So two years after a successful stomach-reduction operation caused her weight to plummet from 323 pounds to 165 pounds, Jessica, now 29, decided to have a surgeon resculpt her body to better fit her new weight.

In 2005, surgeons performed 70,000 body-contouring procedures for patients who'd lost massive amounts of weight. That's a 25 percent increase from a year earlier for a procedure that was practically unheard of a decade ago, according to Dr. Jeffrey Kenkel, a Dallas plastic surgeon who chairs the post-bariatric surgery task force for the American Society of Plastic Surgeons. More than 90 percent of the patients are women.

The Looses realized they would be lucky to claim even a small fraction of the costs of body resculpting through their medical insurance. Some patients get limited coverage if their excess skin is chronically irritated or infected. But in most cases, the surgery is considered cosmetic.

Patients can pay up to $50,000 out of pocket. Plastic surgeons typically insist on cash upfront or offer an outside financing plan -- essentially a surgical credit card.

At first the Looses talked about getting three procedures for Jessica and one for Leo, with each surgery lasting about six hours. But the high cost forced them to scale back, at least for now, to two surgeries for Jessica at a cost of $26,000.

Jessica looked at photos of previous patients and discussed the downsides with her Bellevue, Wash., plastic surgeon, Dr. Sepehr Egrari, before deciding to undergo the surgery herself last year.The biggest risk was blood clots. Kenkel said he's still collecting data, but estimates 3 to 8 percent of patients develop clots, often in their legs. Treatment can require patients to take blood thinners for up to six months. In rare cases, lung clots can cause death.

"We make their contour better in exchange for scars," Kenkel said. "Sometimes the scars are long and are going to be in areas where they may be visible."

First up for Jessica was a lower-body lift to remove her belly rolls. One rather odd risk: She'd lose her belly button if doctors damaged the delicate "stalk" keeping it attached.

This time, Egrari sliced and peeled back the skin from each breast as if it were an orange, trimming away some fat underneath. He continued the incision under her arms, removing a large wedge of skin. As he prepared to stitch Jessica back together, he used a circular metal ring to cut new holes for her nipples at a point higher up her chest.

Despite not undergoing the third surgery, which would have reshaped her legs and thighs, Jessica was impressed with her new look. Her belly was flat, her arms no longer flabby and her breasts much improved. In the months afterward, the scars that outlined her new contours began to fade a little.

Yet she felt unsatisfied. Her body, it seemed, still had many flaws. She hadn't reached the idealized image she'd sought. It wasn't a surgical problem, she said, rather a problem of perception.

"Some patients who enter the whole process have a mental image of what they used to look like, and oftentimes it's hard to get to that mental image," he said. "Their skin is permanently damaged by obesity and has lost its elasticity."

Today, looking back on their three-year weight-loss journey, Jessica and Leo say the changes on the inside have been as great as the physical transformation. Both say they feel things more acutely now and have shed the feelings of detachment they experienced when they were overweight. The experience has strengthened their relationship.

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