Abstract
Although weight loss surgery (WLS) is currently the most effective management approach for those with a Body Mass Index greater than 40, many patients are left with excess skin and a sense that they are aesthetically worse than they were before. This in-depth qualitative study explored patients' (n = 7) experiences of having plastic surgery post WLS. Thematic analysis revealed three broad themes; (i) a journey which involved investing time, energy and money; (ii) goals such as health, improved body esteem, choice and a desire to feel normal; (iii) barriers to achieving these goals including shame, guilt and self-criticism. Transcending these themes was a gradual recognition that their problems should not be treated with a surgical approach alone but were more psychological in nature, which emerged through shifting expectations that could never be met and an acknowledgement that their physical shape was not the key cause of a negative sense of self. Accordingly, by the end of their surgical journey they began to question whether they had set out on the wrong journey with the wrong goals in mind which is discussed in the context of social comparisons and the need for coherence between beliefs about causes and solutions. © 2014 © 2014 Taylor & Francis.