and stuff has a lot to play in that perception that people have of what is perfect. And I think they're all very unrealistic expectations, you know? So people want to show their best version, right? Yeah. So they will make a lot of pictures. Some of them will even try to fool other people with some some Photoshop content. Yeah.
• 13:26
  And it's presented as reality. It's very misleading. Of course, surgery is effective. Don't get me wrong. But I mean, we just need to cut these corners, those overly pessimistic and over-optimistic. And what's in the middle? That's the reality. That's the truth. What then should, and you've kind of touched on it a little bit there, you know, what makes a good candidate for surgery and what?
• 13:48
  When might it be better to wait? So obviously you just mentioned there about blood results and stuff in terms of different levels. What is a good candidate and a bad candidate? And is there anything that somebody should do prior to going for surgery to kind of be a good candidate?
• 14:06
  Well, I would name three options. Okay. Three points. Two already discussed. So proper preparation, then stable wait for six months at least. Yeah. And third, which is one of the most important things, is mental preparation. Is the person really ready for it? Yeah. Because when I see people preparing for surgery...
• 14:26
  they should be preparing more for the healing process instead than for surgery itself. Of course, the first days after surgery are relatively tough, but emotional burden is also a huge weight to carry. And if I see people who were very well prepared,
• 14:46
  they take it very easily they usually heal quicker they're happier after surgery so working with your mind and going to the surgical theater without any idea that's i can still turn around i can still stop this yeah the person should not have anything any any such ideas in mind yeah really great advice you know i know a lot of people that are going or coming up to now having this kind of surgery and you know there there is people
• 15:13
  They're still not sure about it in their head, but they've maybe gone ahead. And I think it is such a surgery that it's going to affect you for the rest of your life, essentially. So it needs to be the right thing for you and the right process for you. And there's no way back. No, exactly. So I think, you know, it's a really big decision to make and commit to. And I think as long as you've thought about all that fully and the after effect, because I've seen a lot of people afterwards, very, very down because of the recovery time and all that sort of stuff.
• 15:43
  Yeah, it can be a lot. Yeah, what should be absent in the past period are surprises. Yeah. Patients know very well what to expect. Yes. So we always recommend to visit a few surgeons, a few clinics. Yeah. Make a personal research. Listen to the surgeons, listen to Mark, for example. Yeah, yeah.
• 16:02
  take experiences from other people. Yeah. Build personal knowledge about what to expect. Because people research when they're trying to buy a house, buy a car, relocate. But sometimes when they purchase surgical procedures, they buy them like bananas in the shop. This is, well, maybe playing with fire. Of course, surgeons will stop bad candidates from getting surgery if they see that they are physically or mentally unprepared. Yeah.
• 16:30
  But it's easier to work with people than the homework. Yes, I think that is the key bit here. It's just make sure you know what you're getting yourself into, essentially, and know what the outcome's going to be, because it's going to be another road, a long road ahead to...
• 16:46
  normal again, I suppose. But what should patients really be looking for when they're choosing a surgeon or a clinic? Obviously you work for Nord's Aesthetics, which is an amazing clinic, but yeah, what would your advice be there for somebody that is thinking about going down this route and choosing that surgeon and clinic?
• 17:05
  Definitely the clinic itself. Yeah. It should be modern, clean and search for results. Search for obvious open experiences. Nothing should be hidden. For example, we have a group on Facebook for people who are considering surgery. Yeah. And it's totally non-moderated. People write what they want. Yeah.
• 17:24
  So people can see how other patients who recently had surgery, how they feel. Yeah. They post photos. They share genuine experiences. Yeah. So this builds trust. Trust, yeah. The clinics shouldn't hide anything. Transparency is the key. Yeah. Yeah.
• 17:41
  When I kind of made that decision that I wanted to go down because of my neck, the way it is, and made the decision to want to go down the surgical route or whatever. And, you know, you look up the surgeon's work and you, you know, look and your work is fantastic. You're very, very transparent on social media about all the surgeries and things that you have done. And the results are incredible of some of the people that you've worked on. So thank you. Well, I like happy patients. Yeah, yeah, yeah. It seems to be a lot. Yeah.
• 18:08
  There seems to be a lot of happy results anyway from the patients. But yeah, no, I totally agree. I think reading them reviews and I suppose for me, it did take me a while to process that mental side of do I want to really go ahead and get this done? And that was a process in itself. So we have kind of touched on a lot there. But yeah.
