One of the nearly inevitable adverse effects of bariatric surgery is loose, excess, skin, and generally speaking, the only recourse for dealing with it is more surgery.Here in Canada, whereas bariatric surgery is covered by our healthcare system, with the exception of medically necessary panniculectomies, post bariatric surgery body contouring surgery is not. Putting aside both quality of life and aesthetics as rationale for skin removal surgery (and there are very reasonable arguments supporting both), here’s a new one (at least for me). If the outcomes of this small study hold true, body contouring surgery may dramatically enhance long term weight loss outcomes.The study was retrospective and it sought simply to compare the long term weights of those who had both body contouring surgery and bariatric surgery with those who only had bariatric surgery.Interestingly, the study found that while weight loss was comparable between subjects 2 years post bariatric surgery at 35.6% in the bypass/contouring group and 30.0% in just bypass group (with the 5% additional difference perhaps explicable simply on the basis of the weight of removed skin), with time, the just bypass group regained significantly more weight. By 5 years (the duration of the study), the bypass/contouring group were maintaining a 30.8% loss, while the just bypass group had regained such that they were only maintaining a 22.7% loss.Now this was a small study, and retrospective rather than randomized – in turn this might mean that the association is related to other factors (for instance socio-economics as body contouring is expensive and clearly those that can afford it, may well have other privileges and circumstances that might be beneficial to post-surgical weight management). Also worth noting that the 5 year losses of the just bypass group aren’t as high as seen in other bariatric surgery studies. Am looking forward to more research on this (ideally randomized), as for many post bariatric surgery patients, excess skin has a dramatically negative effect on their quality of life, and perhaps, if it was shown that body contouring surgery helped patients maintain their losses, insurers and governments might cover the procedure.