Jacqueline Adan knows she made the right decision to have skin removal surgery after losing 350 lbs., but she didn’t expect the months of pain that would come with it.

After four years of hard work, Adan was thrilled to lose well over half her weight — at her highest in 2012, she weighed over 500 lbs. — but she was dealing with body dysmorphia because of her excess skin.

“When I got down to my lowest weight and had all that loose skin I was still being made fun of, and when I looked in the mirror it was hard to see anything but all this extra skin,” the Montessori preschool teacher, 31, tells PEOPLE. “You still feel fat and you still can’t fit into clothes because the skin won’t fit. I felt proud of myself and I knew I had lost 350 lbs., but when I looked in the mirror I saw my body completely differently. It was hard to see anything but that same, overweight girl.”

So in June 2016, she started the long process of skin removal surgery. While it’s often seen as an instant fix, Adan’s experience shows how difficult it can be. Her first surgery was a lower body lift, followed by upper body and arm lifts five months later. Then she had more skin taken off in June 2017, and had skin removal on her legs in Jan. 2018.

“People don’t fully understand what goes into this process. They think it’s just cosmetic, and it’s hard for me to hear that,” she says.

The surgeries left Adan extremely swollen and in severe pain, especially her most recent leg surgery.

“I think because I had so much weight taken off my legs during the surgery, and because I had back to back surgeries, my body didn’t react well this time,” she says. “I dealt with a lot of swelling, and my body is hanging on to a lot of fluid.”

“This is why I wanted to talk about my body dysmorphia — I’m seeing myself in the mirror and I’m seeing myself a lot bigger than I have, and it’s hard to make that distinction that it’s not weight gain, it’s just fluid,” she adds. “Now that I’m swollen, I feel like everyone’s noticing.”

But with each surgery — Adan expects to undergo about three more after those first five — she’s learning more about the process, and figuring out how to push through.

“I’m so glad that I did it, not just for my physical health but for my mental health and wellbeing. But they are very difficult procedures,” she says. “Recovery was a lot, and I felt like each one, you had to dig down deeper and deeper to find the strength to keep continuing to heal and move forward. There are times at home when you’re in so much pain and wondering how this could ever get better, how could this pain ever go away? You can’t move, after the leg ones. It’s hard to walk; it’s hard to go to the bathroom. You have to dig down deep and find that strength to recognize that this isn’t going to last forever and it’s going to get better and better.”

But Adan wants people dealing with skin removal, or body dysmorphia, or weight struggles, to know that they’re not alone.

“I hope that no one ever feels ashamed or embarrassed if they are struggling with an eating disorder or body dysmorphia or with their own body image or self love,” she says. “For me, actually admitting I needed some help and realizing that I was struggling and accepting what was going on and admitting it was exactly what I needed to overcome this and continue to move forward. No matter what you are going through or struggling with, it is okay to ask for help!”