Managing Excess Skin After Weight Loss

Whether you’re losing weight using weight loss medications like Wegovy® and ZepboundTM or off-label like Ozempic® and MounjaroTM, or if you’ve had bariatric surgery, excess skin is a concern. Most bariatric patients should expect to develop some loose skin after their procedure. At their highest weight, they may have stretched their skin. The good news is that the skin can shrink back down with proper exercise and proper weight loss. However, we have seen some patients with remarkable little loose skin but these patients were very discipline with their eating and exercise.

Starting BMI

First, the excess skin you will experience primarily depends on your starting weight. If you started at a very high BMI, you’ve stretched your skin more, and it’s unlikely to return to normal. A cosmetic procedure may be necessary to remove some of it.

Pace of Weight Loss

How quickly you lose your weight is also very important. We suggest the patients lose between two and three pounds a week, a sweet spot that allows the skin to retract somewhat. It’s also a healthy weight loss goal. If you lose weight too fast, you are at risk for losing muscle mass…this then slows down your metabolism. Some patients will lose significantly more weight in the first few months, and others will have more plateaus after their surgery. However, slow and steady wins the race and shows the least excess skin.

Age

Your age is correlated to how much excess skin you’ll have. Older patients typically have less elastic skin, which can be seen during their weight loss. Younger patients tend to have more elastin and collagen in their skin and their skin tends to “snap back” better. That said, some excess may be unavoidable.

Genes

Your genetics, too. Of course, we’re not going to blame your mom or dad for your excess skin, but the genes they passed down to you make a difference. Some people have naturally supple skin, while others will be more prone to excess and hanging skin.

Does Plastic Surgery Make Sense?

Typically, plastic surgery after massive weight loss focuses on the most common areas of excess skin. Most patients will see excess skin in the abdomen, under the arms, and thighs. Some will also see facial skin issues. Plastic surgeons have many options to tighten that skin and improve its appearance. There are a few things to consider,

• plastic surgery is not covered under insurance and can be expensive.
• plastic surgery does come with risks, and patients should understand that it is still major surgery, even if it is only dealing with excess skin.
• you should not have plastic surgery or skin removal within the first two years after surgery, as any fluctuations in your weight can negate the results of that surgery. You also want to be in good shape so that you can recover from your plastic surgery as quickly as possible.

Generally, by the two-year mark, patients have stabilized at their goal weight, and this is a perfect time to begin considering aesthetic options.

Before considering plastic surgery, you should have two habits under your belt. First, ensure you’re drinking plenty of water and staying hydrated. Hydration also affects the skin, making it tighter and plumper, significantly improving its aesthetics. Second, be sure you are on a consistent strength training regimen. Building muscle also helps to fill in the excess skin with shapely toned muscle.

The Bottom Line

Excess skin may be an unavoidable part of weight loss and bariatric surgery. However, we haven’t yet met a patient who would trade their weight loss and disease resolution for improved skin aesthetics. There are plenty of ways to manage extra skin, and we always encourage you to speak to your support group buddies to understand what they have done with theirs. Ultimately, you have plenty of options. Just be sure whatever you do is safe and healthy.