Reaching your weight loss goal is a significant achievement that can improve your health and boost self-esteem. However, losing a large amount of weight - especially quickly - can result in loose, sagging skin. This is particularly common in people who undergo bariatric surgery or take weight-loss medications like GLP-1 agonists. Fortunately, there are effective treatments for loose skin after significant weight loss. Both surgical and non-surgical options can help improve body contour, restore confidence, and support your wellness goals.
Understanding Loose Skin After Weight Loss
Losing weight to manage overweight or obesity can significantly reduce disease risk. However, major weight loss can sometimes result in loose skin. For some people, this may lead to feelings of self-consciousness and discomfort that may interfere with quality of life.
The skin is the largest organ in your body, forming a protective barrier against the environment. The innermost layer of your skin consists of proteins, including collagen and elastin. Collagen, which makes up 80% of your skin’s structure, provides firmness and strength. Elastin provides elasticity and helps your skin stay tight.
During weight gain, skin expands to make room for increased growth. Pregnancy is one example of this expansion. Skin expansion during pregnancy occurs over a few months. The expanded skin typically retracts within several months of delivery. By contrast, when skin has been significantly stretched and remains that way for a long period of time, collagen and elastin fibers become damaged. As a result, they lose some of their ability to retract. Consequently, when you lose a lot of weight, excess skin may hang from the body. In general, the greater the weight loss, the more pronounced the effect of loose skin. What’s more, researchers report that people who have weight loss surgery form less new collagen, and its composition is not as strong as the collagen in young, healthy skin.
Factors Contributing to Loose Skin
Several factors contribute to loose skin following weight loss:
Read also: Weight Loss and Skin Elasticity
- Length of time: In general, the longer someone has had overweight or obesity, the looser their skin will be after weight loss due to elastin and collagen loss.
- Amount of weight lost: Rapid loss of substantial body weight typically results in a greater amount of loose skin than more moderate weight loss.
- Age: Older skin has less collagen than younger skin and tends to be looser following weight loss. As we age, production of collagen and elastin-two proteins that help our skin stay plump, firm and smooth-slows down, resulting in areas of lax, sagging skin on the face, neck and body. In fact, after you turn 20, your collagen production declines 1% every year, and your skin’s thickness decreases about 7% every 10 years.
- Genetics: Genes may affect how your skin responds to weight gain and loss.
- Sun exposure: Chronic sun exposure reduces skin’s collagen and elastin production, which may contribute to loose skin.
- Smoking: Smoking leads to a reduction in collagen production and damage to existing collagen, resulting in loose, sagging skin. Research shows that tobacco smoke and the intake of nicotine have a toxic effect on skin and increase the chances of premature aging. The effects are caused both by the smoke and the breathing in of toxins. In a study comparing smokers with nonsmokers, hydration and firmness were lower in the smokers’ skin.
- How quickly weight is lost: Slow and steady wins the race, and experts agree that’s the best strategy for weight loss, too, especially if your goal is to trim down by 100 pounds or more. Slow, gradual weight loss gives that all-important collagen and elastin in the epidermis time to retract. Gradual weight loss is also considered better for your general health. The CDC recommends trimming down at a rate of 1-2 pounds per week.
- The percentage of total body weight lost
Potential Problems Caused by Excess Loose Skin
For some people, loose skin from a lot of weight loss may cause physical and emotional challenges:
- Physical discomfort: Excess skin may be uncomfortable and possibly interfere with normal activity. Loose skin can form folds that trap moisture, sweat, and bacteria. That’s why health care experts recommend washing between the folds with pH-balanced liquid soap, cleanser, or disposable wipes before gently patting skin dry. Other things that can help you stay dry include staying away from tight clothing or wearing items made from fabrics that are quick-drying or wick away sweat.
