Losing weight, and keeping it off, can be hard enough. But many people who achieve their weight loss goals can then be faced with another factor: loose, baggy skin. So what can you do about it? We spoke with Edward Malin, MD, a plastic surgeon with the Plastic and Reconstructive Surgery and Vein Center at Beth Israel Deaconess Hospital in Plymouth, Massachusetts. Here's what Dr. Malin said works, what doesn't, and what people should know before they consider surgery.
Excess skin isn't a problem for everyone who experiences weight loss. But the more weight you lose, the faster you lose it, and the longer you were overweight, the more likely you are to experience this side effect. Plenty of people who have lost weight come to accept and love their skin and stretch marks. But for others, loose skin—which often occurs around the arms, legs, neck, and midsection—may be uncomfortable or even painful.
In general, the skin has some degree of elasticity—known as skin turgor—that allows it to expand and contract around a person's changing body frame, Dr. Malin said. But that degree of elasticity is different for everyone and depends partially on their overall health and the health of their skin.
It also depends on how much weight a person loses and how fast they lose it. "We don't really understand completely why some people's skin contracts better than others, but we do know that excess skin is a common problem for people who lose more than, say, 20 or 30% of their body weight," Dr. Malin explained.
People who undergo bariatric surgery and lose a large amount of weight all at once are likely to have some excess skin afterward, Dr. Malin said. For example, a European Journal of Plastic Surgery article published in January 2022 noted that individuals who undergo bariatric surgery (up to 90%) have excess skin following the procedure. Women can also experience excess skin around their stomach after losing weight post-pregnancy—especially if they gave birth to multiples.
But excess skin can also happen to people who lose a lot of weight through improved diet and exercise. "We do believe that a slower weight loss is less likely to cause this because it allows the skin time to contract," Dr. Malin explained. "But we see patients who have lost weight quickly, and patients who have lost weight over time, so there's really no guarantee."
Non-surgical Methods To Treat Excess Skin
So, are there some non-surgical methods I can use to get rid of that extra skin? "The short answer is probably not," Dr. Malin said. "If a patient really wants to get rid of those prominent skin folds that won't go away no matter how much they exercise or how they eat, there aren't many non-surgical things that can be done."
Drinking lots of water and staying hydrated can certainly help keep skin healthy, Dr. Malin added. Not smoking, keeping skin protected from the sun, and using moisturizer are all also important for improving skin health and elasticity—which may also improve the appearance and help minimize things like wrinkles.
But none of these techniques will get rid of extra skin folds due to weight loss, Dr. Malin said. Nor will specially marketed creams, supplements, or exercises targeted at certain body parts. Strength training may help build muscle underneath, but it can't shrink skin that's already been stretched out.
Surgery for removing excess skin, also called skin excision, or body contouring should be performed by a board-certified plastic surgeon. These procedures involve large incisions, so patients are generally put to sleep using general anesthesia.
The extent of the procedure, and the recovery time needed, depends on the body parts involved. Common surgeries for skin excision focus on:
- The abdominal area—abdominoplasty, also called a tummy tuck
- The upper arms—Brachioplasty, or arm lift
- Breasts—for both women and men
Some patients opt for a full "lower body lift," Dr. Malin said, which tightens the skin around the thighs and buttocks with an incision that runs around the waist.
Some people, in addition to excess skin, also have extra pockets of fat that won't budge—no matter how much they diet or exercise. In these cases, Dr. Malin said, liposuction (a procedure that removes fatty tissue) can also be performed along with skin excision.
What Is the Recovery Like?
Skin excisions that involve larger incisions, especially those around the midsection, may require several days in the hospital. On the other hand, a patient undergoing an arm lift could be sent home that same day. Body contouring procedures could also fall under either circumstance.
"The recovery time for an arm lift includes compression garments and limited activity—lifting no more than 20 pounds, for example," Dr. Malin said. Most skin incisions take six to eight weeks to heal, and healthcare providers and patients should follow up closely with each other during this time.
Healthcare providers also won't perform more than one or two skin excision surgeries at one time, so someone who's lost weight all over may need multiple surgeries, months or even years apart, to remove all of the excess skin that's bothering them.
These procedures can be pricey and often aren't covered by insurance. However, carriers may approve some procedures if healthcare providers and patients can make the case that excess skin folds were causing pain, rashes, or infections.
It's not a good idea to undergo surgery for excess skin if you're still in the process of losing weight—or if there's a good chance you'll gain it back right away. "We look to see that a patient is at a healthy weight based on their body mass index or based on their lifestyle and how they feel," Dr. Malin explained. "I want a patient to be at that stable weight for about six months since their weight loss, which gives the body time to get back to equilibrium."
Sometimes, a plastic surgeon may refer you to a nutritionist or a personal trainer, to help with weight loss, before they address their excess skin. Healthcare providers will also consider the patient's overall health when determining whether they're a good candidate for surgery.
Women who might still want to have children should not have any type of skin-removal procedure around their midsection. When a patient gains back weight after skin excision surgery—either because of pregnancy or for other reasons—"the effects can be somewhat unpredictable," Dr. Malin said. Those effects can include stretch marks, widening of the surgical incision, or fat being distributed in unusual places beneath the skin.
Body contouring procedures can be performed either in hospitals or ambulatory surgical centers. "Making sure the facility is accredited and that the doctor is board-certified in plastic surgery is the most important thing," Dr. Malin said. "And make sure you understand what your surgeon's goal is: When I meet with patients, I try to articulate, either through photographs or drawings, what I think we can achieve for them."
As with any type of surgery, there are risks—which should also be discussed with your healthcare provider before you make the decision to proceed. For example, body contouring surgery may lead to complications such as blood clots, infection, or heavy bleeding. Additionally, skin excision surgery can cause swelling and pain, for example, and some patients have warned that it's not the quick fix they expected.
For many other people, however, these procedures can be empowering and life-changing. "We know that this can be an important part of the weight loss journey that helps patients get their lives and their bodies back," Dr. Malin said.
A Quick Review
It's common for weight loss to cause excess skin which may be uncomfortable or painful. The recovery depends on how much skin you want to remove, so it may be a quick procedure or it may involve multiple surgeries over a course of time.
If you want to get rid of excess skin after losing weight, consult your healthcare provider for surgical treatment options.
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