Changes After Weight Loss Surgery at Advanced Surgical Associates

Hair loss after bariatric surgery is very common and can occur in up to 40% of patients. We lose hair every day as part of a natural growth cycle, but many other external factors including stress, genetics, environment and diet can also cause hair loss in both men and women. Losing hair after weight loss surgery is most often caused by the initial, drastic reduction in nutritional and vitamin intake. The sudden change in calorie and nutrient absorption is a shock to the body.

Of course, pattern baldness (a genetic condition) is unavoidable. We often recommend adding Biotin to your vitamin regimen.

Why Might I Lose Hair?

The body is a well-tuned machine. However, as we get older and our lifestyle patterns change, that delicate balance can be thrown off. This can result in overeating, under exercising and other behaviors that are not optimal for good health in adulthood.

Bariatric surgery aims to re balance the body, at least with regard to caloric intake and weight. It does so by restricting the number of calories that can be consumed or absorbed into the body.

Vitamin and Mineral Deficiency

Weight loss surgery can cause protein and iron deficiencies in your diet, especially if you do not stay abreast of your nutritional intake. As such, hair can grow back shorter and thinner as the normal hair cycle is disrupted and the root is weakened.

Hormone Fluctuations

Weight loss also causes changes in hormone levels (usually for the better, but changes nonetheless). These fluctuations can cause hair growth to be altered or stunted. After significant weight loss, the body will continue to adjust its hormone balance until it stabilizes at more normal levels when the patient reaches their weight loss goals.

Caloric Restriction

In the case of an obese bariatric patient, the body will be used to consuming far more than it needs. This means that after bariatric surgery patients will be “depriving” their bodies of half or more of their usual caloric intake.

The result is a shock to the body as it struggles to regain its caloric equilibrium with the new healthier lifestyle. This shock may, in turn, cause temporary hair loss and nutrients and vitamins are routed to other parts of the body.

Surgical Trauma

The trauma of surgical procedure itself can also contribute to hair loss. Surgery in and of itself causes a temporary disturbance to the body that may also cause hair loss. Every person’s body reacts to traumatic effects in different ways, making causes difficult to pinpoint and prevention virtually impossible.

Non-Surgery-Related Causes of Hair Loss

It is also important to remember that there are other reasons for hair loss that should be considered along with typical post-surgical issues.

Stress can cause hair loss as it affects many of the body’s normal functions. This can be heightened by obesity. One of the lifestyle changes on which a patient needs to focus includes stress reduction. Lowering stress levels may prevent some hair loss or thinning.

Genetic baldness, known as pattern baldness, can also be a contributing factor at virtually any age in adulthood. Patients should learn more by speaking to their physician. No matter what the cause of hair loss, it can be very stressful to see hair falling out.

When Might I Lose Hair?

Typically, if they lose any at all, patients can expect to start losing their hair between three and six months after surgery. Some patients may lose it sooner and some much later. On average, it will start to regain its former thickness about a year to 18 months after surgery when the patient’s weight and eating patterns have stabilized.

Gastric bypass patients typically have a higher chance of losing hair than gastric banding or gastric sleeve patients as the restriction and malabsorption of calories is greater.

Preventing Hair Loss after Weight Loss Surgery

Hair is a complex part of the human anatomy. Hair follicles are sturdy, but also susceptible to many of the lifestyle and behavioral changes that we experience over the course of our lifetimes. As such, predicting hair loss after weight loss surgery is difficult at best. Further complicating the issue is the possibility of other factors that may be contribute to hair loss that are unrelated to weight loss surgery. Mitigating weight loss surgery-caused hair loss starts with a well-planned post-surgical diet that follows the recommendation as outlined in our post-op guide.

Every patient will have a custom diet plan made specifically to ensure they receive the proper balance of vitamin and nutrient levels for their bodies and lifestyle. Following this post-surgical plan may not prevent hair loss altogether but it may shorten the duration of hair loss or reduce the amount of hair lost.

Patients should understand that a great deal of success after weight loss surgery revolves around learning about their bodies and understanding what they need to stay healthy. They must help themselves strike the right balance between weight loss and health – everything in moderation.

Patients should also be mindful of rushing their weight loss efforts by eating less than is prescribed to them in their post-surgical diet regimen. It is easy to eat less and less as the numbers on the scale drop, but doing so can lead to serious malnutrition as well as extended periods of hair loss. Further, a starvation or extreme low-calorie diet may not have any benefit to long term weight loss —in fact it may be counterproductive. Ultimately preventing hair loss after weight loss surgery may be impossible, but there are ways to help mitigate its effects.