• 18:29
  It is really important that mental and emotional readiness when considering this kind of treatment. And is there anything else you would want to maybe say on that mental aspect and emotional side, like just being prepared? Well, if the patient follows any other person who already had the surgery, it serves as a genuine experience transfer. So initially, many questions that the patient had become clear. Yeah.
• 18:58
  I would say seeing experiences of other people is the best thing that the patients can access. That's reality. Yeah. Yeah. No, I don't think that's... Sometimes we see unrealistic expectations crashing because they expected to see what they saw on social media. Yeah. So they begin to question the surgery and then they begin to dig deeper.
• 19:19
  But this time they have their eyes open and the critical information. So it's overly positive, then slightly negative reality hits. And then we are somewhere in the middle. Yeah, I suppose to there's a lot of
• 19:32
  you know, just post surgery where people maybe look at themselves and obviously they're still in that post surgical swelling and all that. And I think, you know, I suppose that ties in with what you're saying there about that reality of, you know, where they sort of see themselves in the end.
• 19:50
  yeah and there's a difference let's say those people who were very well prepared they're extremely happy from day one yeah because the moment they wake up after surgery they look down let's say the abdomen or they take a look in the mirror check the neck and bingo that's what they wanted yeah and others who made a pretty well not to say irrational but swift decision they will be happy in the long run but it's
• 20:18
  they realize that, okay, it's done. Now what? Yeah. And they are a bit scared. Because the change is massive, it's instant. It's already there. You wake up, no way back, you live with the result. Yeah. Now that's, I think that's, I suppose, I really,
• 20:34
  important reality check to have before you have any sort of surgery, you know, know that you're going to live with this for the rest of your life. And it is, it's one of them things that, you know, you can't go back from once you make that decision and it needs to be the right decision.
• 20:49
  So it would take a lot of McDonald's to return. Definitely. I don't know if anybody has enough money in their pocket to, to, to get back to that. But, but yeah, I suppose what for you does responsible patient centered care look like in this, I suppose, space of cosmetic surgery and all that there, like what, what makes, and obviously you work for, for an orthostatic. So, you know, for you, what are the.
• 21:18
  those, I don't know, you mentioned there about cleanliness and stuff like that, but what should people look for in a reputable clinic, I suppose, is what I'm trying to say? So there are three stages that the patient goes through, the pre-op, then the stay in the clinic, and then the post-op. Okay. So during the pre-op, the conditions have to be clear. Usually it's not the surgeon who directly communicates with the patient. There are representatives. The surgeon lays his medical opinion,
• 21:48
  then the patient should have a separate consultation with the anesthesiologist. Well, the health questionnaire shouldn't include two or three questions. It should be a lot. The patients have to be transparent, not to hide anything. Pre-op testing is extremely important. And the patient can also ask the percentage of rejected patients
• 22:06
  There has to be a certain one, especially for clinics as big as ours. The system is very strict because we want good outcomes and we don't sort of stop before rejecting a person if we see elevated risks, because let's put it clear, it's elective plastic surgery has to be safe in the first place.
• 22:27
  Of course, most weight loss patients really need the surgery, but it's not life and death situation. Yeah. It's quality of life. So that's the pre-op. Then during the surgery, we always prescribe certain medications so patients can ask, how is their care planned when they are in the OR? And afterwards, what about compression? How many checkups they will have after surgery? Where will they live? Is it far from the clinic? What happens if this or that's?
• 22:56
  occurs, post-op care messages, medications after surgery. How about pain relief recommendations, logistics if they're traveling abroad, visits with the surgeon, how many tape changes. So here in the Nords, we have a pretty good system because most of our patients live one floor down from the inpatient. Yes.
• 23:16
  So if the patient has a question, they can always go up on floor and the nurses are always there to help. And if it's facial surgery, usually the patients stay one night in the ward.
• 23:30
  If it's abdominal surgery, it's two nights in the inpatient facility. And then everything what changes is just one slowdown. And even the apartments are visited by nurses daily. Yeah. So the patient can expect a nurse coming to their apartment every single day to check the drains, check compression. If the nurse sees anything abnormal, let's say some fluid accumulates around the wound, she'll raise the red flag and a visit with the surgeon will be organized. Okay.
