Paul Mason, once called the world's fattest man, has lost more than two thirds of his weight and now wants surgery to remove his excess skin.
The 51-year-old former postman from Ipswich, England weighed 980 pounds. After having gastric bypass surgery three years ago, he has slimmed down to a comparatively svelte 350 pounds. The dramatic weight loss has left Mason with huge folds of excess skin around his stomach, arms and legs.
According to the British newspaper The Sun, Mason must use a wheelchair because the excess skin hampers his ability to walk.
"It doesn't matter how much toning up you do, it's only going to get worse," The Sun quotes Mason as saying.
Dr. Jeff Kenkel, a professor of plastic surgery at UT Southwestern Medical Center in Dallas, said loose skin is a common side effect of weight loss surgery, not only because of the massive fat loss but also because the skin is so damaged from being overstretched that it loses its elasticity.
"It's like letting all of the air out of balloon -- it collapses and wrinkles," he said.
Kenkel estimated that Mason's weight loss has left him with as much as 50 pounds of baggy skin around the abdomen -- and up to 75 pounds of excess skin overall.
Removing the extra skin certainly could help improve Mason's mobility, Kenkel said.
"That much skin would affect his joints and his balance. If the apron of skin around his abdomen hangs below his knees, it would get in the way."
The skin is likely to cause other problems too, according to Kenkel. Sweat and dirt can get trapped in the folds, causing painful rashes and fungal infections. And, as Mason has complained, the excess weight causes the skin to tear and split.
Nevertheless, Britain's National Health Service has said skin removal surgery must wait until Mason's weight remains stable for at least two years. According to Kenkel, one to two years is a standard waiting period for this type of procedure.
Removal of overhanging skin is known as a pannusectomy, and doctors say it's considered reconstructive rather than cosmetic surgery.
"You have to lift up the skin, make an incision to free up the excess tissue and cut the skin out," said Dr. Constantino Mendieta, a plastic surgeon in Miami.
If there is a great deal of flabby, stretched-out skin, Mendieta said the surgeon would have to use a crane or devise their own special piece of equipment to hoist it upward and out of the way. In Mason's case, it will probably require several procedures to get the job done.
Recovery tends to be rough going as well. Mendieta estimated it takes at least 3-4 weeks before a patient is back on his feet and about six months before all the swelling goes down. Complications like wound breakage, blood clots and infection are common, partly because those who undergo this type of surgery are usually in poor health.
"It's a paradox, but because they've lost so much weight they are often malnourished and have other health problems like diabetes," he said.
However, Mendieta said the results are worth it because being free of the skin can make a world of difference to the patient, both psychologically and physically.
"Even though it's such a tough procedure and a long recovery, most find it's worth it," he said.
History of Eating Disorders
Mason has told various British press that he ballooned to his enormous size by eating 20,000 calories a day. He claimed he developed an eating disorder in his 20s as an emotional response to a break up, his father's death and the deterioration in his mother's health.
At the height of his disorder, he would gorge on an entire package of bacon, four sausages and four eggs complete with bread and hash browns for breakfast. For lunch he would eat quadruple portions of fish and chips along with two kebabs, followed by a roast dinner, curries or pizza and more chips in the evening. During the day, he'd snack on 40 packages of chips plus sausage rolls and pasties.
As his weight grew, he was left unable to stand or walk. He was finally left bedridden. He quit his job as a postman when his weight prevented him from completing his deliveries. Eventually, a specially-adapted house was built and home aides were brought in to care for him. British taxpayers have footed the bill for everything, including his medical care, to the tune of $2.5 million.
In 2009, he underwent gastric bypass surgery to reduce the size of his stomach. Now that he's shed more than 600 pounds -- and his title as the world's fattest -- he says he hopes he can someday travel, meet a woman and live a normal, healthy life.
Mason said he is desperate to lose even more weight but believes it won't be possible without the additional surgery.
"I am doing my part in getting my weight down and they now need to do their part and remove the excess skin," he said. "It is stopping me from being able to get on with my life."