Treatments for Hair Loss

Many men look at their hair as a sign of their youth and virility. There is, though, a certain degree of expectation that hair will thin or fall out as a man gets older. Hair loss can have a bigger impact to women who often expect their hair to remain thick and full throughout their lives.

Because of the expectation of a full head of hair, many patients often rush to start a hair loss treatment program to try to stem or reverse the issue. Without knowing the true cause of hair loss, treatment may be ineffective, leading to frustration and a waste of money. Most forms of hair loss result from issues that cannot be corrected long-term by over-the-counter products, gels or creams. For example:

• Stress-related hair loss cannot be reversed or improved unless the stress itself is addressed.
• Weight loss surgery patients should hold off for a year or two after surgery to begin addressing any lingering hair loss that they experienced after surgery. The body requires time to heal and stabilize after surgery.
• Hormonal imbalances, often caused by obesity, can also contribute to hair loss and this may be more significant with age. Hormone replacement therapy may be effective, but has risks.
• Pattern baldness and genetic predispositions are also common causes of hair loss, especially in older adults. There is nothing that can reverse this condition. 

There are many options to stem hair loss, including hair transplants. However, before pursuing any of them, we strongly urge patients to speak to our office.

We understand that hair loss, no matter what the cause, can be alarming. Since hair loss related to bariatric surgery is a temporary condition, we do not recommend altering your prescribed routine or taking additional supplementation to avoid or reverse hair loss. You must be especially careful not to take minerals such as iron and zinc or vitamins in excess as this could cause a dangerous overdose. We often recommend adding Biotin to your vitamin regimen.

Together we can devise a plan to understand the cause of the hair loss and create an effective treatment protocol.

Any time the skin is stretched by excess weight, extra or loose skin after subsequent weight loss is common. The degree and amount of excess skin depends on various factors.

The more weight the patient loses after surgery the more likely they are to have excess skin. As the human body becomes obese, the skin is stretched, often beyond its elastic limit – that’s the cause of stretch marks. Once the elasticity of the skin is compromised, it will no longer be able to return to its former tightness.

How quickly the weight is lost will also determine the amount of excess skin. The quicker the weight loss, the greater the likelihood for loose skin. Gastric bypass patients may find that they experience greater volumes of excess skin because of the dramatic weight loss in the first few months after surgery. 

As we get older, the elasticity of our skin is reduced and naturally becomes less taut – weight loss or not. The older the patient, the greater the likelihood that there will be hanging skin. Genetics play a part, too.

Considering the above, as well as the patient’s ability to heal, all we know is that it is a combination of factors that determines how much excess skin the patient will have.

What Can I Do About Extra Skin?

While there is rarely a medical necessity for the removal of excess skin, many weight loss surgery patients opt to undergo a cosmetic surgical procedure called body contouring. This procedure consists of first removing most of the excess skin and second tightening the skin that remains. The procedure may include a breast lift, abdominal lift, buttocks or thigh lift or whole-body lift. These procedures are generally considered cosmetic or aesthetic and are rarely covered by insurance. While the aesthetic benefits can be immense, this is still surgical procedure that comes with risk. We caution our patients to fully understand the risks and benefits of cosmetic surgery.

Cosmetic Surgery after Weight Loss Surgery

The only way to eliminate excess skin entirely is through cosmetic surgical procedure. Various surgeries exist to assist weight loss patients regain the aesthetic and skin tightness they expect of their newly slimmed bodies. These surgeries include:

• Body contouring
• Tummy tucks
• Arm, leg or thigh lifts
• Breast lifts (sometimes combined with augmentations)

Patients must be very careful about cosmetic surgery after weight loss surgery, as even seemingly minor procedures come with risk. There are several considerations to make before undergoing a cosmetic procedure, including:

• You should not have a cosmetic procedure for at least 18 months to two years after your weight loss procedure. It is important that your weight stabilizes before you undergo a cosmetic procedure. Significant weight fluctuations can reverse a successful aesthetic procedure
• Be sure that you will not become pregnant after your cosmetic surgery. Once again, a pregnancy, while very exciting, can create yet another excess skin problem.
• Cosmetic procedures are not meant for weight loss.

Your cosmetic procedure will likely not be covered by insurance as it is virtually always considered an elective or aesthetic procedure. Please be aware of the total cost of your cosmetic procedure beforehand.

It is advised that body contouring only be performed when the patient has stabilized at their goal weight. If the patient were to lose more weight after body contouring the potential for more excess skin to develop is likely. Similarly, if the patient regains some of their weight, the elasticity of the newly contoured skin will be compromised and when they lose that weight, they will develop sagging skin.

We encourage you to speak to our office before you undergo a cosmetic procedure to ensure that you are ready to undergo another surgery and that your bodyweight has stabilized.