- Emotional discomfort: An older longitudinal study found a possible increase in self-consciousness after weight loss. Despite your weight loss, loose skin may become an issue that impacts your body image, as well as your mental and physical well-being. Loose skin may be a reminder of when you had overweight or obesity. You may feel so self-conscious that you withdraw from social activities or feel anxious or depressed.
- Decreased physical activity: While a 2022 study found that weight loss encouraged more people to exercise, excess skin was found to interfere with exercise in some people after bariatric surgery.
- Skin irritation and breakdown: An older 2014 study found that of 124 people who requested plastic surgery to tighten skin after weight loss surgery, 44% had reported skin pain, ulcers, or infections due to the loose skin. If moisture continues to collect within folds of skin, the skin can rub together and cause a condition called intertrigo. (In babies, it’s called diaper rash.) This red or brownish-red rash is more common in warm, humid climates and during the summer months and can cause itching and stinging. In the early stages, you can take steps to keep skin dry and apply a chafing powder or gel. If left untreated, this rash can lead to an infection. Yeast infection Although common and typically not serious, yeast infections, or candidiasis, are another reason for giving loose skin folds some extra love. This fungus overgrowth can cause discomfort, including redness, itchiness, and burning. If left untreated, the infection can worsen, and you would need to talk with your doctor. Again, keeping skin dry within skin folds is the key to prevention. Another of the challenges with loose skin and mobility is chafing. Similar to a skin rash, chafing happens when skin rubs against skin or clothing, causing redness, bumps, itching, burning, or increased skin warmth. If left unattended, the symptoms can become more uncomfortable and even lead to bleeding or an infection. Although typically not serious, as with treating a skin rash or yeast infection, keeping the skin dry and clean is important to prevent this condition. If you’ve lost a significant amount of weight, loose skin may pose a greater concern beyond hygiene and infection. For some, loose skin may actually get in the way of taking part in activities and exercise. Excess skin hanging on the thighs, upper arms, and belly can make it hard to move. So even after you’ve slimmed down your body fat, you may still face hurdles moving about your daily life.
- Body dissatisfaction: Loose skin from weight loss may negatively affect body image and mood.
Natural Remedies to Tighten Loose Skin
The following natural remedies may improve skin strength and elasticity to some degree in people who have lost small to moderate amounts of weight.
Resistance Training
Engaging in regular strength training is one of the most effective ways to build muscle mass in both young and older adults. A groundbreaking 2023 study published in Scientific Reports found that resistance training can rejuvenate aging skin by improving skin elasticity and increasing dermal thickness. This research suggests that the benefits of resistance training go beyond just building muscle; it can have a direct, positive impact on the skin itself. The Physical Activity Guidelines for Americans recommends doing strength training twice a week. While research isn’t currently available, it’s possible that an increase in muscle mass may help improve the appearance of loose skin. Remember the lower layer of the skin called the hypodermis, where fat is stored? As that fat is burned or removed, skin can sag. Building muscle beneath that skin can help fill the gap. That’s why strength training, which focuses on muscle growth, has been shown to improve skin elasticity and thickness. But be sure to talk with your doctor before starting any new exercise routine.
Collagen Supplements
Collagen hydrolysate is very similar to gelatin. It’s a processed form of the collagen found in the connective tissue of animals. Although it hasn’t been tested in people with loose skin related to major weight loss, an older study suggests that collagen hydrolysate may have a protective effect on skin’s collagen. In a controlled 2019 study, skin elasticity, along with texture and hydration, increased significantly after 12 weeks of taking a liquid collagen supplement. It comes in powdered form and can be purchased at natural food stores or online. Another popular source of collagen is bone broth, which can also provide other health benefits. Lotions, serums, and creams that contain retinoids may have some positive effects on saggy skin, as retinol promotes the skin’s ability to make collagen. But creams containing collagen don’t seem to have much benefit for the skin’s natural collagen production.
