Most individuals will want skin removal after massive weight loss. For sleeve and gastric bypass patients we can start the process for trying to obtain insurance approval about a year out from surgery. For Duodenal Switch patients the process can typically be started 1.5 years out from surgery as there is typically more weight that is lost for them. Any issues with skin fold irritation or infection should be documented by the primary care provider with documentation of prescriptions so that information can be gathered and sent to the insurance along with pictures documenting the amount of excess skin and the irritated skin folds. Not all insurance cover skin removal however the ones that do will typically want to see that the excess belly skin hangs below the pubic bone. If it does not, then they will not approve surgery. Even if it does, they sometimes will not approve the surgery and the process can take some time. Medicare never approves skin removal. There are self-pay options that can be discussed with my office staff that include medical loans and different payment options if you choose to pursue skin removal on a self-pay basis. It is not vain to want to have your excess skin removed. Now that you have accomplished your weight loss and improved health goals, there is nothing wrong with wanting to look better and have your clothes fit properly and to not have your excess skin be cumbersome during exercise or daily activities. Don’t feel ashamed or judge yourself for wanting to have your excess skin removed. It is perfectly natural and acceptable.