• 23:57
  Safety comes first. Yeah. And then the logistics team takes the patient to the airport, but it doesn't end there because they have a contact. If they are worried, if they have questions, they can always take photos, describe the problem and send it to us. We'll respond as soon as possible. Yeah. And every patient should know that they can contact the rep, get a timely response and they can return to the clinic
• 24:18
  if they need any more care. My advice for patients is not to be extremely quick with flying home. Surgery is not sports. So we ask the patient to spend seven or eight full days in our country, in our apartments, before they fly. Because if anything bad happens, it usually happens within the first few days. For example, bleeding, which is
• 24:38
  in general complications are rare but if we would exclude one most common complications from this rare situation bucket then it would be bleeding okay if there's anything infectious so the bacterias don't stay there for two weeks waiting to cause infection it's straight there a few days after surgery fever is up and then we take a look at the wound yeah so the early post-op is the most important and it sums up so we have pre-operative planning
• 25:02
  We have the stay in the hospital, definitely with antibiotic prophylaxis. There are so many things scheduled and organized. Sometimes patients don't even know that they're getting additional prophylaxis, that they are getting separate medication to reduce post-op swelling, that they're getting, let's say, in case of tummy tuck surgery, they're getting a special analgetic injection straight in the muscle to decrease post-op pain for the first 24 hours. Yeah.
• 25:30
  I would need to take the list because during nearly 10 years of intensive surgical practice, we have been constantly building the system of how to make people's experience better and the whole process safer. Yeah. No, I think that's really reassuring, I think, for anybody that is considering it, you know, with nortostatics. And I think, you know, there's a lot...
• 25:52
  There's a lot that you've said there, and I think, you know, the key is do what's right for you, but definitely take into consideration and look at all, I suppose, the full care as a package and not just...
• 26:04
  you know, the surgery itself, you know, because, you know, you do have recovery time and stuff kind of ties into what I was going to say there in terms of, and I suppose you maybe really have answered it, but for somebody that was feeling really overwhelmed, you know, by their options in terms of clinics and surgeries and stuff, what first step would you recommend somebody take to be able to decide on what is right for them?
• 26:34
  consultation with a doctor. Yeah. Contact a few clinics and combine the outcomes. Yeah. And don't be surprised if recommendations differ. We usually joke that a visitor doctor is like going to a church. We have different ones. And the stories can differ vastly. Yeah. But when you actually get a conversation with a surgeon, let's say...
• 26:55
  Sometimes I consult people who have consultations elsewhere and they say, well, I've been there and they recommended something else. So you can discuss why was it so. Yeah.
• 27:04
  Maybe some clinics are slightly smaller. They tend to split the surgical plan into separate ones. There are many different strategies how clinics organize their work. Yeah. And only when people search, they discover these gems of knowledge. Yeah. And getting different quotes and different options from different clinics doesn't mean that there's anything bad with it. And all we can say that we can describe how we work. Yeah. Yeah.
• 27:33
  but there's nothing bad in doing things differently. No. And I think, ultimately, with what you said there before, like, reviews speak for themselves as well, and that too. So, you know, I think...
• 27:45
  that would factor into a big part of who you end up choosing to go with as well. You know, everything we've covered there is stuff that I know everybody listening will be really, really, really interested to listen to. I've had so many people ask me about, you know, Nord's aesthetics itself, you know, about surgery, loose skin. So I'm so excited to get this episode out there because this has probably been one of the most asked episodes.
• 28:10
  episodes to talk about. So, but yeah, but if anybody, I suppose, just to kind of wrap things up, if anybody was wanting to, you know, either book consultation with Nord's Aesthetics or, you know, even follow you on social media, where can everybody find everything? I know I'll link everything in the caption below the podcast. So if anybody is looking, all the links will be down there. But I just suppose for you just to be able to give yourself, you know, if people want to
• 28:40
  So I post my work on Instagram, dr.somulenos. That people can also find the results of the clinic in their webpage. And if they would like to book the surgery, so they should simply come back to clinic. They will be assigned with a personal representative
• 28:56
  And they can choose whichever surgeon they desire and proceed with this. Yeah. No, well, that is all great advice. Thank you so much, Dr. Samuel Linus, for joining me for this episode of the podcast. It has been incredible talking to you, incredible just getting your insight from a surgeon's point of view and being able to talk through a lot of
• 29:15
  you know, I suppose personal concerns of mine, but also concerns of everybody else in this community, weight loss community that have these questions. So thank you so much for giving up your time and sharing all that with us. So I'm happy to participate in this conversation. Thank you for making this information accessible for so many people. So you...
• 29:34
  you basically show not the front end but also the back end of this whole process yeah i think that's really important i think to to show the full i suppose not just the journey but the after effects of the journey as well i think it's so important i hope everybody goes and gives dr samuelinas following stuff on instagram and yeah all that's left for me to say is thank you again thank you