Plagued by the prospect of excess and loose skin, one writer investigates the surgical and noninvasive options that lie ahead.
I have lost 85 pounds without bariatric surgery. Weight loss has been on my mind basically my entire life, most especially since I started this journey in earnest in July 2019. And, as proud of myself as I most certainly am for losing this weight and finally getting healthier, it is met toe-to-toe with pervasive anxiety and a nagging question: What about excess skin?
Because of the slower pace at which I’m losing my weight, I haven’t yet encountered loose skin, though I have at least 50 more pounds left to go. I worry, perhaps too much, if I will be able to make it through to my goal weight without needing skin tightening at the end of this journey.
It’s a pretty unsexy topic—which is why it’s rarely, if ever, discussed. But for those like me who are on major weight loss journeys, or whose bodies have changed significantly through pregnancy, it’s a question that plagues us: Am I going to encounter excess skin the more weight I lose? And if I do, what can I do about it?
Apparently, I’m not the only one with questions, according to New York City plastic surgeon to the stars Lara Devgan. “Skin tightening remains one of the elusive black boxes in the world of plastic surgery,” she says. That said, we’re all still learning about best practices—from me to medical professionals.
So, I decided to investigate further. Rounding up five renowned dermatologists and plastic surgeons from across the country, I ask them all my questions. And here’s what they have to say.
If you want to try to reduce loose skin from major weight loss, lose the weight slowly.
“Losing weight gradually rather than rapidly may prevent excess skin after major weight loss,” Los Angeles–based dermatologist Harold Lancer says. “However, rapid large-scale weight loss will invariably result in excess skin.” Devgan seconds that. “The best way to prevent skin laxity after weight loss is to do your best to lose weight at a slow and steady pace,” she says. “Although it may sound appealing to get to the finish line quickly, that is actually the worst thing you can do in terms of skin laxity.” Slowly losing weight, she says, allows the skin to contract and shrink as the shape of the body shrinks.
“Although it may sound appealing to get to the finish line quickly, that is actually the worst thing you can do in terms of skin laxity.”
If you are having weight loss surgery, consider a surgical one-two punch: weight loss surgery immediately followed by a skin removal surgery.
Though I personally haven’t opted for weight loss surgery, many do—and there is zero shame in that. But because of the more rapid pace with which weight is lost after surgery comes the greater likelihood of excess skin. Why do we have to worry about excess skin, especially after more rapid weight loss? It’s “because collagen and elastin fibers are destroyed when skin is stretched significantly and remains stretched for an extended amount of time,” New York City plastic surgeon David Shafer says. “Patients should plan on staged procedures if having a weight loss surgery followed by a skin removal surgery.”
Skin elasticity is dependent on two primary factors: age and genetics. But lifestyle choices matter too.
“Typically, younger patients with thicker and more sebaceous skin will have more skin contraction during weight loss due to better elasticity,” Devgan says. “Starting in the 20s, tissue elasticity begins to decline. Even in the absence of weight fluctuation, loss of tissue turgor and decreased firmness can be seen in midface descent in the late 20s, breast laxity in the 30s, abdominal laxity in the 40s, and extremity laxity in the 50s.”
However, everyone’s body is different, Devgan says. “There is a tremendous amount of variability in the human experience, so some patients may lose 50 pounds with minimal change in their body, while others can lose as few as 10 and see tissue laxity.” If you are genetically blessed with unusually superb tissue elasticity, Devgan says, it can be less dramatic. (And lucky you.)
Also, lifestyle choices can factor in, as well, Boston-based dermatologist Ranella Hirsch says. How long were you at the weight you started losing from? Are you a smoker? Do you spend a lot of unprotected time in the sun? All these factors play into skin elasticity.
Keep the skin well hydrated.
“Using an emollient moisturizer rich in vitamin E will help improve the barrier protection of the skin and lock in moisture,” Devgan says. And the topical medical-grade ingredients you use on your face for firmness and tightness of the skin—like hyaluronic acid, peptides, niacin, squalene, vitamins C and B, retinol, and bakuchiol—can work elsewhere, too, she says. “Most people focus on using these for the face and neck in their daily routines, but from a molecular perspective, their efficacy is present anywhere on the body.”
But save your money on creams that promise you the world.
“Losing large amounts of weight rapidly tends to leave skin behind,” Hirsch says. “Though creams with incredible claims abound, they actually do little.”
Instead, consider noninvasive treatments and even weight training.
Building muscle through weight training might help reduce the appearance of lax skin, New York City dermatologist Dendy Engelman says. “This helps reduce the appearance by replacing the lost fat with muscle mass.” And there are nonsurgical options for dealing with loose skin following weight loss, but they won’t help with skin folds or hanging skin.
“Noninvasive treatments such as laser and radiofrequency can help tighten the skin, but there is a limit to how much they can do,” Shafer adds. “Hanging skin generally needs to be surgically excised with procedures such as abdominoplasty, body lift, and arm lift.” There is a difference between loose skin and hanging skin, Shafer says. “It’s possible patients can manage and treat excess skin cases without undergoing skin removal surgery, such as if the skin is loose but not hanging.” He adds, “In that case, noninvasive treatments may be useful, but hanging skin most often requires surgical excision.”
“Noninvasive treatments such as laser and radiofrequency can help tighten the skin, but there is a limit to how much they can do.”
If excess skin is interfering with your life, then it’s time to consider plastic surgery—with the input of multiple medical professionals.
“After major weight loss, people may have skin that hangs off their body,” Engelman says. “These heavy folds can cause health problems such as pain, inflammation, and frequent infections from the skin constantly rubbing together. This can happen while exercising or during everyday activities. When a person is having functional issues because of their excess skin, it should be a sign that this problem needs to be addressed.” And, of course, everyone’s journey is different.
Lancer says some individuals will tolerate moderate laxity and be happy with the weight loss accomplishment; others will seek out skin tightening for as little as a five-pound weight loss (he is based in L.A. after all). But, he says, if plastic surgery does become the option on the table, “I would recommend getting at least three opinions from doctors who exclusively do excess body skin reduction. Once you select a doctor, do one small area on your body, so you can evaluate the procedure, how your body heals, and your results. Afterward, you can determine whether you’d like to proceed with a full-blown larger procedure.”
He suggests consulting with a dermatologist for nonsurgical options, then having that doctor recommend plastic surgeons who deal with excess body skin reduction if you feel that is the right path for you. It is a major decision that should not be taken lightly. Bring medical professionals along for the entire weight loss journey (even if you’ve already started) and ask all the questions: Which specific procedure is best? How much will it cost? Will insurance cover it? (From my research thus far, no if it is cosmetic, but perhaps yes if it would help correct something that is limiting the functionality of your daily life.) No question is off-limits, and don’t try to make these decisions alone.
Above all—and perhaps most importantly—be proud of yourself.
If this piece applies to you at all, be it from long-standing weight you carried or from losing weight gained from pregnancy or anywhere in between, that means one thing: You’ve taken major steps toward better physical health, and that should be applauded. “Everyone’s weight loss story is different, and some days are harder than others,” Engelman says. “I say, try to be kind to yourself. You’ve just reached a huge accomplishment and should be proud of that.”
Devgan agrees. “Accomplishing a personal health goal like major weight loss is an incredible achievement that anyone should be proud of,” she says. “While excess skin can feel like a burden or source of self-consciousness, it is also a reminder of the metaphorical and literal shedding of the weight of a prior version of oneself. You cannot have a couture gown without a seam, and you cannot have a surgery without a scar. Life has limitations, but that does not make it less beautiful. It makes it more real.”
