Losing weight, and keeping it off, can be hard enough. But many people who achieve their goals of slimming down and finding a healthy weight can then be faced with another frustrating factor: loose, baggy skin left over from their larger selves.
Excess skin isn’t a problem for everyone who diets or steps up their exercise routine. 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—are not only embarrassing, but extremely uncomfortable or even painful.
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 he says works, what doesn’t, and what people should know before they consider surgery.
Why do some people have excess skin after weight loss?
In general, skin has some degree of elasticity that allows it to expand and contract around a person’s changing body frame, explains Dr. Malin. 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.”
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 says. 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 says. “But we see patients who have lost weight quickly, and patients who have lost weight over time, so there’s really no guarantee.”
Are there non-surgical ways to treat excess skin?
“The short answer is probably not,” Dr. Malin says. “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, he says. Not smoking, keeping skin protected from the sun, and using moisturizer are also important for improving skin health and elasticity—which may also improve appearance and help minimize things like wrinkles.
But none of these techniques will get rid of extra skin folds due to weight loss, he says. 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.)
What are the surgical options?
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), thighs, breasts (for both women and men), and face and neck. Some patients opt for a full “lower body lift,” Dr. Malin says, which tightens the skin around the thighs and buttocks with an incision that runs around the waist.
Surgeries 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.
“The recovery time for an arm lift includes compression garments and limited activity—lifting no more than 20 pounds, for example,” he says. Most skin incisions take six to eight weeks to heal, and doctors and patients should follow up closely with each other during this time.
Doctors 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 doctors and patients can make the case that excess skin folds were causing pain, rashes, or infections.
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 says, liposuction (a procedure that removes fatty tissue) can also be performed along with skin excision.
What to know before you consider surgery for excess skin
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 says. “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.”
If patients are still overweight or obese even after losing significant weight, a plastic surgeon may refer them to a nutritionist or a personal trainer to help them lose more weight before they address their excess skin. Doctors will also consider patients’ overall health—and may take body measurements and photographs—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 says. 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 in 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 says. “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 doctor before you make the decision to proceed. Skin excision surgery can cause swelling and pain, for example, and some patients warn 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 says.
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