Loose skin after weight loss is completely normal, but there are ways to fix it

    Abdulaziz Sobh

    Losing a lot of weight, whether, through diet and exercise, surgery or a combination of different approaches is not all shine and smiles "after" the photos. If you lose a significant amount of pounds, having loose skin is normal and extremely common. Also normal? Feeling a little bad about that.

    "This is a legitimate concern that patients have when they seek surgery for obesity," says Vivek Prachand, M.D., a bariatric surgeon and associate professor of surgery at the University of Medicine in Chicago.

    Why does loose skin after significant weight loss occur? The truth of maybe a little less serious (but a real conversation): if you were previously in a larger body, excess fat is likely to spread your skin. Combine that with the fact that collagen and elastin (an elastic protein) in the skin naturally decreases as you get older, and you have a recipe for excess skin, explains Manish Shah, MD, a plastic surgeon certified by meeting in Denver.

    "There may not be enough elasticity for the skin to contract again to its new and smaller body size," says Constance Chen, M.D., a board-certified plastic surgeon in New York City.

    Stretch marks are a sign that the skin is, well, stretched beyond the point of no return: once you see them, "a significant weight loss is much more likely to result in loose, hanging skin," says the Dr. Chen

    Does everyone have loose skin after significant weight loss?
    No, it is not inevitable, says Dr. Prachand. But it is not easy to predict who will experience it, he says. He has had some patients who have lost 200 pounds in a year after obesity surgery and have very little excess skin. On the other hand, some have lost as little as 60 pounds and have more.

    "The magnitude of the weight loss does not predict the amount of excess skin you may have," he says. Other factors, such as genetics, smoking (which degrades collagen and elastin) and sun exposure also play a role in skin elasticity.

    It is also normal to assume that losing weight quickly could cause sagging skin, but it is not necessarily the case. "Sometimes, patients consider having surgery that does not allow them to lose weight so quickly due to fear of excess skin," says Dr. Prachand. "I understand these concerns, but there is no solid evidence that I lose plays so quickly. A role."

    Will loose skin ever disappear on its own?
    It may be, but that can take a long time.

    "In general, it can take weeks to months, even years," says Dr. Chen. If after one or two years the skin is still loose, it may not tighten more, she says.

    Is it possible to tighten loose skin without surgery?
    Unfortunately, probably not. "Non-surgical methods that help tighten the skin will generally not be effective enough to tighten the amount of loose skin that occurs with massive weight loss," says Dr. Chen.

    For example, abdominal binders can help relieve back pain, but they do nothing for the skin. Compression garments can be worn to maintain excess skin, but neither will they do anything to affect the change in the longer term.

    Dr. Shah says that if you have small amounts of loose skin, devices such as Bodytite and Renuvion, which are minimally invasive body contour technologies, can help. "The best results come from surgery by far," he says.

    How is surgery for loose skin?
    Body contouring surgery often involves a "tummy tuck" with lifting arms, breasts, face, lower body or thighs, according to the American Society of Plastic Surgery.

    Dr. Prachand and Dr. Chen say there are certain indicators they are looking for before recommending skin removal surgery to patients:

    Patients must be at least two years out of their weight loss surgery.
    Your weight must have remained stable for at least six months.
    Your BMI should ideally be less than 30.
    Patients cannot smoke.
    Diabetes patients need stable blood glucose levels.
    Oh, and if you've had bariatric surgery to lose weight, here's a surprise: surgery to remove excess skin is harder to recover.

    "Body contouring requires more general body healing than obesity surgery itself, which is a minimally invasive procedure," says Dr. Prachand. It is important not to ignore the seriousness of the surgery thinking that it is "cosmetic", because it is much more than that.

    In fact, you probably need two to four weeks to recover, with a total recovery of up to six months after surgery, says Dr. Shah. (That means you may not see the results you are looking for aesthetically so far, either).

    "The pain for surgery is relative and only moderate in intensity," he adds. However, you are probably too tired to go to work: during the first few weeks, a simpler daily routine is a necessity, says Dr. Shah.

    You should also know that you may need a touch-up surgery. "The scars must be fine, some of the skins loosen and must be tightened again, and there may be asymmetries to perfect," he says.

    In the long term, this surgery can help you maintain weight. Research in plastic and reconstructive surgery found that patients who received body-contouring surgery were more likely to maintain their weight loss, compared to those who underwent bariatric surgery alone.

    "After body contouring, improvements in physical and social functioning help reinforce healthy lifestyle changes," says Dr. Prachand.


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