Consume Certain Nutrients and Stay Hydrated
Certain nutrients are important for the production of collagen and other components of healthy skin:
Read also: Weight Loss and Red Light Therapy
- Protein: Adequate protein is vital for healthy skin. The amino acids proline, hydroxyproline, and glycine play a direct role in collagen production. Your body turns protein into building blocks called amino acids and reuses them to make other proteins, including the collagen that is essential for the elasticity of skin.
- Vitamin C: Vitamin C is needed for collagen synthesis and also helps protect skin from sun damage.
- Omega-3 fatty acids: The omega-3 fatty acids found in fatty fish and plant sources, including walnuts, chia, and flax, may help increase skin elasticity and have anti-aging effects. Foods rich in omega-3 fatty acids, such as salmon, tuna, walnuts, almonds, and edamame, help restore collagen in your skin and help improve firmness
- Water: Staying well-hydrated may improve the skin’s appearance. An older 2015 study found that women who increased their daily water intake had significant improvements in skin hydration and function. Since skin cells are 64% water, it’s essential for healthy skin. Drinking 2 or more liters of water per day may significantly improve skin health. Experts advise drinking 2 or more liters of water daily for skin health.
Skin care
Skin health can also be approached from the outside through a variety of products that help nourish, moisturize, and protect it. There’s no magic cream or lotion that can tighten up excess saggy skin, but some products do help prevent skin from loosening.
The best example of this is sunscreen. Sun damage impacts the skin’s elasticity and can cause skin to sag over time. Applying plenty of lotion with sun protection factor (SPF) 30 or higher can help keep this damage from happening. Likewise, hydrating the skin from the outside in can help improve the appearance of skin and prevent dry, flaky skin.
Lotions that contain vitamin C or hyaluronic acid may help reduce sun damage to skin and skin discoloration, but they won’t improve the tightness or elasticity of skin over the long run.
Avoid Smoking and Alcohol
Like nicotine, alcohol is a toxin that can damage the skin on a cellular level. Alcohol is a diuretic, which means it makes you pee more. So drinking it can lead to dehydration. Since the skin is 64% water, dehydration can have a visible impact and can affect skin health beneath the surface. Drinking too much alcohol can also deplete the body of beneficial vitamins, like A, B, and C, that are essential for skin health.
Tracking your weight loss
Although your top goal may be losing weight, it’s important to keep in mind that as the pounds drop away, there may be an impact on your skin. Tracking your weight loss weekly can prompt you to pace yourself when necessary so that your skin can keep up. Try keeping a journal to document your nutrition, exercise, skin care, and other health habits. Keeping track of your progress can help you make adjustments along the way that could ultimately make your weight loss plan more successful in the long run.
Read also: Surgical Options for Excess Skin
Medical Treatments to Tighten Loose Skin
Medical or surgical treatments are more invasive options to tighten loose skin after major weight loss.
Body Contouring Surgery
People who have lost a significant amount of weight via bariatric surgery or other weight-loss methods often request surgery to remove excess skin. In body contouring surgery, a surgeon makes a large incision and removes excess skin and fat. They then suture the incision with fine stitches to help minimize scarring.
Specific body contouring surgeries include:
- Abdominoplasty (tummy tuck): Removal of skin from the abdomen.
- Lower-body lift: Common procedure removes sagging skin from the buttocks, thighs, and abdomen. Removal of skin from the belly, buttocks, hips, and thighs.
- Upper-body lift: Removal of skin from the breasts and back.
- Medial thigh lift: Removal of skin from the inner and outer thighs.
- Brachioplasty (arm lift): Eliminates loose skin on the upper arms, often called “bat wings.” Removal of skin from the upper arms.
- Breast lift (mastopexy): to remove excess skin and breast tissue
Multiple surgeries are usually performed on different body parts over time after major weight loss. Body contouring surgeries may require a brief hospital stay, followed by a period of recovery time at home. There may be also some complications from the surgery, such as bleeding and infections. Several studies have found that body contouring surgery may improve quality of life after significant weight loss.
