Losing a bunch of weight—whether it's through diet and exercise, surgery, or a combination of different approaches—isn't all glitter and smiling "after" photos. If you shed a significant number of pounds, having loose skin is normal—and extremely common. Also normal? Feeling a little bummed about it.
“This is a legitimate concern that patients have when seeking obesity surgery,” says Vivek Prachand, M.D., a bariatric surgeon and associate professor of surgery at The University of Chicago Medicine.
Why does loose skin after major weight loss happen? The maybe-a -little-downer (but real talk) truth: If you were in a larger body previously, excess fat likely stretched out your skin. Couple that with the fact that collagen and elastin (an elastic protein) in the skin naturally decrease as you age, and you've got a recipe for excess skin, explains Manish Shah, M.D., a board-certified plastic surgeon in Denver.
“There may not be sufficient elasticity for the skin to contract back down to your new, smaller body size,” says Constance Chen, M.D., a board-certified plastic surgeon in New York City.
Stretch marks are one sign of skin being, well, stretched past the point of no return: Once you see them, “it’s much more likely that significant weight loss will result in loose, hanging skin,” says Dr. Chen.
Does everyone have loose skin after major weight loss?
Nope—it’s not inevitable, says Dr. Prachand. But it’s also not easy to predict who is going to experience it, he says. He’s 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 weight loss doesn’t predict how much excess skin you may have,” he says. Other factors, like genetics, smoking (which degrades collagen and elastin), and sun exposure also play a role in your skin’s springiness.
It’s also normal to assume that losing weight quickly could cause sagging skin, but that’s not necessarily the case, either. “Sometimes, patients will consider doing surgery that doesn’t allow them to lose weight as quickly because of the fear of excess skin," says Dr. Prachand. "I understand these concerns, but there’s no strong evidence that how quickly you lose plays a role."
Will loose skin ever go away on its own?
It might, but that can take a long time.
“In general, it can take anywhere from weeks to months—even years,” says Dr. Chen. If after one to two years skin is still loose, it may not get any tighter, she says.
Is it possible to tighten loose skin without surgery?
Sadly, probably not. “Nonsurgical 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 instance, abdominal binders can help relieve back pain but do nada for skin. Compression garments can be worn to hold in excess skin, but they also won’t do anything to effect more long-term change.
Dr. Shah says that if you have small amounts of loose skin, then devices like Bodytite and Renuvion, both of which are minimally invasive body-contouring technologies, may help. “The best results come from surgery by far,” he says.
What is surgery for loose skin like?
Body-contouring surgery often involves a “tummy tuck” with arm, breast, face, lower body, or thigh lifts, per the American Society of Plastic Surgery.
Dr. Prachand and Dr. Chen say there are certain indicators they look for before recommending loose skin-removal surgery to patients:
- Patients have to be at least two years out from their weight-loss surgery.
- Their weight has to have remained stable for at least six months.
- Their BMI should ideally be under 30.
- Patients can't smoke.
- Patients with diabetes need stable blood-glucose levels.
Oh, and if you’ve had bariatric surgery to lose the weight, here’s a surprise: surgery to remove excess skin is tougher to recover from.
“Body contouring requires more overall body healing than obesity surgery itself, which is a minimally invasive procedure,” says Dr. Prachand. It’s important not to brush off the seriousness of the surgery thinking that it’s “cosmetic,” because it’s much more than that.
Indeed, you’ll likely need two to four weeks to recover, with full recovery taking as long as six months after surgery, says Dr. Shah. (That means you might not see the results you're looking for aesthetically until that point, either.)
“The pain for surgery is relative and only moderate in intensity,” he adds. Still, you probably will be too exhausted to go to work: During the first couple of weeks, a simpler daily routine is a must, says Dr. Shah.
You should also know going in that you may need touch-up surgery. “Scars need to be finessed, some skin loosens and needs to be retightened, and there may be asymmetries to perfect,” he says.
Long-term, this surgery may actually help you keep the weight off. 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 had bariatric surgery alone.
“After body contouring, the improvements in physical and social functioning helps reinforce healthy lifestyle changes,” says Dr. Prachand.
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