In recent years, as weight loss surgeries have been on the rise, so have procedures like tummy tucks, breast lifts, thigh lifts and upper arm lifts, which are usually associated with significant weight loss, according to new data from the American Society of Plastic Surgery (ASPS).

“We’re seeing exponential growth in concurrent surgeries, and we’re realizing that this is really a continuum of care for these patients,” said ASPS President Dr. Scot Glasberg, a private-practice plastic surgeon based in Manhattan, New York.

“Hanging skin can be very painful and get in the way for daily activities,” Glasberg told Reuters Health by phone.

Since 2000, ASPS has been reporting a comprehensive estimate of cosmetic and reconstructive surgeries performed by board-certified doctors in the U.S., including ASPS member surgeons, with data gathered via mailed questionnaires.

In the 2014 report, they estimate that overall, 1.7 million cosmetic surgical procedures were performed, a slight increase from 2013 but an overall decrease from 2000. Breast augmentation has been the top procedure since 2006.

Breast lifts were up 3 percent since 2013 and 75 percent since 2000, with an estimated 92,724 performed in 2014. Among people who experienced massive weight loss, the procedures increased by 10 percent just since 2013.

Thigh lifts and tummy tuck procedures increased by five percent between 2013 and 2014 and more than 70 percent each since 2000.

With more than 16,000 estimated upper arm lifts in 2014 compared to about 300 in 2000, that procedure had increased by more than 4,000 percent over the 14-year period.

These procedures were all up specifically after massive weight loss as well.

According to the American Society for Metabolic and Bariatric Surgery, there were almost 180,000 weight loss surgeries in the U.S. in 2013.

It’s important for bariatric surgery patients to have initial consultations including discussions about how weight loss surgery “is not a one and done deal,” Glasberg said.

“Bariatric surgery has become much more common over the past decade,” said Dr. Justin B. Dimick, chief of minimally invasive surgery at the University of Michigan in Ann Arbor, who was not involved in collecting the new data.

“As these patients lose weight they may have excess ‘loose’ skin and need plastic surgery procedures to remove it a year or two later,” Dimick told Reuters Health by email.

Roughly one in five people who have weight loss surgery will need body contouring as well, he said.

He recommends waiting until weight loss is complete before assessing whether a patient is a good candidate for skin removal procedures, and then only performing one at a time.

“Each operation has unique risks, so these add up when you do multiple procedures at the same time,” Dimick said.

Currently, insurance covers most bariatric surgeries but covers less than half of post-weight loss body contouring procedures, Glasberg said.

Not all patients can afford to pay for body contouring out of pocket. The price tag varies widely by region and provider, but can run up to $20,000 per procedure in more expensive areas like New York and Beverly Hills, he said.

“I feel bad for patients who can’t because they are left to live with this other issue after the weight loss,” Glasberg said. Obese people may have lived with taunting for their weight for many years, and can continue to be haunted by body image issues exacerbated by hanging skin, he said.

Those who can get body contouring after weight loss are some of the happiest patients in his practice, he said.

Patients pursuing weight loss surgery and body contouring should make sure they see a board certified plastic surgeon at an accredited facility, he said.