Alternative Medical Procedures
Although body-contouring surgery is by far the most common procedure to remove loose skin, less invasive options with a lower risk of complications include:
- Radiofrequency treatment: Such treatments may use a combination of infrared light, radiofrequency, and massage to reduce loose skin. While this treatment doesn’t induce weight loss, it may help reduce small areas of fat cells. This treatment uses low-frequency electromagnetic waves to create heat that penetrates the skin and encourages collagen and elastin production as well as production of new skin cells. It can take as long as 6 months for skin to show improvement in tone, texture, and firmness. The good news is there is no downtime afterward, and side effects tend to be minor. With one treatment, you can see an improvement that can last up to 3 years. Radiofrequency (RF) energy can also be used to heat the skin and trigger collagen production. In contrast to ultrasound, RF focuses on epidermal layers to achieve a firmer, smoother appearance. Brand name treatments include Profound® RF, Exilis®, Morpheus8®, Renuvion, and Thermage®. A third class of skin tightening treatments combines intense pulsed light (IPL) with radiofrequency (RF) to heat deeper layers of skin and induce the natural healing response, which in turn triggers collagen production. The addition of IPL allows a provider to treat a large amount of skin and skin conditions, while the RF energy can be hyper-focused to treat deep layers of skin. Combination non-surgical skincare treatments tend to be extremely effective, as they are able to treat multiple concerns in one procedure.
- Ultrasound: A 2019 research review of ultrasound treatment for skin tightening found it to be efficacious, effective, and safe with minimal adverse effects. Similar to radiofrequency therapy, this procedure stimulates collagen growth by targeting skin tissue deep within the dermis. The result is that over time, the body begins to make collagen again, which makes sagging skin firmer and more elastic. You can expect to feel warmth at the site along with temporary swelling, redness, or tenderness. Some skin tightening treatments use focused ultrasound energy, which heats skin at specific depths (up to 5mm deep) and locations to induce collagen production and help skin become firmer. Treatments are delivered via a handheld device, which transmits the ultrasound waves through the skin’s surface. Ultrasound technology has been used in medicine for many decades, and ultrasound skin tightening has an excellent safety profile.
- Laser skin tightening: This method uses a light to send heat deep into the skin to tighten loose skin all over the body. Unlike the other nonsurgical procedures, laser skin tightening requires three to five treatments to show results, which will appear gradually about 6 months after the final treatment. Laser treatments utilize controlled thermal energy to heat deeper skin layers, triggering the body's natural healing response and encouraging new collagen formation.
It appears that although there are fewer risks with these alternative procedures, the results may not be as dramatic as with body contouring surgery.
GLP-1 Medications and Body Contouring
GLP-1 medications have changed how people lose weight. While they may not work as quickly as bariatric surgery, which often results in major weight loss within six to 12 months, GLP-1 medications can still lead to significant weight loss over 12 to 18 months. Gradual, significant weight loss from medication can lead to loose or sagging skin, prompting many to choose body contouring surgery to feel more comfortable and confident in their bodies. If you’re on weight-loss medications and exploring surgery for loose skin, consult both your physician and a board-certified plastic surgeon. You will need to stop your medication for a short time before surgery. Some GLP-1 drugs slow digestion, which can raise the risk of problems with anesthesia. Your surgical team will tell you how long to stop the medication before the procedure. They will also let you know when it is safe to start taking it again. Your surgeon will want to make sure your weight has been stable for at least six months before the surgery.
