NHS refuses to remove saggy skin of Buckinghamshire man who lost 19st Paul Thorn lost 19 stone through an NHS gastric bypass operation in 2007 Underwent further operations to get rid of unsightly excess skin Hoped for further op to remove skin from arms, bottom and pubic area Says skin has left him suicidal, unemployed and unable to have a girlfriend Rubs, bleeds and means he has to 'tuck' skin into trousers to go to the loo Local CCG have refused surgery as they say it is a cosmetic procedure Cite previous Body Dysmorphic Disorder diagnosis and said op won't help Mr Thorn says recent doctor's assessment agrees defect is not 'imagined' A man has been refused an NHS operation to remove his excess skin after weight loss surgery -despite being so depressed he has tried to kill himself four times. Paul Thorn, who went from 30 to 11 stone following a gastric bypass operation, has been refused the operation. Instead the 30-year-old claims and has been told his issues with his appearance are 'all in his head'. Mr Thorn lost the weight following his operation on the NHS in 2007 and was initially happy with his appearance. Paul Thorn, 30, used to weigh 30 stone but lost 19 stone after gastric bypass surgery. He is upset he has been refused an operation to remove excess skin caused by the weight loss, which rubs, bleeds and leaves him unable to leave his house or have a relationship The excess skin is so bad he has to lift it to use the toilet and tuck it into his trousers when he gets dressed, and has led him to attempt suicide four times this year, Mr Thorn says Here he is pictured before (left) and after (right) the NHS gastric bypass operation in 2007 after which he lost 19 stone. Initially, he was happy with his appearance, but soon became so depressed by his excess skin But the dramatic weight loss left him with unsightly excess skin which caused his self-esteem to plummet to an all-time low, leaving him too embarrassed to leave the house, get a job, or have an intimate relationship. Mr Thorn paid for a tummy tuck operation at a private clinic in Poland and the NHS later funded further procedures to remove excess skin from his thighs and chest. Mr Thorn hoped the NHS would fund a final operation to remove excess skin from his arms, bottom and pubic area. 434 shares But despite numerous applications the NHS Aylesbury Vale, Clinical Commissioning Group (CCG) have supported decisions to refuse the surgery made by the Individual Funding Request team, Clinical Triage Panel and Case Review Committee. They recently wrote to Mr Thorn to confirm their support of the decision not to fund an operation to remove his remaining excess skin citing a previous diagnosis of Body Dysmorphic Disorder - an imagined defect in appearance - as one of their reasons. But Mr Thorn said the issues with his appearance are far from imagined as his excess skin rubs, causing sores and bleeding. Losing weight will be the answer to many people's prayers. But they may not realise dramatic weight loss can have a deeply distressing side-effect: excess skin. This hidden downside of losing weight occurs as a result of damage to the deeper layers of skin, the dermis, which contains two proteins: elastin, which helps it retract, and collagen, for strength. When the skin is stretched too much through weight gain, these proteins tear and break, resulting in a loss of elasticity and strength. Unfortunately, while losing weight causes the fat cells to lose their fat, the skin cannot retract. It is linked unpleasant health problems, from infections to back pain. Doctors say the excess skin after weight loss is the same skin damage that occurs during pregnancy - but all over the body. Factors that affect how much skin is left include age, how quickly the weight was lost (gastric bands are slower than bypasses, for example), and, for women, the number of children she has had. Many patients patients develop an "apron" of skin around the abdomen, and loose skin under the arms, chest and inner thighs. This excess skin can cause a range of medical problems. One of the most common is intertrigo - a bacterial, fungal, or viral infection that occurs often due to the difficulty in keeping these folds of excess skin clean and dry. Patients also find the folds of skin make it difficult to exercise. Excess skin is a problem particularly for people who undergo bariatric (weight loss) surgery. He said it is so bad he has to lift it to use the toilet and tuck it into his trousers when he gets dressed. He said he has become so depressed by his excess skin and his fight to have it removed he had tried to commit suicide on four occasions in the last year alone. Mr Thorn said: 'It's not just the excess skin that's made me depressed but the fight to have it removed. 'I'm obviously happy to have lost the weight but being left with all this excess skin makes me feel as though I'm still fat. 'I'm still so self-conscious about my body I'm too embarrassed to let people see it. 'I'm too embarrassed to go swimming and I feel too embarrassed to meet a woman as I'm scared she'll be repulsed by my body. 'I'm only 30 but I feel like I have the body of an elderly man. The excess skin chafes, I get sores and have to use creams to soothe them. It gets in the way when I want to go to the toilet, sometimes I lose my testicles within all the skin, it is that bad. In a letter to Mr Thorn following his appeal against their decision, the Aylesbury Vale Clinical Commissioning Group said Mr Thorn was physically healthy and they therefore did not see fit to alter the previous decision not to fund the operation to remove his excess skin. Despite Mr Thorn's claims surgery to remove his excess skin would prevent him from wanting to take his own life they said an application for surgery based on preventing suicide was not one they could accept. They added they could not demonstrate further surgery would improve his mental health, wellbeing social integration or improved self-image. The letter went on to cite a previous diagnosis of Body Dysmorphic Disorder (BDD) and approved a referral for Mr Thorn to see a psychiatrist who specialises in BDD. But Mr Thorn said he was unhappy with their decision as it didn't take new evidence into consideration including a recent examination from psychiatrist Dr Jessica Gibson from Aylesbury Vale Mental Health Services, who said in her opinion he did not meet the criteria for BDD. In a letter to Mr Thorn and his GP, Dr Gibson wrote: 'Having examined Paul's excess skin today, it is my opinion that Paul does not have Body Dysmorphic Disorder. There is clear evidence of excessive skin on his arms, hip and buttock regions and pubic area. These have a significant impact on his self-esteem, confidence and most importantly his function. He needs to lift the excess skin in the pubic region in order to urinate. He believes it will prevent him from having an intimate relationship with a woman. I therefore do not believe that there is an imagined defect in appearance. But the local CCG have refused his application, citing a previous diagnosis of Body Dysmorphic Disorder (BDD) - where a person constantly imagines defects in their appearance Mr Thorn said, he wishes he could afford the procedure himself but his confidence is so low he's unable to find work and no longer knows where to turn. He said: 'They have cited my mental health and suicide attempts as a reason not to fund the operation but it is the excess skin and the fight to have it removed which is causing the depression. Having this excess skin has left me with no confidence, I feel too embarrassed to go out or meet anyone. 'If I had the skin removed I'd have the confidence to go out to work and maybe meet a girlfriend. Without it I could live my life again. I don't want to lose my thirties like I have my twenties - fighting for this skin to be removed. If I was given funding for the operation I could go on to live a good life but until then I am suffering and will carry on suffering for the rest of my life. A spokesperson for Aylesbury Vale CCG said: 'The CCG is aware of this case, but we do not discuss individual details. We can advise however, that aesthetic surgery for the removal of redundant skin after weight loss programmes or bariatric surgery will not normally be funded. Aylesbury Vale Adult Mental Health Services added they could not comment on individual cases as it would breach patient confidentiality. To find out more visit Mr Thorn's Facebook page.