Non-Invasive Skin Tightening Options After Weight Loss
Many individuals embarking on a weight loss journey have found a beacon of hope in semaglutide, a revolutionary medication for those struggling with weight management. Originally developed for diabetes treatment, this game-changing weight loss medication operates by imitating GLP-1, a hormone pivotal to appetite control and curtailing snack cravings. By inducing prolonged sensations of satiety through decelerating gastric emptying, semaglutide effectively supports adherence to lower-calorie diets-essential for lasting weight loss success. Semaglutide offers numerous advantages that extend far beyond simple weight reduction. Clinical research on adults taking semaglutide has demonstrated an impressive average weight reduction of 35 lbs (15.9 kg) across a span of 68 weeks-representing approximately 15% of total body weight. This medication provides exceptional convenience due to its once-weekly injectable format, making it ideal for individuals with hectic schedules. While significant weight reduction is commendable, it often results in the development of loose skin, which can be disheartening after considerable effort to shed pounds. Many individuals experience this condition when they lose weight rapidly, manifesting in different body areas such as the abdomen, arms, thighs, and neck. As we age, our skin's natural elasticity diminishes, making it less capable of contracting after substantial weight loss. This natural aging process, combined with rapid weight reduction, contributes to varying degrees of loose skin commonly seen after significant weight loss. Rapid weight loss, though effective in shedding pounds quickly, can significantly impact skin elasticity. This accelerated process can damage collagen and elastin-the essential proteins that maintain skin firmness and elasticity. The duration a person has been overweight significantly affects skin elasticity recovery after weight loss. Fortunately, numerous non-invasive skin tightening procedures specifically target loose skin resulting from substantial weight loss. By stimulating collagen and elastin production, these advanced treatments dramatically improve both skin texture and tightness. Non-invasive and minimally invasive treatments offer both immediate skin contraction effects and contribute to long-term aesthetic enhancement-improvements that often significantly boost an individual's confidence and quality of life. Radiofrequency microneedling combines the proven benefits of traditional microneedling with targeted radiofrequency energy to penetrate deeper skin layers effectively. This dual-action approach dramatically boosts collagen production, resulting in firmer, more refined skin texture with visible improvements in skin laxity. Personalized treatment protocols can be developed to concentrate on specific areas of concern, providing patients with a customized experience designed for their unique skin tightening requirements. Advanced ultrasound technologies deliver focused energy deep into the skin's foundational layers, stimulating natural collagen renewal without damaging the surface.
Non-Surgical Body Contouring
Non-surgical body contouring includes much more than skin tightening. Today, you have options to reduce fat, smooth cellulite, rejuvenate vaginal tissues, and remove unwanted hair. In general, completely non-invasive skin tightening treatments can be safely performed by a licensed, trained aesthetician or registered nurse working under physician supervision.
When is Surgery the Best Option for Loose Skin?
If you have significant loose skin that forms folds or hangs away from the body, non-surgical treatments may not be enough. In these cases, surgical body contouring can remove excess skin for a smoother, firmer appearance.
- Tummy Tuck (Abdominoplasty): Removes excess abdominal skin and tightens the underlying muscles. Best for patients with loose, stretched skin after major weight loss.
- Arm Lift (Brachioplasty): Eliminates loose skin on the upper arms, often called “bat wings.” Ideal for patients with significant skin laxity despite toning exercises.
- Thigh Lift for Smoother, Tighter Legs: Targets excess skin on the inner and outer thighs. Helps reshape and contour the legs after weight loss.
Who is a Candidate for Excess Skin Removal Surgery?
You may be a good candidate for skin removal surgery if:
- You’ve maintained your goal weight for at least six months - small weight fluctuations are normal, but significant regain can affect results
- You are in good health - chronic medical conditions can raise the risk of complications
- You have realistic expectations - body contouring surgery can improve your shape, but it won’t make you look like a supermodel
- You understand the risks - like any surgery, complications such as bleeding, infection, and scarring are possible
What to Consider When Choosing a Surgeon
“If you decide to have skin removal surgery, do your research and choose a board-certified plastic surgeon who has experience in the type of procedure you’re considering,” advises Dr. Champaneria. Skin removal surgery typically involves incisions and recovery time. Board-certified plastic surgeons at Scripps provide advanced body contouring procedures in safe, accredited settings.